Updated on February 6, 2024
4 min read

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. 

Both drugs bind to opioid receptors in the central nervous system (CNS), relieving pain. 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 and oxycodone are prescription opioids that treat pain.
  • 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

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

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 seizures4, 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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Updated on February 6, 2024
18 sources cited
Updated on February 6, 2024
  1. Shmerling, RH. “Is tramadol a risky pain medication?” Harvard Health, 2019.
  2. Stoops et al. “Intravenous oxycodone, hydrocodone, and morphine in recreational opioid users: abuse potential and relative potencies.” Psychopharmacology (Berl), 2010.
  3. Zacny, J. “Profiling the subjective, psychomotor, and physiological effects of tramadol in recreational drug users.” Drug Alcohol Depend, 2005. 
  4. Compare Tramadol vs. Oxycodone.” GoodRx Health.
  5. Morgenstern, J. “No Reason to Choose Tramadol over Morphine.” Emergency Medicine News, 2019.
  6. Tramadol.” MedlinePlus, 2022.
  7. Oxycodone.” MedlinePlus, 2021.
  8. TRAMADOL (Trade Names: Ultram®, Ultracet®).” Drug Enforcement Administration (DEA), 2020.
  9. “Prescription Opioids DrugFacts.” National Institute DrugFacts.
  10. Khan A., Rasaily, D. “Tramadol use in premature ejaculation: daily versus sporadic treatment.” Indian journal of psychological medicine, 2013.
  11. OXYCODONE (Trade Names: Tylox®, Percodan®, OxyContin®).” Drug Enforcement Administration (DEA), 2020.
  12. Drug Scheduling.” Drug Enforcement Administration (DEA).
  13. Beakley B., Kaye, A. “Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review.” Pain Physician, 2015.
  14. Boostani, R., Derakhshan, S. “Tramadol induced seizure: A 3-year study.” Caspian J Intern Med, 2012
  15. Ghodse, AH., Galea, S. “8 - Opioid analgesics and narcotic antagonists.” Side Effects of Drugs Annual, 2010.
  16. Senay et al. “Physical dependence on Ultram (tramadol hydrochloride): both opioid-like and atypical withdrawal symptoms occur.” Drug Alcohol Depend, 2003.
  17. Pothiawala S. “Tramadol Overdose: A Case Report.” Proceedings of Singapore Healthcare, 2011.

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