In the US, historically Tylenol has been used in combination with other pain relievers.

Tylenol with Codeine
Tylenol with oxycodone (Percocet)
Tylenol with Darvon (Darvocet)

In OTC products Tylenol with just about EVERYTHING.

This is now changing as the US FDA is trying to cut Tylenol mixtures completely off the approval lists.

In the past Darvocet was released when the patent for Darvon expired. The same is true for Ultracet. It did not come on the market until Ultram went generic.

While it might be true that mixing Tylenol with tramadol results in more efficient pain relief, I think it is just basically a marketing ploy. Drug companies do this all the time with their drugs, even to the point of massaging data in studies to get the FDA to approve the new mixture.

We are seeing a change in the US about this trend with Tylenol. And in fact it may even result with some OTC brands including Tylenol Extra strength 500mg tabs being removed from the OTC market in the future and becoming RX only.

Ultram was a huge money maker for McNeil when it came out. Going generic really was painful for them. Adding their own Tylenol to make a new product restored a lucrative situation to their balance sheets!

As far as the nausea issue...all opiates cause nausea. I received far more complaints about nausea side effects than I ever did regarding Tramadol (which was never). Opiate nausea may occur when doses are too high for that particular patient, and dose adjustments often take care of them.

The nausea of Tramadol is different IMO and more connected to the serotonin actions of this drug. SSRIs are also reported high in nausea when first starting them.

And it is correct that Tramadol is recommended for Fibro patients specifically. This is because some studies show that the pain receptors for opiates are blocked by high endogenous endorphins in this disorder. I saw this mentioned at a chronic pain seminar during the Fibro portion. Opiates are no longer being recommended for Fibro patients for this reason. Also opiates have a checkered past for not working well for peripheral neuropathies.

When I was given Tramadol last year, I had one brief episode of nausea at the 50mg dose level, that lasted briefly...about 30 minutes. I haven't had any recurrance of that since. I don't take Tramadol every day, and only use it on very bad nights in fact with no further problem.

I worked many years in night shifts and never once had a nausea question regarding Tramadol. But nausea with opiates? Very very common.