- Side Effects
- Drug Interactions
- Pregnancy & Breastfeeding
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.
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?
The most frequent side effects of hydrocodone and tramadol include:
- shortness of breath,
- allergic reactions,
- abdominal pain,
- itching, and
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.
- FDA Panel Backs RSV Vaccine for Infants, Some Toddlers
- Seniors: Stay Social, Active for 'Optimal Aging,' Study Shows
- Diabetes Med Metformin Might Help Prevent Long COVID
- Disability a Growing Concern for U.S. Cancer Survivors
- Smoke From Wildfires Is Especially Tough If You Have Asthma. Here’s How to Protect Yourself
- More Health News »
What is the dosage for tramadol vs. hydrocodone?
- 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 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?
- Tramadol 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.
Subscribe to MedicineNet's General Health Newsletter
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.
Health Solutions From Our Sponsors
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.
Multimedia: Slideshows, Images & Quizzes
Prescription Drug Abuse: Addiction, Health Risks, and Treatments
Learn how prescription drug and over-the-counter (OTC) drug abuse can endanger your health. Get the latest information on...
Pain Management: Surprising Causes of Pain
What's causing your pain? Learn the common causes of lower back pain, as well as pain in the knee, stomach, kidney, shoulder,...
Teen Drug Abuse: Warning Signs, Statistics, and Facts
Teen drug abuse is a growing concern today. Learn statistics, facts, warning signs, and effects related to teen substance abuse...
Pain Management: 15 Easy Ways to Reduce Chronic Pain
Chronic pain can be a symptom of many conditions, including arthritis, headaches, and others. Comprehensive chronic pain...
Pain Management: Signs Your Muscle Pain Is Something Else
Could your achy muscles be a sign of more than a tough workout? Learn when a twinge might warrant a visit to the doctor's office.
Opioid Dependence Quiz: Test Your IQ of Opioid Misuse Disorder
What are opioids? Take this quiz to learn about opioids (opiates, narcotic pain killers) as well as addiction and dependence that...
Pain Management: Why Does My Calf Muscle Hurt?
There's a group of muscles on the back of each lower leg that doctors call "calf muscles." They play a key role in helping you...
Pain Management: Knee Pain Dos and Don'ts
Your knees go through a lot in the course of a day, and sometimes they can run into trouble. Here are a few things you can do...
Pain Management: All About CBD Oil
Cannabidiol oil: It's made from marijuana and everyone seems to be talking about it. But what is it, and what does it really do?
Pain Management: One-Move Fixes for Pain and Stress
A quick stretch, yoga pose, or on-the-spot exercise can help fix sudden aches from head to toe. Learn how to quash pain with just...
Prescription Drug Abuse: Know The Warning Signs
Learn about prescription drug abuse facts and statistics about the dangers and misconceptions of abusing common prescription...
Pain Management: Visual Guide to Frozen Shoulder
It's got nothing to do with cold weather. It means your shoulder is jammed up. WebMD guides you through the causes of frozen...
Pain Management: Ergonomic Tips for a Home Office
Are you working at home? Find out how to set up a workspace to prevent stiffness, protect your muscles and joints, and avoid...
Pain Management: All About Your Knees
They do their job so well that you might take them for granted. Learn how they're put together, what can go wrong with them, and...
Pain Management: Why Knees Hurt
Your knees have lots of parts, and you use them a lot, so there's plenty that could go wrong. WebMD explains common things that...
Related Disease Conditions
Drug Abuse and Addiction
Drug abuse and addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
What Is the Strongest Painkiller?
The most powerful pain reliever is a class of medications known as “opioids,” which have a significant risk of addiction and dependency. These drugs are routinely recommended by doctors for severe pain treatment, as well as a variety of other illnesses.
Pain Management and Rheumatoid Arthritis
Second Source article from WebMD
Second Source article from Government
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
What Do You Do When Pain Management Doesn't Work?
If you suffer from chronic pain, it can be frustrating when your pain medications are no longer effective. Here is what you can do when pain management doesn’t work.
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.
Teen Drug Abuse
Drugs commonly abused by teens include tobacco products, marijuana, cold medications, inhalants, depressants, stimulants, narcotics, hallucinogens, PCP, ketamine, Ecstasy, and anabolic steroids. Some of the symptoms and warning signs of teen drug abuse include reddened whites of eyes, paranoia, sleepiness, excessive happiness, seizures, memory loss, increased appetite, discolored fingertips, lips or teeth, and irritability. Treatment of drug addiction may involve a combination of medication, individual, and familial interventions.
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.
Are Any Opioids Safe?
Although opioids can be safe when taken as prescribed, long-term opioid use carries significant risks. Learn more about how opioids work and how to use them safely.
Pain Management: Neuropathic Pain
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
How Are Opioids Healthy?
Opioids are powerful pain relievers. Unlike steroids or nonsteroidal anti-inflammatory drugs, these do not cause bone or kidney damage. However, this does not mean these are healthy.
Treatment & Diagnosis
- Drug Abuse Prevention: Putting a Halt to Huffing
- Arthritis Pain Relief Update
- Chronic Pain: Dealing With Back and Neck Pain
- Chronic Pain and Fatigue - What You Can Do
- Pain Management
- Pain Management: Painkiller Addiction
- Chronic Pain Treatments for Mind and Body
- Cancer Pain Management with Ann Reiner
- Pain Management: Routes to Relief
- Pain Management: Dealing with Back Pain
- Opioid Dependence FAQs
- Pain Management: OTC NSAIDs - Doctors Dialogue
- Pain Management Over-The-Counter
- Prescription Drug Abuse
- Doctors Answer Pain Questions
- What Pain Medication Can I Take While on Warfarin?
- Does Pain Medication Affect Men and Women Differently?
- Drug Abuse: Low Self-Esteem & Drug Abuse in Boys
Medications & Supplements
- Gabapentin vs. Tramadol
- Oxycodone vs. Tramadol for Pain
- tramadol/acetaminophen - oral, Ultracet
- hydrocodone/acetaminophen - oral, Lortab, Norco, Vicodin
- tramadol - oral, Ultram
- hydrocodone/ibuprofen - oral, Vicoprofen
- Tramadol vs. Codeine
- Oxycodone vs. Hydrocodone
- Ketorolac vs. tramadol
- Lyrica vs. Tramadol
- Cyclobenzaprine vs. Norco (hydrocodone acetaminophen)
- Hydrocodone vs. Hydromorphone (Differences between Side Effects)
- Percocet vs. Hydrocodone
- Oxycodone for Pain (OxyContin, Roxicodone, Oxecta, Oxaydo, Xtampza ER, Roxybond)
- Tramadol (Ultram) Side Effects
- Lyrica (pregabalin) vs. Norco (hydrocodone and acetaminophen)
- Oxycodone vs. Vicodin (hydrocodone/acetaminophen) for Pain
- Ketorolac vs. hydrocodone
- tramadol and acetaminophen (Ultracet)
- Benzodiazepines vs. Narcotics (Opioids)
- hydrocodone (Zohydro ER)
- Tramadol vs. Vicodin
- Lyrica vs. Hydrocodone
- Ultram (tramadol) Side Effects, Warnings, and Interactions
- chlorpheniramine and hydrocodone, Tussionex, TussiCaps, Tussionex Pennkinetic, Vituz
- Side Effects of Ultracet (tramadol and acetaminophen)
- What Are Opioid Equivalents and Conversions?
- Codeine Side Effects, Warnings, and Interactions
- hydrocodone/homatropine (Tussigon)
- hydrocodone and ibuprofen, Vicoprofen
- Pain Medications (Narcotics)
- Side Effects of Vicodin (hydrocodone/acetaminophen)
- Olinvyk (oliceridine)
- Side Effects of Tussionex (chlorpheniramine and hydrocodone)
- Tussigon (hydrocodone)
- Zohydro ER (hydrocodone)
Prevention & Wellness
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
Hydrocodone 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
Anesthesiology Dec. 2011
"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.
U.S. Drug Enforcement Agency DEA.gov
Top Tramadol vs Hydrocodone Related Articles
Chronic PainChronic 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.
Drug AbuseDrug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Prescription Drug Abuse: Addiction, Health Risks, and TreatmentsLearn how prescription drug and over-the-counter (OTC) drug abuse can endanger your health. Get the latest information on depressant, pain reliever, and stimulant addiction.
Hydrocodone vs. Hydromorphone (Differences between Side Effects)
Hydrocodone (brand name Zohydro ER) and hydromorphone (brand names Dilaudid and others) are opioid narcotics prescribed to patients with moderate to severe pain for which other pain therapies have not provided adequate pain management. Both narcotics have a Black Box Warning from the FDA about serious side effects including coma and death.
Common side effects of both hydrocodone and hydromorphone include:
Side effects unique to hydrocodone include:
- Spasm of the ureter
Side effects unique to hydromorphone include:
- Dry mouth
Both narcotics can be habit forming and addictive. Examples of symptoms that you may be addicted to hydrocodone or hydromorphone include:
- You are taken the drug in larger doses than your doctor prescribed.
- You have a persistent desire, and often have unsuccessful attempts to cut down or control the use of the drug.
- You have a strong desire or craving for the drug.
- You spend a lot of time doing various things to get or use the drugs.
- You have problems at work, school, or relationships.
- You withdraw from social activities because of the drug.
FDA Prescribing Information.
NIH; National Institute on Drug Abuse. "The Science of Drug Abuse and Addiction: The Basics." Updated: Oct 2016.
hydrocodone (Zohydro ER)
Hydrocodone (Zohydro ER) is a narcotic pain reliever prescribed for the relief moderate to severe pain. Common side effects include:
Drug interactions, warnings and precautions, dosage, and pregnancy and breastfeeding safety should be reviewed prior to taking this medication.
Oxycodone for Pain (OxyContin, Roxicodone, Oxecta, Oxaydo, Xtampza ER, Roxybond)Oxycodone (brand names OxyContin, Roxicodone, Oxecta, Oxaydo, Xtampza ER, Roxybond) is a narcotic pain-reliever prescribed for moderate to moderately severe pain. Some side effects include lightheadedness, dizziness, sedation, nausea, vomiting, drowsiness, and constipation. Drug interactions, dosing, and pregnancy and breastfeeding information should be reviewed prior to taking this medication.
Oxycodone vs. Tramadol for Pain
Oxycodone and tramadol are prescription medications used to manage acute and chronic moderate to severe pain. Oxycodone is an opiate (narcotic) derived drug whereas tramadol is a man-made synthetic drug. Tramadol is not a narcotic, and it is not a nonsteroidal anti-inflammatory drug (NSAIDs). Some of the side effects of oxycodone and tramadol are the same, for example:
- Dry mouth
Serious side effects for oxycodone and tramadol differ. Oxycodone and tramadol are habit forming drugs and patients may become addicted. Withdrawal symptoms include:
Drug interactions, dosing, and pregnancy and breastfeeding safety information differs for these drugs and should be reviewed prior to administration.
Oxycodone vs. HydrocodoneOxycodone (OxyContin, Oxaydo, Xtampza ER, Roxybond) and hydrocodone (Zohydro ER) are prescription opioid pain medications. Both drugs have similar uses and side effects, for example dizziness, sedation, nausea, vomiting, drowsiness, constipation, headache, and rash. Oxycodone and hydrocodone are addictive and may cause withdrawal symptoms if discontinued abruptly. Consult your doctor before taking if pregnant or breastfeeding.
Prescription Drug AbuseLearn about prescription drug abuse facts and statistics about the dangers and misconceptions of abusing common prescription drugs.
Teen Drug AbuseDrugs commonly abused by teens include tobacco products, marijuana, cold medications, inhalants, depressants, stimulants, narcotics, hallucinogens, PCP, ketamine, Ecstasy, and anabolic steroids. Some of the symptoms and warning signs of teen drug abuse include reddened whites of eyes, paranoia, sleepiness, excessive happiness, seizures, memory loss, increased appetite, discolored fingertips, lips or teeth, and irritability. Treatment of drug addiction may involve a combination of medication, individual, and familial interventions.
Teen Drug Abuse SlideshowTeen drug abuse is a growing concern today. Learn statistics, facts, warning signs, and effects related to teen substance abuse of over-the-counter (OTC) medications, prescription drugs, alcohol, illegal street drugs and more.
tramadol (Ultram)Tramadol (Ultram) is an opioid painkiller (analgesic) indicated for the management of moderate to moderately severe pain in adults. Side effects are similar to other opioid and include dizziness, nausea, drowsiness, and others. Like other opioid medication, tramadol may cause addiction and withdrawal symptoms. Do not discontinue abruptly.
Tramadol (Ultram) Side Effects
Tramadol (Ultram, Ultram ER, Conzip) is a drug prescribed for the management of moderate to severe pain, and severe chronic pain.
Side effects include:
You shouldn't take tramadol if you are taking other opioid drugs. Acute intoxication occurs when you take with alcohol, hypnotics, centrally acting opioids, or psychotropic drugs.
You may become addicted to tramadol due to its opioid properties, even if you take it as your doctor has prescribed. Symptoms of withdrawal include:
There is a risk of overdose with this drug.
Some patients had seizures while taking tramadol. Your risk of a seizure while taking tramadol increases if you also are taking these drugs.
- Tricyclic antidepressants
- SSRI antidepressants
- Other opioids
- MAO inhibitors
- Other drugs that reduce the threshold for seizures.
What Are Opioid Equivalents and Conversions?Opioid drugs are all different permutations of highly addictive chemicals, natural or synthetic, that act on the human opioid receptors to kill pain. Switching patients from one to another may be necessary for many reasons, whether cost, drug availability or the patient developing a tolerance. Opioid equivalents and conversions charts allow doctors to switch drugs while maintaining the same level of painkilling effectiveness and avoiding overdosing the patient.