Use in pregnancy & lactation: 
Since TM-Plus Tablet is a fixed combination of active ingredients including Tramadol Hydrochloride, it should not be used during pregnancy & lactation. 

Side effects
The most commonly reported undesirable effects during the clinical trials performed with the Paracetamol/Tramadol Hydrochloride combination were nausea, dizziness and somnolence. 

Precaution 
It should be used with caution in opioid-dependent patients, or in patients with cranial trauma, patients prone to convulsive disorder, biliary tract disorders, in a state of shock, in an altered state of consciousness for unknown reasons, with problems affecting the respiratory centre or the respiratory function, or with increased intracranial pressure. 

Overdosage
If a tramadol user presents with any of the following symptoms, call for emergency medical help immediately:
Respiratory distress, irregular heart rate, irregular heart rhythm, changes in pupil size, unconsciousness, vomiting, pale or clammy skin, hyperthermia, muscle rigidity, muscle pain, limp or weakened body, purple or bluish colour to nails and lips, seizures.
It is important to remember that a tramadol overdose can become life-threatening. Waiting to call for emergency help may mean the difference between life and death for a suffering individual.

Drug interactions
Types of drugs known to interact with tramadol include warfarin, ketoconazole, erythromycin, lithium, phenelzine, serotonin, desvenlafaxine, amitriptyline, citalopram, fluoxetine, digoxin, paroxetine, sertraline, oxycodone, almotriptan, eletriptan, frovatriptan, carbamazepine, cyclobenzaprine, quinidine, rifampin etc.

Pharmaceutical precaution
Store in a cool, dry place and protect from light. Keep out of reach of children.

Packing
TM-Plus Tablet: Box containing 2 x 10 / 3 x 10 / 5 x 10 / 10 x 10 tablets in the blister pack.