Tramadol vs Oxycodone

Key Takeaways

• Tramadol and oxycodone are prescription opioids used to treat pain
• Oxycodone is 6 to 10 times more potent than tramadol
• Tramadol has a lower risk of addiction
• It also has unique side effects and withdrawal symptoms atypical of opioids

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Tramadol vs. Oxycodone

Tramadol and oxycodone are opioid analgesics used for moderate to severe pain control. They are prescribed in cases when no other pain reliever has worked. 

Both drugs bind to opioid receptors in the central nervous system (CNS). This mechanism causes the pain relief effect of opioids. 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}

Brand Names, Forms, and Dosage

Tramadol

Brand names for tramadol include:⁶

• ConZip
• Qdolo
• Rybix ODT
• Ryzolt
• Ultram
• Ultram ER

There’s a tramadol-acetaminophen combination product marketed under the brand name Ultracet. Tramadol also has generic brands.

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

Oxycodone

Brand names for oxycodone include:⁷

• Oxaydo
• Oxecta
• Oxycontin
• Oxyfast
• Roxicodone
• Xtampza ER

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

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 is later increased depending on the body’s reaction. 

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What Do They Treat?

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 chronic pain.^{7, 11}

Addictiveness 

Tramadol

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

Tramadol’s effects (licit and illicit) usually kick in within 1 hour. Although slower-acting than other opioids, it can still be abused 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. It’s a Schedule II controlled substance, more potent than tramadol. The classification means it has 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) 

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Side Effects

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

• Headache
• Sleepiness or drowsiness
• Dizziness
• Constipation
• Nausea
• Vomiting
• Itching
• Dry mouth
• Allergic reactions
• Changes in heartbeat
• Mood changes
• Seizures
• Difficulty swallowing
• Difficulty breathing (respiratory depression)

Both drugs also showed 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 (including symptoms like nervousness, uncontrollable shaking, muscles rigidity, and seizures)^{4, 5, 13, 14}
• Hypoglycemia (lower-than-normal blood sugar levels)⁵

Sources vary when it comes to tramadol causing life-threatening breathing problems. One study found tramadol not to cause respiratory depression. However, it may generate more nausea than oxycodone.¹ Another study suggests tramadol has respiratory depressant potential but to a lesser degree than oxycodone.¹⁵

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

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

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

Insurance Coverage and Costs

Medicare and insurance companies cover tramadol and oxycodone, although some limitations apply. Polices and limitations differ amoung states. In addition, pharmacies may have their own policies. 

The cost of Tramadol and Oxycodone varies depending on dosage, quantity, dispensing pharmacy, and insurance coverage.

Precautions and Warnings

Here are some guidelines on the safe use of tramadol and oxycodone:^{4, 6, 7}

• Use both tramadol and oxycodone only for their accepted medical use. Take the drugs only in situations where non-opioid treatments don’t work. 
• Take tramadol or oxycodone as directed by your doctor. Don’t take a higher dosage or at more frequent intervals.
• Don’t chew, crush, or dissolve an extended-release tablet. Doing so may lead to severe problems like overdose and death.
• The two drugs are usually prescribed for adult use. They should only be prescribed for younger users when necessary.  
• Pregnant breastfeeding mothers should avoid these two drugs unless the benefits outweigh the risks. Opioids can be passed on to newborns, potentially causing neonatal opioid withdrawal syndrome (NOWS). 
• Don’t mix alcohol with oxycodone or tramadol. Alcohol can increase the drug concentration in the body and increase the risk of respiratory depression. 
• Ask your doctor how to stop the drugs safely. Sudden stopping of drug use may lead to severe and dangerous withdrawal symptoms.

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