Tramadol vs. Oxycodone: What’s the Difference?

Tramadol and oxycodone are opioid analgesics that treat moderate to severe pain. Doctors prescribe them in cases when no other pain reliever has worked. 

Oxycodone has 6 to 10 times higher potency than tramadol.^{1, 2}

Unlike other opioids, tramadol has another unique mechanism. It acts as a serotonin and norepinephrine reuptake inhibitor (SNRI), a class of antidepressant drugs. Unfortunately, this SNRI action contributes to withdrawal symptoms unique to tramadol.^{1, 3, 4, 5}

Key Takeaways

• Tramadol has a lower risk of addiction, but it is still possible to abuse it.
• Oxycodone is 6 to 10 times more potent than tramadol.
• Tramadol has a lower risk of addiction, but it is still possible to abuse it.
• Seek professional help immediately if you suspect you or a loved one is addicted to prescription opioids.

Drug Overviews

Tramadol

Tramadol is available as a tablet in immediate-release and extended-release forms. The standard dosage is 50 to 100 mg every 4 to 6 hours, with 400 mg as the maximum daily dose. The maximum daily dose is decreased for elderly patients.

Brand names for tramadol include ConZip and Qdolo.⁶

Tramadol also has generic brands. There is also a tramadol-acetaminophen combination product that is commonly prescribed.

Oxycodone

Oxycodone is available as a tablet in immediate-release and extended-release forms. The standard starting dosage is 5 to 15 mg every 4 to 6 hours. 

People start on a low dose, which may increase later depending on the body’s reaction and pain level. 

Brand names for oxycodone include:⁷

• Oxaydo
• Oxycontin
• Roxicodone
• Xtampza ER

Oxycodone also has generic brands. Some products combine oxycodone with other drugs (aspirin, acetaminophen, ibuprofen, naltrexone, or naloxone).  

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Use

Tramadol

Tramadol treats moderate to severe pain when non-opioid options are ineffective. It’s used for acute pain (like post-operative pain) but only for 3 to 7 days. It’s also used for chronic pain but only as a last option.^{6, 8}

Other off-label uses for Tramadol include treatment for restless leg syndrome and premature ejaculation.^{9, 10}

Oxycodone

Oxycodone treats moderate to severe pain when less potent, non-opioid options are not working. It’s used for acute pain (for 3 to 7 days only) and sometimes chronic pain.^{7, 11}

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Addictiveness 

Tramadol

When tramadol was approved in the United States in 1995, it was not a controlled substance. Due to low diversion and abuse reports, it was re-classified as a Schedule IV drug in 2014. This means it has a low potential for abuse and a low risk of dependence.^1,12 

Tramadol’s effects (licit and illicit) usually kick in within an hour. Although slower-acting than other opioids, people can still abuse it at a lower risk. 

In 2016, 1.6 million Americans aged 12 and above misused tramadol products. In 2017 and 2018, 1.8 and 1.5 million people misused tramadol.^{8, 12}

Oxycodone

Since the 1960s, oxycodone was already known to be highly addictive. 

Oxycodone is a Schedule II controlled substance, meaning it’s more potent than tramadol. It has a high potential for abuse, with use potentially leading to severe psychological or physical dependence. 

Oxycodone’s effects usually kick in within 15 minutes. It’s more potent and fast-acting than tramadol and morphine.

Oxycodone is likely to be abused for its euphoric effect or to prevent withdrawal caused by other opioids. Abuse increased with the extended-release forms as people realized they could crush the tablet and then snort or inject the powder.^{11, 12}

Here are the sample numbers of oxycodone users in the U.S. aged 12 years and above:¹¹

• 2015: 27.9 million users (15.2% or 4.3 million are misusers)
• 2016: 27.6 million users (14.1% or 3.9 million are misusers)
• 2017: 26.7 million users (14.0% or 3.7 million are misusers) 
• 2018: 26.4 million users (12.8% or 3.4 million are misusers) 

Side Effects

Tramadol and oxycodone cause several side effects that are typical of opioids:^{4, 6, 7}

Both drugs can also cause nearly all symptoms typical of opioid withdrawal. 

Tramadol

Although tramadol has a lower addiction risk, it causes additional side effects that are not typical of opioids: 

• Serotonin syndrome ⁠— includes symptoms like nervousness, uncontrollable shaking, muscles rigidity, and seizures^{4, 5, 13, 14}
• Hypoglycemia ⁠— lower-than-normal blood sugar levels⁵

Another unique aspect of tramadol is that it causes withdrawal symptoms atypical for an opioid. These unusual symptoms are observed in 10% of tramadol withdrawal cases:^{8, 16}

• Hallucinations
• Paranoia
• Extreme anxiety
• Panic attacks
• Confusion
• Numbness or tingling in one or more limbs

Naloxone is the go-to treatment for opioid overdoses. However, it is only partially effective against tramadol.¹⁷ 

Oxycodone

Oxycodone has its own unique side effects, which include:^{4, 7}

• Trouble sleeping
• Loss of energy
• Sweating
• Stomach pain
• Flushing
• Erectile dysfunction 
• Irregular menstruation
• Decreased libido

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