Tramadol vs. Hydrocodone

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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What is the difference between tramadol and hydrocodone?

  • Tramadol (Ultram) and hydrocodone (Zohydro ER) are both prescription opiates and narcotics for pain, though tramadol is less potent.
  • Hydrocodone is used for people with severe pain that don't experience pain relief from weaker opiates like tramadol or codeine.
  • Hydrocodone is derived from the poppy plant like other narcotics, including morphine, oxycodone, heroin, and opium. Hydrocodone is also partially synthetic. Tramadol is completely synthetic.
  • Though hydrocodone is more potent than tramadol, in their usual doses, both these drugs are less potent that other opiates like morphine or fentanyl. This means their potential for addiction and withdrawal is lower, but is still a risk.
  • Side effects for both drugs - aside from potential addiction and withdrawal - may include dizziness, confusion, sedation, constipation and others.
  • Opiates work because the central nervous system has opioid receptors in the nerve cells that, when coupled with natural opioids your body makes, govern pain sensation, reward, aspects of gastrointestinal function, and aspects of respiratory function, and aspects of urogenital function.
  • Opiate drugs mimic the natural opioids produced by the body. Their molecules fit into the same receptors and activate them. Hydrocodone, tramadol, morphine, and all other poppy derivatives target and activate opioid receptors.
  • 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 receptors with pharmaceutical opioids like hydrocodone, 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 pleasure reactions, pharmaceutical opioids are highly addictive. Euphoria and profound sense of wellbeing 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.

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What are the uses for tramadol and hydrocodone?

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.

Hydrocodone is used for the relief of mild to moderately severe pain and for suppressing cough.

What are the side effects of tramadol and hydrocodone?

SIDE EFFECTS: The most frequent side effects of hydrocodone and tramadol include:

Serious side effects of tramadol include seizures. It may cause serotonin syndrome when combined with other drugs that also increase serotonin (see drug interactions section).

Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery.

Hydrocodone can depress breathing, and should be used with caution in elderly, debilitated patients, and in patients with serious lung disease.

This is not a full list of side effects for either tramadol or hydrocodone. 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:

Can I get addicted to tramadol and hydrocodone?

Hydrocodone and tramadol are habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief especially with tramadol. Hydrocodone, however, is much more potent and therefore more highly addictive. If tramadol or hydrocodone is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop.

The psychological or physical dependence tramadol and hydrocodone 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. Hydrocodone has a more serious Schedule II classification because of its higher potential for abuse.

What are the withdrawal symptoms of tramadol and hydrocodone?

Abrupt withdrawal from tramadol and hydrocodone may result in

Withdrawal symptoms are similar to other opiates. Prescribing doctors should gradually reduce doses of hydrocodone and tramadol in order to avoid these symptoms.

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How should tramadol and hydrocodone be taken (dosage)?

Tramadol

  • 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.

Hydrocodone

  • The initial dose for adults is 10 mg orally every 12 hours (extended release formula).
  • The dose may be increased every 3 to 7 days by 10 mg every 12 hours as needed to control pain.
  • Capsules must be swallowed whole and not chewed.

Which drugs interact with tramadol and hydrocodone?

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Which drugs interact with tramadol and hydrocodone?

madol and hydrocodone 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 hydrocodone. Therefore, alcohol and other sedatives should not be used when taking tramadol or hydrocodone.

 Carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body.

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 inhibitors (SSRIs), for example, fluoxetine (Prozac), may result in severe side effects such as seizures or a condition called serotonin syndrome.

Hydrocodone, also, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Hydrocodone should not be administered within 14 days of stopping an MAOI.

This is not a complete list of drug interactions for tramadol and hydrocodone. 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 hydrocodone safe to take during pregnancy or while breastfeeding?

No one has systematically studied the safety of tramadol or hydrocodone 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 hydrocodone 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.

REFERENCES:

FDA Prescribing information

Tramadol Compound Summary
PubChem

Hydrocodone Compound Summary
PubChem

"Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants"
Randy A. Sansone, MD and Lori A. Sansone, MD
Psychiatry (Edgemont)
April, 2009

"How Does The Opioid System Control Pain, Reward And Addictive Behavior?"
European College of Neuropsychopharmacology
ScienceDaily
Oct., 2007

"Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior"
Ream Al-Hasani, Ph.D and Michael R. Bruchas, Ph.D
Anesthesiology Dec. 2011

"Opioid Receptors: A video on Mu, Delta, Kappa and ORL1 receptors"
Flavio Guzman, MD
PsychopharmacologyInstitute.com

"Reward Processing by the Opioid System in the Brain"
Julie Le Merrer, Jérome A. J. Becker, Katia Befort, and Brigitte L. Kieffer
Physiological Reviews
Oct. 2009

"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.
Anesthesiology
Jan. 2010

"Drug Scheduling"
U.S. Drug Enforcement Agency DEA.gov

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Summary

Tramadol (Ultram) and hydrocodone (Zohydro ER) are both prescription opiates used to treat pain. Tramadol is less potent per-dose than hydrocodone. Both are less potentially addictive than other opioids like morphine and heroin, but they also may cause dependence and withdrawal symptoms after prolonged use. Learn about side effects, dosage, and pregnancy safety information.

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Reviewed on 4/24/2017
References
REFERENCES:

FDA Prescribing information

Tramadol Compound Summary
PubChem

Hydrocodone Compound Summary
PubChem

"Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants"
Randy A. Sansone, MD and Lori A. Sansone, MD
Psychiatry (Edgemont)
April, 2009

"How Does The Opioid System Control Pain, Reward And Addictive Behavior?"
European College of Neuropsychopharmacology
ScienceDaily
Oct., 2007

"Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior"
Ream Al-Hasani, Ph.D and Michael R. Bruchas, Ph.D
Anesthesiology Dec. 2011

"Opioid Receptors: A video on Mu, Delta, Kappa and ORL1 receptors"
Flavio Guzman, MD
PsychopharmacologyInstitute.com

"Reward Processing by the Opioid System in the Brain"
Julie Le Merrer, Jérome A. J. Becker, Katia Befort, and Brigitte L. Kieffer
Physiological Reviews
Oct. 2009

"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.
Anesthesiology
Jan. 2010

"Drug Scheduling"
U.S. Drug Enforcement Agency DEA.gov

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