Updated on February 6, 2024
6 min read

Tramadol vs. Hydrocodone: The Main Differences

Key Takeaways

Tramadol vs. Hydrocodone: The Main Differences

​​Tramadol and hydrocodone change how the brain responds to pain. Like other opioids, these drugs lessen pain by reducing the pain signal severity received by the brain.

Both drugs are available under various brand names, as generics and combination drugs with acetaminophen (Tylenol).

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What is Tramadol?

Tramadol relieves moderate to moderately severe pain. Tramadol extended-release capsules and tablets are for people who experience continuous pain.

The drug is in a class of medications called opiate (narcotic) analgesics.

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What is Hydrocodone?

Hydrocodone is used to treat severe pain. It is used when other pain medications are not strong enough to relieve pain. 

Hydrocodone is often prescribed for pain management after surgery. If you can use other forms of the medicine, you shouldn’t take extended-release capsules or tablets.

Hydrocodone is also in the class of medications called opiate (narcotic) analgesics.

Side Effects

Common side effects of hydrocodone and tramadol include:

  • Lightheadedness
  • Dizziness
  • Nausea
  • Vomiting
  • Shortness of breath
  • Sedation
  • Allergic reactions
  • Constipation
  • Abdominal pain
  • Rash
  • Itching

Serious side effects of tramadol include seizures and dependency. The drug may also cause serotonin syndrome when taken with other drugs that increase serotonin.

Hydrocodone can affect thinking and the physical abilities needed for driving or operating machinery. The drug can also depress breathing, making it difficult to breathe. 

It should be used with caution in: 

  • Elderly, debilitated people
  • Those with serious lung disease

Other side effects may also occur for tramadol or hydrocodone. Ask your healthcare provider about the potential side effects of these medications if you’re prescribed them.


Certain people may be more at risk of side effects from tramadol or hydrocodone. Side effects of both medications are more likely or can be more intense if you’re older.

Side effects of tramadol or hydrocodone can also be more intense if you have:

  • Kidney or liver disease
  • Chronic obstructive pulmonary disease
  • Other chronic diseases

Those with depression who take tramadol may be at heightened risk of suicide.


Other Drugs 

Tramadol and hydrocodone can have dangerous interactions with other medicines and illegal substances. 

These interactions can heighten the risk of life-threatening side effects, including breathing problems and coma. They can also be fatal.

It’s essential to speak to your doctor about all the medications, supplements, or illicit drugs you take before using tramadol or hydrocodone.


Drinking alcohol or taking illegal drugs while taking tramadol or hydrocodone can cause dangerous or fatal side effects.

When medications combine tramadol or hydrocodone with acetaminophen, there are other interactions to consider. For example, taking extra acetaminophen with the medicine can contribute to liver damage.

The following can also cause dangerous effects when people take them with tramadol or hydrocodone:

  • Other medicines
  • Vitamins
  • Supplements 


Addiction potential

Hydrocodone comes with a black box warning regarding the potential for misuse. 

It’s possible to build a tolerance to hydrocodone or tramadol, especially if you don’t take it as prescribed. Developing a tolerance to a drug means that the same dosage no longer achieves the same effect.

People who build a tolerance often take more medication than recommended to reach the same effect. Tolerance can then lead to dependence.

A person is more likely to develop a dependence on hydrocodone or tramadol if they have a history of drug or alcohol misuse. If you notice yourself becoming dependent, contact your doctor immediately.

Don’t stop taking the drug, especially if you’ve been taking it for weeks or months. Your doctor will change the dosage to taper you off the medication slowly. This helps avoid withdrawal.

Tell your doctor immediately if you experience withdrawal symptoms when you stop taking hydrocodone or tramadol.


Additionally, the FDA advises that children under 18 shouldn’t take hydrocodone or other opioids like codeine. Likewise, they state that doctors shouldn’t prescribe tramadol to children younger than 12.

Tramadol can lead to dangerous side effects in children between the ages of 12 and 18 if they have specific medical conditions. 

Children who take tramadol or hydrocodone are at risk of life-threatening:

  • Breathing problems
  • Addiction
  • Overdose
  • Death


Pregnant women or women who plan to become pregnant shouldn’t take tramadol or hydrocodone. Taking these medicines or other opioids during pregnancy can lead to life-threatening health issues in the baby after birth.

Breastfeeding women should also avoid taking opioids, including tramadol and hydrocodone. The baby can receive unsafe levels of these medications through breast milk.


Tramadol is milder than hydrocodone. Doctors may prescribe it for pain that isn’t as severe. If someone isn’t getting relief from tramadol or other milder opioids, a doctor may choose hydrocodone.

Sometimes an adult may use hydrocodone to treat a severe cough. This is because it helps reduce activity in the brain that causes coughing. Doctors don’t usually prescribe tramadol for this purpose.

Overdose & Addiction Potential

Tramadol and hydrocodone are habit-forming. Mental and physical dependence can develop. However, this is unlikely when the drugs are used for short-term pain relief, as prescribed, especially with tramadol.

Hydrocodone is much stronger and more addictive. If someone suddenly stops taking tramadol or hydrocodone after prolonged use, withdrawal symptoms may occur.

The psychological or physical dependence hydrocodone and tramadol can cause is similar to other narcotics.

Tramadol is a schedule IV medicine on the federal list of controlled substances as defined by the U.S. Controlled Substance Act. 

Hydrocodone has a more severe Schedule II classification due to its higher potential for misuse.

Treatment for Hydrocodone or Tramadol Addiction

Acute opioid withdrawal is rarely life-threatening. However, it can be intense and unpleasant, presenting challenges to early recovery.

Opioid withdrawal can often be successfully managed through medical detox. This can serve as a starting point for more comprehensive treatment for substance use disorders.3

Detox involves a high level of care with 24-hour monitoring by medical professionals. During detox, the body flushes away the substance and other toxins. During detox a person experiences withdrawal symptoms.

Healthcare professionals help to manage these symptoms safely while keeping the person as comfortable as possible. Sometimes this involves medications.4

The FDA has approved three types of medicines for opioid use disorder treatment. The following help to manage opioid withdrawal:3

  1. Methadone
  2. Buprenorphine
  3. Lofexidine

Each of these drugs act differently. 

Sometimes, combination of the drugs can help:3 

  • Relieve withdrawal symptoms
  • Manage cravings
  • Reduce some of the euphoric effects of any other opioid drugs used while taking treatment

Detox is usually the first step in a more comprehensive treatment plan for substance use disorders. But detox alone isn’t usually enough to support long-term recovery. 

Your treatment team will encourage you to continue with some type of treatment following a successful detox.4

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​​​​Tramadol and hydrocodone are both prescription opiates used to treat pain. Hydrocodone is stronger per dose than tramadol.

Both drugs are less potentially addictive than some other opioids like heroin and morphine. However, they may cause dependence and withdrawal symptoms after use. 

People should take tramadol and hydrocodone with caution and only as prescribed by a doctor.

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Updated on February 6, 2024
6 sources cited
Updated on February 6, 2024

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