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Tramadol/celecoxib carries a significant risk of abuse and addiction, potentially leading to overdose and even death. It can also cause serious, possibly life-threatening breathing difficulties. To minimize your risk, your doctor should prescribe the lowest effective dose for the shortest period. Consult your healthcare provider regarding the availability of naloxone for treating opioid overdoses and educate family or household members on recognizing and responding to overdose signs.

• The risk of severe breathing issues is heightened when beginning this medication, increasing the dosage, or taking an incorrect dose/strength.
• Combining this drug with alcohol or other substances that cause drowsiness or respiratory issues may result in grave side effects, including death.
• Other medications may interfere with the elimination of tramadol/celecoxib from your body, affecting its efficacy. Ensure you understand how to properly take this medication and which drugs to avoid.

Seek immediate medical attention if you experience very serious side effects such as slow or shallow breathing, unusual lightheadedness, severe drowsiness or dizziness, and difficulty waking up.

• Store this medication securely to prevent theft, misuse, or abuse. If someone accidentally ingests it, seek medical help immediately.
• Nonsteroidal anti-inflammatory drugs (including celecoxib) may rarely increase the risk of heart attack or stroke, a risk that can occur at any time during use but is more likely with prolonged use. This risk is higher in older adults or those with heart disease or risk factors, such as smoking, family history, high blood pressure, or diabetes. Do not take this medication immediately before or after heart bypass surgery (CABG).
• Celecoxib may also rarely cause serious (sometimes fatal) bleeding in the stomach or intestines, which can occur without warning. Older adults may be at greater risk.

Discontinue use and seek medical assistance if you notice rare but serious side effects, including persistent stomach/abdominal pain, black/tarry stools, vomit resembling coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, confusion, weakness on one side of the body, difficulty speaking, or sudden vision changes.

• Women of childbearing age should discuss the benefits and risks of this medication with their doctor. Inform your doctor if you are pregnant or planning to become pregnant, as this drug may harm an unborn baby and complicate labor/delivery. It is not advised for use during pregnancy from 20 weeks until delivery. If deemed necessary between 20 and 30 weeks, use the lowest effective dose for the shortest duration. Avoid using this medication after 30 weeks of pregnancy. Infants born to mothers using this drug long-term may develop severe (possibly fatal) withdrawal symptoms. Report any symptoms in your newborn, such as persistent crying, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.

• This medication is not for use in children under 12 years old. Children aged 12 to 18 should not use it after certain surgeries (e.g., tonsil/adenoid removal) and it is not advised for children in this age group who are obese or have respiratory issues. Some children may be particularly sensitive to tramadol in this medication, resulting in serious (rarely fatal) breathing problems such as slow/shallow breathing. Discuss the risks and benefits with your healthcare provider.

When taking this medication, you might experience mild side effects like nausea, vomiting, stomach upset, gas, constipation, lightheadedness, dizziness, drowsiness, or headache. These usually improve over time. To ease constipation, incorporate dietary fiber, stay hydrated, and exercise regularly. A suitable laxative may also be recommended by your pharmacist. To prevent dizziness and lightheadedness, rise slowly from sitting or lying positions.

It's important to monitor your blood pressure, as this medication might cause an increase. Contact your healthcare provider if you notice persistently high readings. While many users experience no serious side effects, be vigilant for signs such as sleep apnea, mood changes, severe abdominal pain, symptoms of adrenal insufficiency, or kidney problems. Swelling in the groin or calf, difficulty urinating, or symptoms of heart failure should also prompt immediate medical attention.

In rare cases, this medication can lead to severe liver disease or serotonin syndrome, especially if combined with other serotonin-enhancing drugs. Symptoms such as persistent nausea, jaundice, dark urine, fast heartbeat, hallucinations, coordination loss, or unexplained fever require urgent care. Furthermore, some individuals metabolize this drug into a potent opioid more rapidly, heightening the risk of serious effects like slow breathing or severe drowsiness.

Lastly, though rare, severe allergic reactions can occur. Seek immediate help if you experience fever, swollen lymph nodes, rash, or difficulty breathing. Always contact your healthcare provider if you notice any side effects not mentioned here.

Some medications that can interact with this drug include: ACE inhibitors (like captopril, lisinopril), aliskiren, angiotensin II receptor blockers (such as valsartan, losartan), cidofovir, lithium, naltrexone, certain pain medications (mixed opioid agonist-antagonists like butorphanol, nalbuphine, pentazocine), samidorphan, and "water pills" (diuretics such as furosemide). This drug may increase the risk of bleeding when combined with other medications that also cause bleeding. These include anti-platelet drugs like clopidogrel and "blood thinners" such as dabigatran, enoxaparin, and warfarin.

Be sure to check all prescription and over-the-counter medicine labels carefully, as many contain pain relievers/fever reducers (aspirin, NSAIDs like naproxen or ibuprofen) that are similar to celecoxib and could raise your risk of side effects if taken together. However, if your doctor has recommended taking low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams daily), you should continue doing so unless advised otherwise by your doctor. Consult your doctor or pharmacist for more information.

Avoid taking MAO inhibitors (such as isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) with this medication, as it may cause a serious (possibly fatal) interaction. Most MAO inhibitors should not be taken for two weeks before starting this medication. Consult your doctor on when to begin or cease these medications.

The risk of serotonin syndrome or toxicity is higher if you are also using other drugs that increase serotonin levels. Examples include street drugs like MDMA ("ecstasy"), St. John's wort, and certain antidepressants (including SSRIs like fluoxetine, paroxetine, and SNRIs like duloxetine, venlafaxine). The risk may increase when these drugs are started or their doses are raised.

Some other medications can affect how this drug is eliminated from your body and thus its effectiveness. These include azole antifungals (such as itraconazole), macrolide antibiotics (such as erythromycin), quinidine, rifamycins (like rifampin), ritonavir, and drugs for seizures (such as carbamazepine).

The chance of severe side effects like slow or shallow breathing and extreme drowsiness or dizziness may increase if this medication is used with other products that cause drowsiness or breathing issues. Inform your doctor or pharmacist if you are using other opioid pain or cough relievers (like codeine, hydrocodone), alcohol, marijuana (cannabis), sleep or anxiety medications (such as alprazolam, lorazepam, zolpidem), muscle relaxants (like carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Always check labels on all your medications (including allergy or cough-and-cold products) since they may contain ingredients causing drowsiness. Consult your pharmacist to use these products safely.

Lastly, this medication may interfere with certain lab tests (such as amylase or lipase levels), potentially leading to incorrect test results. Ensure that lab personnel and all your healthcare providers know you are using this drug.