Tramadol vs Oxycodone for Pain: How Do They Differ?

Tramadol and oxycodone are both opioid pain medications. They are used to control moderate to severe pain and carry some of the same risks, such as dependence (drug abuse and opioid addiction) and life-threatening respiratory depression. However, there are some significant differences between oxycodone & tramadol. For example, tramadol carries a lower risk of opioid dependence compared to oxycodone. Please continue reading to find out how tramadol and oxycodone are different in terms of uses, efficacy, and side effects.

What are the main differences between tramadol and oxycodone?

Type of drug and DEA classification

Both tramadol and oxycodone are prescription medications and controlled substances that are closely regulated. They have a chemical structure similar to morphine (an opiate used as an analgesic).

Tramadol is a centrally-acting synthetic opioid analgesic (narcotic painkiller). The Drug Enforcement Agency (DEA) lists tramadol as a Schedule IV (4) controlled substance because of its low potential for abuse and addiction.

Oxycodone is also an opioid (narcotic) analgesic. The DEA lists oxycodone as a Schedule II controlled substance because of its high potential for abuse, which can lead to physical and psychological dependence.

Brand names

Tramadol is sold under the trade names Ultram, Ultram ER, Rybix ODT, Ryzolt, Conzip, and Qdolo. It is also available in generic form. Combination products containing tramadol include Ultracet (tramadol and acetaminophen) and Seglentis (tramadol and celecoxib).

In addition to the generic version, oxycodone is sold under brand names OxyContin, Oxaydo, and Xtampza ER. Combination products containing oxycodone include Percodan (oxycodone and aspirin) and Xartemis XR, Roxicet, Oxycet, and Percocet (oxycodone and acetaminophen).

Note: The brand names Ryzolt, Rybix ODT, and Ultram have been discontinued in the U.S., and generic tramadol products are available.

Uses

Both oxycodone & tramadol are used to treat moderate to severe pain in people who require pain relief around the clock. They are used to relieve pain that cannot be treated with other non-opioid drugs, such as acute pain (sudden onset pain that is expected to heal after treatment), post-operative pain, pain from injury or trauma, and cancer pain.

Both oxycodone and tramadol relieve pain by binding to opioid receptors in the central nervous system to block pain signals. Additionally, tramadol can increase amounts of serotonin and norepinephrine, which are chemicals that help control pain and mood.

Age range

Tramadol is approved for use in adults and children 12 years of age and older. Oxycodone is approved for use in adults and opioid-tolerant children 11 years of age and older (pediatric patients who are already receiving and tolerating opioid medications).

Dosage forms and doses

Tramadol comes as a tablet, extended-release tablet, extended-release capsule, and liquid. The usual dose of the tablets is 50 milligrams (mg) to 100 mg every 4-6 hours as needed for pain relief, with a maximum daily dose of 400 mg.

Oxycodone comes as a tablet, capsule, extended-release tablet, extended-release capsule, liquid solution, and concentrated solution. The usual dose of oxycodone tablets is 5 mg to 15 mg every 4-6 hours as needed for pain relief.

For both tramadol and oxycodone, the lowest effective dose is used for the shortest time possible.

Onset of action and duration of effect

Tramadol and oxycodone both start working within an hour. Their effects last for 4-6 hours (regular formulations) and 12-24 hours (extended-release formulations).

Side effects

The most common side effects of tramadol include headache, drowsiness, nervousness, mood changes, uncontrolled shaking, dry mouth, indigestion, heartburn, and constipation.

The most common side effects of oxycodone include headache, drowsiness, mood changes, dry mouth, stomach pain, constipation, and flushing.

Risks and warnings

Risks associated with the use of tramadol and oxycodone include:

Serious allergic reactions
Life-threatening respiratory depression
Fatal overdose
Drug interactions with other central nervous system depressants
Serotonin syndrome (too much serotonin in the body)
Withdrawal symptoms if the medicine is discontinued suddenly
Opioid abuse and addiction leading to psychological and physical dependence
Neonatal opioid withdrawal syndrome if the opioid drug is used by a pregnant woman
Impaired physical and mental abilities due to drowsiness and reduced concentration with risks while driving or doing other hazardous activities

In addition, taking tramadol and oxycodone can increase seizure risk, especially when these medications are used in combination with certain antidepressants and other opioids.

Oxycodone can cause severe hypotension (low blood pressure), including postural hypotension or orthostatic hypotension (fainting when going from a lying or sitting position to standing).

Opioids should be used with caution in people with increased intracranial pressure or head injury and gastrointestinal conditions such as paralytic ileus.

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What provides better pain control: tramadol or oxycodone?

One study done in a double-blind fashion looked at tramadol versus oxycodone for intravenous patient-controlled analgesia (postoperative pain management) after maxillofacial surgery. This study found that tramadol is the stronger medication, with a 8:1 potency ratio compared to oxycodone. However, people in the tramadol group had a higher incidence of side effects compared to oxycodone.

Another study was done on tramadol versus oxycodone for postoperative analgesia in the immediate recovery period after knee surgery. It showed people in the tramadol group had similar or better control of pain scores compared to the oxycodone group. Tramadol was also better at relieving pain compared to hydrocodone alone or a combination of tramadol with oxycodone or hydrocodone. In addition, tramadol caused fewer side effects while treating acute pain effectively.

Find out: How Long Does Oxycodone Stay in Your System?

Frequently Asked Questions

What painkiller is the same as tramadol?

Oxycodone and hydrocodone are painkillers that are similar to tramadol. All three are opioid analgesics and are used to treat severe symptoms of pain.

Can tramadol provide pain relief from severe pain?

Tramadol can provide adequate analgesia (pain relief) from severe pain. It is typically used for short-term relief of severe pain, such as postoperatively. Patients are not usually given tramadol for long-term (chronic) pain conditions due to the risks associated with this medicine.

Is tramadol stronger than hydrocodone?

Small studies have shown that tramadol is slightly weaker and less effective in controlling acute musculoskeletal pain compared to hydrocodone. In addition, it can also cause more side effects and is more expensive than hydrocodone. Your healthcare provider will choose tramadol versus hydrocodone or other drugs (non-opioids like acetaminophen or diclofenac sodium) based on your medical history and pain score.

Learn more: Hydrocodone vs Oxycodone: What’s the Difference?

Is tramadol stronger than codeine?

Both tramadol and codeine are opioid analgesics and are equally effective in controlling pain. They both have about 1/10 the potency of morphine. There is no evidence that one has a favorable potency compared to the other or a significant difference in analgesic efficacy.