- Tramadol vs. codeine comparison
- What are tramadol and codeine?
- What are the uses for tramadol and codeine?
- What are the side effects of tramadol and codeine?
- Can I get addicted to tramadol and codeine?
- What are the withdrawal symptoms of tramadol and codeine?
- How should tramadol and codeine be taken (dosage)?
- Which drugs interact with tramadol and codeine?
- Are tramadol and codeine safe to take during pregnancy or while breastfeeding?
Tramadol vs. codeine comparison
Tramadol (Ultram) and codeine are both opiates and narcotics prescribed for moderate pain. Codeine is also a cough suppressant. Codeine is derived from the poppy plant like other narcotics, including morphine, heroin, and opium. Tramadol, on the other hand, is synthetic, though it is similar to codeine.
Both these drugs are less potent than other opiates, which means their potential for addiction and withdrawal are lower. That doesn't mean they're safe, however. Both can be physically and psychologically habit-forming.
Neither tramadol nor codeine should be taken with alcohol or other sedatives or tranquilizers because they may potentially magnify the effects. Particularly dangerous is the potential for respiratory depression, which can make you stop breathing if you take too much of either codeine or tramadol, or mix either of them with the wrong medication.
What are tramadol and codeine?
Tramadol and codeine are both opiates. Codeine is made from the poppy plant, just like morphine, heroin, and opium. Tramadol is chemically similar to codeine, but it's synthesized from precursor molecules in a lab. Many doctors like it because it has a lower potential for addiction than other opioids, though that doesn't mean it's non-addictive.
Opiates work because the central nervous system has three main opioid receptors in the nerve cells that, when coupled with natural opioids your body makes, govern pain sensation, reward, aspects of gastrointestinal function, aspects of respiratory function, and aspects of urogenital function. These receptors are named after Greek letters: Mu receptors, Delta receptors, and Kappa receptors. They sit on the membrane of nerve cells and activate when an opioid -- whether naturally occurring in the body or introduced in the form of a drug -- fits into the molecule like a key in a lock.
Opiate drugs mimic the natural opioids produced by the body. Their molecules fit into the same receptors and activate them. Codeine, tramadol, morphine, and all other poppy derivatives target and activate mostly the Mu receptors, meaning they are "Mu receptor agonists."
These receptors and the naturally occurring (endogenous) opioids they pair with are responsible for the body's own efforts to deaden pain. Because of this, flooding the Mu receptors with pharmaceutical opioids like codeine, tramadol, and others can increase the painkilling (analgesic) properties of that part of the central nervous system.
Unfortunately, because the endogenous opioid system also governs reward pathways, pharmaceutical opioids are highly addictive. Endorphins are the main endogenous opioids your nervous system secretes in response to sex, a delicious meal, and other forms of pleasure. Because opiate drugs activate the same Mu receptors endorphins do, euphoria and a profound sense of well-being are potential side effects of all the opiate drugs on the market. Patients can become addicted physically and mentally as both their bodies and minds begin to crave that state of bliss.
Tramadol and codeine are much less potent than other opiates like morphine, heroin, and its synthetic counterpart Fentanyl. Because of this, short-term use of tramadol and codeine for cough or moderate pain symptoms comes with a relatively low risk of addiction or withdrawal.
The endogenous opioid system, as mentioned before, helps govern the muscle reflex that expands and contracts your ribcage to breathe in and out in response to carbon dioxide levels in the blood. Because opiate drugs suppress this respiratory response, small doses of drugs like codeine can help suppress coughing and reduce the pain of a sore throat in all sorts of diseases and conditions in which coughing and throat pain are symptoms. However, though researchers understand the cough reflex is associated with the endogenous opioid system, they haven't figured out the exact mechanism by which codeine suppresses coughs. They don't know why, for instance, it doesn't work for some chronic coughs.
What are the uses for tramadol and codeine?
Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.
Codeine is used for the relief of mild to moderately severe pain and for suppressing cough.
What are the side effects of tramadol and codeine?
SIDE EFFECTS: The most frequent side effects of codeine and tramadol include:
- shortness of breath,
- allergic reactions,
- abdominal pain,
- itching, and
This is not a full list of side effects for either tramadol or codeine. Make sure you ask your doctor about the potential side effects of these drugs if you are prescribed them.
For more information, please visit the MedicineNet drug monographs for these medications:
Latest Medications News
Daily Health News
Can I get addicted to tramadol and codeine?
Codeine and tramadol are habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If tramadol or codeine is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop.
The psychological or physical dependence tramadol and codeine can cause is similar to other narcotics. Tramadol is a Schedule IV medication on the federal list of controlled substances as outlined by the U.S. Controlled Substance Act. Codeine has a more serious Schedule II classification because of its higher potential for abuse.
What are the withdrawal symptoms of tramadol and codeine?
Abrupt withdrawal from tramadol and codeine may result in
Withdrawal symptoms are similar to other opiates. Prescribing doctors should gradually reduce doses of codeine and tramadol in order to avoid these symptoms.
How should tramadol and codeine be taken (dosage)?
- The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain.
- The maximum dose is 400 mg/day.
- To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25-50 mg every 3 days to reach 50-100 mg/day every 4 to 6 hours.
- Tramadol may be taken with or without food.
- The recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. To convert from immediate release to extended release, the total daily dose should be rounded down to the nearest 100 mg. Extended release tablets should be swallowed whole and not crushed or chewed.
- The usual adult dose of codeine for pain is 15-60 mg every 4-6 hours as needed.
- The dose for cough is 10 to 20 mg every 4-6 hours as needed.
- The maximum dose for treating cough is 120 mg every 24 hours.
Subscribe to MedicineNet's General Health Newsletter
Which drugs interact with tramadol and codeine?
Both tramadol and codeine may increase central nervous system and respiratory depression when combined with alcohol. Alcohol and anesthetics, narcotics, tranquilizers (like alprazolam [Xanax]), or sedative hypnotics can produce further brain impairment and even confusion when combined with tramadol or codeine. Therefore, alcohol and other sedatives should not be used when taking tramadol or codeine.
Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50% to 60%.
Combining tramadol with monoamine oxidase inhibitors or MAOIs (for example, tranylcypromine [Parnate]) or selective serotonin reuptake inhibitors (SSRIs), for example, fluoxetine (Prozac), may result in severe side effects such as seizures or a condition called serotonin syndrome.
Drugs that stimulate and also block opioid receptors (for example, pentazocine) reduce the effect of codeine. Such drugs should not be combined with codeine.
Monoamine oxidase inhibitors (MAOIs) class of antidepressants (for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate], selegiline [Eldepryl], and procarbazine [Matulane]) significantly increase the action of codeine. Codeine should not be used in patients taking MAOIs or within 14 days of stopping MAOIs.
This is not a complete list of drug interactions for tramadol and codeine. If a doctor prescribes you either of these narcotics, make sure you provide a full list of other medications you're taking to avoid dangerous interactions.
Are tramadol and codeine safe to take during pregnancy or while breastfeeding?
No one has systematically studied the safety of tramadol or codeine during pregnancy, but pregnant mothers should avoid using any opiate because of the risk of dependence in the developing fetus. Small amounts of both tramadol and codeine are secreted in breast milk, but the dose is typically too tiny to cause problems with the baby. Still, if you are prescribed either of these medications while breastfeeding, you and your doctor should carefully evaluate the risks before you make a decision on whether to take it.
Tramadol (Ultram) and codeine are both opioids or opiates used to control pain. Codeine is also used as a cough medication. Both codeine and tramadol are less potent, and therefore less addictive, than other opiate medications like morphine. Read more about side effects, dosage, and pregnancy safety information.
Multimedia: Slideshows, Images & Quizzes
Low Back Pain: Symptoms, Causes, Treatment, Relief
Do you suffer from low back pain? Watch this slideshow to see common triggers of lower back pain and what kind of treatments you...
Back Pain Quiz: Test Your Back Pain IQ
There are numerous causes of chronic lower back pain and only one ailment gets more complaints. What is it? Quiz your knowledge...
Headaches Quiz: Learn About Headache Pain
If you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and treatments for...
Pain Quiz: Test Your IQ of Pain
Is pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we...
Nerve Pain: Symptoms, Causes, and Treatment Options
Learn about nerve pain symptoms, causes, and treatment options. Discover medications, treatments, and natural remedies that can...
Back Pain: Find Relief, Treat Your Back Pain
Back pain conditions are very common. Learn the truth and get the facts behind myths, remedies, causes and treatment for back...
Chronic Pain Syndrome: Treatment and Management for CPS
What is chronic pain syndrome (CPS)? See causes, symptoms and treatment options including medications. Learn about pain...
Related Disease Conditions
19 Tips on How to Stop a Cough
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease. Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke. Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs. Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Chronic cough treatment is based on the cause, but may be soothed natural and home remedies.
Is a Cough Contagious?
There are many types of coughs: for example, dry cough, wet cough, a barking cough, whooping cough, stress induced cough, acute cough, and chronic cough. Cough is a symptom of an underlying condition or disease. Treatment of cough as a symptom is generally with OTC lozenges and liquids. The cause of the cough will be necessary to treat.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Children's Cough Causes and Treatments
Children's cough causes include infection, acid reflux, asthma, allergies or sinus infection, whooping cough, and exposure to irritants. Treatment for a child's cough include cough medicine for children over the age of four.
Complex Regional Pain Syndrome
Complex regional pain syndrome is a chronic pain condition in which high levels of nerve impulses are sent to an affected site is called complex regional pain syndrome (CRPS). CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affect women more often than men.
Is Whooping Cough (Pertussis) Contagious?
Whooping cough (pertussis) is a highly contagious respiratory infection caused by Bordetella pertussis. Pertussis is characterized by severe coughing fits and whooping sound produced during inhalation. The bacteria spreads via airborne droplets produced during sneezing or coughing. There is a whooping cough vaccine that is typically administered during childhood vaccinations.
Pain Management: Musculoskeletal Pain
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is described in three stages: perimenopause, menopause, and postmenopause. However, not all women undergo natural menopause. Some women experience induced menopause as a result of surgery or medical treatments, such as chemotherapy and pelvic radiation therapy.
Pain Relief Options for Childbirth
Women experience and tolerate pain differently. For some pregnant women, focused breathing is all they need to get through labor and childbirth; but for others, numbing of the pain is desired. There are a number of different medications a woman can take during labor and childbirth. It is important for you to learn what pain relief options are available. Please discuss the options with your health care provider well before your "birth day" so that when you are in labor you understand the choices.
Treatment & Diagnosis
Medications & Supplements
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Tramadol Compound Summary
Codeine Compound Summary
"Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants"
Randy A. Sansone, MD and Lori A. Sansone, MD
"How Does The Opioid System Control Pain, Reward And Addictive Behavior?"
European College of Neuropsychopharmacology
"Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior"
Ream Al-Hasani, Ph.D. and Michael R. Bruchas, Ph.D.
"Opioid Receptors: A video on Mu, Delta, Kappa and ORL1 receptors"
Flavio Guzman, MD
"Reward Processing by the Opioid System in the Brain"
Julie Le Merrer, Jérome A. J. Becker, Katia Befort, and Brigitte L. Kieffer
Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression
Albert Dahan, M.D., Ph.D.; Leon Aarts, M.D., Ph.D.; Terry W. Smith, Ph.D.
"Central and peripheral mechanisms of narcotic antitussives: codeine-sensitive and -resistant coughs"
Kazuo Takahama and Tetsuya Shirasaki
U.S. Drug Enforcement Administration