Doltrac 325mg/50mg Tablet: Comprehensive Guide To Uses, Side Effects, And Safety
Clinical Reference Standards: CDSCO (Central Drugs Standard Control Organisation), Indian Pharmacopoeia (IP) & WHO | Last Updated: September 2026
When to Call Your Doctor IMMEDIATELY
- Slow, shallow breathing or difficulty breathing
- Seizures or convulsions
- Severe allergic reaction (swelling of face, lips, tongue, or throat)
- Yellowing of skin or eyes, dark urine, or severe abdominal pain
- Signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle rigidity)
- Extreme drowsiness or difficulty waking up
- Chest pain or irregular heartbeat
If experiencing severe symptoms, call emergency services immediately.
What is nictram-plus tablet used for?
This medicine is a combination of Paracetamol 325 mg and Tramadol 50 mg used for short-term relief of moderate to severe pain. It works by reducing pain signals in the brain and spinal cord. It is available only by prescription and should be taken exactly as directed by a doctor.
- Generic Name: Paracetamol/Acetaminophen (325mg) + Tramadol (50mg)
- Manufacturer: Nitin Lifesciences Ltd
- Form: Allopathy
- Pregnancy Category: Consult doctor
- Prescription Required: Yes
🇮🇳 nictram-plus tablet के बारे में (Hindi Summary)
उपयोग: यह दवा पैरासिटामोल 325 मिलीग्राम और ट्रामाडोल 50 मिलीग्राम का संयोजन है, जिसका उपयोग मध्यम से गंभीर दर्द के अल्पकालिक उपचार के लिए किया जाता है। यह ऑपरेशन के बाद के दर्द, दांत दर्द, मांसपेशियों की चोट, और पुराने दर्द के तीव्र होने पर राहत देने के लिए निर्धारित की जाती है। यह दवा केवल डॉक्टर के पर्चे पर मिलती है और इसे निर्देशित अवधि से अधिक नहीं लेना चाहिए।
साइड इफेक्ट्स: इस दवा के सामान्य दुष्प्रभावों में मतली, उल्टी, चक्कर आना, नींद आना, सिरदर्द, कब्ज, मुंह सूखना और पसीना आना शामिल हैं। गंभीर दुष्प्रभावों में सांस लेने में कठिनाई, दौरे, गंभीर एलर्जी, और लीवर की क्षति के लक्षण जैसे त्वचा या आंखों का पीला पड़ना शामिल हैं। यदि आपको कोई असामान्य लक्षण दिखे तो तुरंत डॉक्टर से संपर्क करें।
सुरक्षा सलाह: इस दवा को हमेशा डॉक्टर के निर्देशानुसार ही लें। निर्धारित मात्रा से अधिक न लें। इस दवा के साथ शराब का सेवन बिल्कुल न करें। जब तक आपको पता न चले कि यह दवा आप पर कैसा असर करती है, तब तक वाहन न चलाएं। यदि आप गर्भवती हैं, स्तनपान करा रही हैं, या आपको लीवर या किडनी की बीमारी है, तो डॉक्टर को बताएं। इस दवा को बच्चों की पहुंच से दूर रखें।
💊 nictram-plus tablet Uses & Benefits
[{"condition":"Moderate to severe acute pain","description":"Used for short-term relief of pain that is not controlled by non-opioid analgesics alone, such as post-operative pain, dental pain, or musculoskeletal injury.","evidence":"Well-established"},{"condition":"Chronic pain flare-ups","description":"May be prescribed for short-term management of acute exacerbations of chronic pain conditions like osteoarthritis or low back pain.","evidence":"Moderate"},{"condition":"Post-procedural pain","description":"Provides relief following minor surgical or dental procedures when other analgesics are insufficient.","evidence":"Well-established"}]
Off-label uses: [{"condition":"Neuropathic pain","description":"Sometimes used off-label for neuropathic pain, though evidence is limited and other agents are preferred.","evidence":"Limited"},{"condition":"Fibromyalgia","description":"Rarely used off-label for fibromyalgia pain, but not first-line and requires specialist supervision.","evidence":"Limited"}]
Primary treatment for: Moderate to severe acute pain
Also treats: Post-operative pain, Dental pain, Musculoskeletal pain, Chronic pain flare-ups
📋 Drug Information
| Generic Name(s) | Paracetamol/Acetaminophen (325mg) + Tramadol (50mg) |
| Brand Name | nictram-plus tablet |
| Manufacturer | Nitin Lifesciences Ltd |
| Packaging / Form | Varies by brand (Allopathy) |
| Therapeutic Class | PAIN ANALGESICS |
| Action Class | |
| Route of Administration | Oral |
| Storage | Store at room temperature between 15°C and 30°C (59°F to 86°F). Keep away from direct sunlight, moisture, and heat. Do not refrigerate unless specified. Keep out of reach of children and pets. |
| Shelf Life | 24 months from the date of manufacture, unless otherwise stated on the packaging. |
| WHO Guideline | Not established from the available information. The World Health Organization (WHO) analgesic ladder recommends the use of opioid analgesics for moderate to severe pain, but specific recommendations for this fixed-dose combination are not available. |
| ICMR Guideline | Not established from the available information. The Indian Council of Medical Research (ICMR) has not published specific guidelines for this fixed-dose combination. |
👨⚕️ Doctor's Practical Tips
Evidence-based practical advice from experienced clinicians
🔍 Is This Medicine Right for Your Symptom?
Educational reference. Always consult a doctor for diagnosis.
🔬 How This Medicine Works (Pharmacology)
Pharmacokinetics
How It Works
This medicine combines two analgesics with complementary mechanisms. Paracetamol (Acetaminophen) acts primarily in the central nervous system by inhibiting prostaglandin synthesis, likely through interaction with the peroxidase component of cyclooxygenase enzymes, and may also modulate descending serotonergic pathways. Tramadol is a centrally acting opioid analgesic that binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin, enhancing inhibitory pain pathways. The combination provides additive analgesia through both opioid and non-opioid mechanisms, making it effective for moderate to severe pain.
Mechanism Steps
💡 How to Take nictram-plus tablet
Strength: Each tablet contains Paracetamol 325 mg and Tramadol 50 mg.
Dosage Information
| Adult Dosage | The usual adult dose of this medicine is one tablet taken orally every 6 to 8 hours as needed for pain relief, not to exceed the maximum daily dose. The maximum recommended daily dose is 8 tablets in 24 hours, but the duration of therapy should be as short as possible. Dose must be individualized by a qualified clinician based on indication, age, weight, renal and hepatic function, and response to therapy. Do not exceed the prescribed dose. This medicine is intended for short-term use only. |
| Pediatric Dosage | Pediatric dosing is not established from available information. This medicine is contraindicated in children under 12 years of age. Consult a pediatrician for appropriate pain management in children. |
| Elderly Dosage | Elderly patients (above 65 years) may be more sensitive to the effects of tramadol, especially respiratory depression, dizziness, and drowsiness. Dose reduction and careful monitoring are recommended. The maximum daily dose should not exceed 300 mg of tramadol in patients over 75 years. Consult a doctor for individualized dosing. |
| Renal Impairment | In patients with renal impairment, the elimination of tramadol is prolonged. Dose adjustment is required. For creatinine clearance less than 30 mL/min, the dosing interval should be increased to every 12 hours, and the maximum daily dose should not exceed 200 mg of tramadol. This medicine should be used with caution in severe renal impairment. |
| Hepatic Impairment | In patients with hepatic impairment, the metabolism of both paracetamol and tramadol may be altered. Dose reduction and careful monitoring are recommended. This medicine is contraindicated in severe hepatic impairment. For mild to moderate hepatic impairment, consult a doctor for individualized dosing. |
| Maximum Daily Dose | The maximum daily dose of this medicine is 8 tablets in 24 hours, providing a total of 2600 mg paracetamol and 400 mg tramadol. However, the maximum daily dose of paracetamol from all sources should not exceed 4000 mg, and the maximum daily dose of tramadol should not exceed 400 mg. Do not exceed the prescribed dose. |
Dosage Timeline
🍽️ Food Timing Guide
⏰ What to Do If You Miss a Dose
⚠️ Side Effects of nictram-plus tablet
✅ Common Side Effects
🚨 Serious Side Effects
⚠️ Rare Side Effects
Consult your doctor if you experience any unusual symptoms.
🔬 Drug Interactions
| Drug | Severity | Effect |
|---|---|---|
| MAOIs | Major | |
| SSRIs/SNRIs | Major | |
| CNS depressants | Major | |
| Warfarin | Major | |
| Carbamazepine | Major | |
| CYP2D6 inhibitors | Moderate | |
| CYP3A4 inducers | Moderate | |
| CYP3A4 inhibitors | Moderate | |
| Diuretics | Moderate | |
| Anticholinergics | Moderate |
🚨 Major Interactions
- Monoamine oxidase inhibitors (MAOIs)
- Other serotonergic drugs (SSRIs, SNRIs, triptans, etc.)
- CNS depressants (alcohol, benzodiazepines, opioids, etc.)
- Warfarin
- Carbamazepine
⚡ Moderate Interactions
- CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine, etc.)
- CYP3A4 inducers (rifampin, phenytoin, St. John's wort, etc.)
- CYP3A4 inhibitors (ketoconazole, erythromycin, etc.)
- Diuretics
- Anticholinergic drugs
🍷 Alcohol Interaction
Alcohol should be completely avoided while taking this medicine. Both paracetamol and tramadol can interact with alcohol to increase the risk of liver damage, severe sedation, respiratory depression, and impaired motor skills. Alcohol also increases the risk of seizures and serotonin syndrome. Even small amounts of alcohol can be dangerous.
🔎 Check Your Other Medicines
Educational tool. Always confirm with your doctor or pharmacist.
🛡️ Safety & Warnings
🚫 Contraindications
["Known hypersensitivity to paracetamol, tramadol, or any component of the formulation","Severe respiratory depression or acute severe asthma","Uncontrolled epilepsy or seizure disorder","Severe hepatic impairment","Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs","Children under 12 years of age","Post-operative pain management in children under 18 years following tonsillectomy and/or adenoidectomy","Patients with known or suspected gastrointestinal obstruction, including paralytic ileus"]
⚠️ Warnings & Precautions
["Risk of respiratory depression: Use with caution in patients with respiratory disease, and monitor closely.","Risk of seizures: Tramadol lowers the seizure threshold. Avoid in patients with a history of seizures or those taking other seizure-threshold-lowering drugs.","Risk of serotonin syndrome: Avoid concomitant use with serotonergic drugs. Monitor for symptoms.","Risk of dependence and withdrawal: Prolonged use can lead to physical and psychological dependence. Withdrawal symptoms may occur upon abrupt discontinuation.","Risk of hepatotoxicity: Do not exceed the recommended dose of paracetamol. Avoid alcohol and other hepatotoxic drugs.","Risk of renal impairment: Dose adjustment is required in patients with renal insufficiency.","Risk of falls: Tramadol may cause dizziness and drowsiness, increasing the risk of falls, especially in the elderly.","Risk of adrenal insufficiency: Tramadol may rarely cause adrenal insufficiency. Monitor for symptoms like nausea, vomiting, and hypotension.","Risk of hypoglycemia: Tramadol may cause hypoglycemia. Monitor blood glucose in diabetic patients.","Driving and operating machinery: Avoid until you know how this medicine affects you."]
🤱 Lactation Safety
This medicine is not recommended during breastfeeding. Both paracetamol and tramadol are excreted in breast milk. Tramadol may cause serious adverse reactions in a nursing infant, including excessive sleepiness, difficulty breathing, and poor feeding. Consult your doctor for alternative pain management options while breastfeeding.
💊 Overdose Management
Overdose of this medicine can be life-threatening. Symptoms of paracetamol overdose include nausea, vomiting, abdominal pain, and liver damage that may not become apparent for 24-48 hours. Tramadol overdose can cause respiratory depression, seizures, coma, and cardiac arrest. If overdose is suspected, seek emergency medical attention immediately. Treatment includes supportive care, activated charcoal if within 1-2 hours of ingestion, and administration of N-acetylcysteine for paracetamol toxicity. Naloxone may be used for tramadol-induced respiratory depression, but it may not fully reverse all effects. Hemodialysis may be considered in severe cases.
⏰ Missed Dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at the same time to make up for a missed dose. If you are unsure, consult your doctor or pharmacist.
Additional Safety Advice
Always take this medicine exactly as prescribed by your doctor. Do not exceed the recommended dose or duration of treatment. Avoid alcohol completely while taking this medicine, as it can increase the risk of liver damage and dangerous sedation. Do not drive or operate heavy machinery until you know how this medicine affects you, as it can cause drowsiness and dizziness. Inform your doctor if you have a history of liver or kidney disease, seizures, breathing problems, or substance abuse. Do not take other products containing paracetamol while on this medicine to prevent accidental overdose. If you are pregnant, planning to become pregnant, or breastfeeding, consult your doctor before taking this medicine. Keep this medicine out of reach of children and store it in a cool, dry place away from direct sunlight. Do not stop this medicine abruptly without consulting your doctor, as withdrawal symptoms may occur.
👴 Special Considerations for Elderly
💡 For Patients Above 65
Elderly patients are more sensitive to the effects of tramadol, including respiratory depression, dizziness, drowsiness, and falls. Dose reduction and careful monitoring are recommended. The maximum daily dose should not exceed 300 mg of tramadol in patients over 75 years. Consult a doctor for individualized dosing.
🤰 Pregnancy Planning (TTC)
If you are planning to become pregnant, consult your doctor before taking this medicine. Tramadol may affect fertility and is not recommended during pregnancy. Discuss alternative pain management options with your doctor.
🏥 Post-Surgery Considerations
This medicine may be prescribed for post-operative pain. Follow your surgeon's instructions carefully. Do not drive or operate machinery until cleared. Inform your surgeon if you experience severe pain, nausea, or any unusual symptoms.
🦷 Dental Procedures
Inform your dentist if you are taking this medicine before any dental procedure. It may interact with anesthetics or other medications used during dental work. Your dentist may adjust your treatment plan accordingly.
💚 Lifestyle Tips for Better Results
🏋️ Exercise Considerations
While taking this medicine, avoid activities that require full alertness, such as driving or operating heavy machinery, until you know how it affects you. Exercise may be beneficial for pain management, but start slowly and avoid high-impact activities that could worsen your condition. Consult your doctor or physiotherapist for a safe exercise plan.
🥗 Diet Recommendations
💼 Impact on Daily Work & Life
This medicine can cause drowsiness, dizziness, and difficulty concentrating, which may affect your ability to work, drive, or operate machinery. Avoid these activities until you know how the medicine affects you. Inform your employer if your job requires alertness. Take breaks and avoid strenuous tasks if you feel drowsy.
🛑 When to Stop This Medicine
Stop taking this medicine when your pain is adequately controlled or as advised by your doctor. Do not stop abruptly if you have been taking it for more than a few weeks, as withdrawal symptoms may occur. Consult your doctor for a tapering schedule. Seek immediate medical attention if you experience serious side effects.
📅 Long-Term Use Effects
Long-term use of this medicine can lead to physical dependence, tolerance, and withdrawal symptoms upon abrupt discontinuation. It may also increase the risk of liver damage due to paracetamol and renal impairment due to tramadol. Regular monitoring of liver and kidney function is advised for prolonged use. This medicine should generally not be used for more than a few weeks unless specifically directed by a pain specialist.
🌿 Non-Medicine Approaches
These can complement medicine but do not replace prescribed treatment.
Can complement medicine for chronic pain and improve function.
Evidence: Well-establishedMay be used for inflammatory pain but have their own risks.
Evidence: Well-establishedMay provide pain relief for some conditions.
Evidence: ModerateHelps manage chronic pain by changing pain perception and coping strategies.
Evidence: Moderate💉 Vaccination Considerations
💉 If You're Getting Vaccinated
There are no known interactions between this medicine and vaccines. However, if you are scheduled for vaccination, inform your healthcare provider about all medications you are taking. This medicine does not affect the immune response to vaccines.
📦 Storage Guide
✅ DO
Store at room temperature (15-30°C)
❌ DON'T
Do not refrigerate unless specified
✅ DO
Keep in original container
❌ DON'T
Do not transfer to unmarked containers
✅ DO
Keep away from direct sunlight and moisture
❌ DON'T
Do not store in bathroom cabinet
✅ DO
Keep out of reach of children and pets
❌ DON'T
Do not use after expiry date
✈️ Traveling with This Medicine
When traveling with this medicine, carry it in its original packaging along with a copy of your prescription. This medicine is a controlled substance in many countries, so check local regulations before traveling internationally. Store it in a cool, dry place away from direct sunlight. If crossing time zones, adjust dosing intervals as advised by your doctor. Do not pack it in checked luggage; keep it in your carry-on bag. Carry a sufficient supply for your trip and avoid running out.
💰 Cost Analysis & Savings
👥 Real Patient Stories
Educational, anonymized scenarios. Individual results may vary.
💬 Questions Patients Often Ask
A: This medicine usually starts relieving pain within 30 to 60 minutes after taking it orally.
A: This medicine is intended for short-term use only, typically for a few days to a few weeks, as determined by your doctor. Prolonged use can lead to dependence.
A: No, alcohol should be completely avoided while taking this medicine due to the risk of liver damage, severe sedation, and respiratory depression.
A: This medicine is not recommended during pregnancy unless clearly needed and prescribed by a doctor. Tramadol may cause withdrawal symptoms in the newborn.
A: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double dose.
🤔 Common Patient Concerns
🛑 Myths vs. Facts
- Myth: This medicine is safe to take for any type of pain.
Fact: This medicine is only for moderate to severe pain and should be used short-term under medical supervision. - Myth: You can drink alcohol while taking this medicine.
Fact: Alcohol should be completely avoided as it increases the risk of liver damage and dangerous sedation. - Myth: This medicine is not addictive.
Fact: Tramadol can cause dependence and withdrawal, so it should be used exactly as prescribed. - Myth: You can take extra doses if the pain is severe.
Fact: Never exceed the prescribed dose. Taking more can lead to serious side effects, including liver damage and respiratory depression.
🔄 Alternative Options
Generic Alternatives
- Paracetamol + Tramadol combination (generic)