- Oxycodone vs. Tramadol
- What Are They?
- Side Effects
- Drug Interactions
- Warnings and Precautions
Oxycodone vs. tramadol: What's the difference?
- Oxycodone is a semi-synthetic narcotic (opiate) pain medication. It is synthesized from thebaine, a part of the poppy plant.
- Tramadol is a schedule IV, man-made (synthetic) pain reliever (analgesic). It is not a narcotic medication, and it is not a nonsteroidal anti-inflammatory drug (NSAIDs).
- Oxycodone is classified as a Schedule II drug by the US Food and Drug Administration (FDA), which means it has a high potential for addition and abuse. In comparison, Tramadol is classified as a Schedule IV drug, which means it has a lower potential for abuse and a lower risk for dependence.
- Both oxycodone and tramadol are prescribed for the management of acute and chronic moderate to severe pain.
- Common side effects of oxycodone and tramadol include:
- Some of the serious side effects and adverse events are different for oxycodone and tramadol. For example, oxycodone should be used cautiously in the elderly, debilitated patients, and in patients with serious lung disease because it can depress (slow) breathing. Some patients who received tramadol had seizures, and it may cause serotonin syndrome when combined with other drugs that increase serotonin.
- Oxycodone has several drug interactions, and should not be taken with alcohol, barbiturates, muscle relaxants, or benzodiazepines, for example, alprazolam (Xanax). Several other drug interactions occur with oxycodone.
- Tramadol also has several drug interactions, for example, with MAOIs or monoamine oxidase inhibitors, or SSRIs (selective serotonin inhibitors), for example fluoxetine (Prozac).
- The safety of oxycodone and tramadol have not been established. Children born to mothers who were taking oxycodone for a prolonged period of time may suffer side effects.
- Oxycodone is secreted in breast milk in small amounts, so it may cause side effects in the newborn. The safety of tramadol in breastfeeding women has not been established.
What are oxycodone and tramadol?
- Oxycodone is a strong narcotic pain-reliever and cough suppressant similar to morphine, codeine, and hydrocodone. The precise mechanism of action is not known but may involve stimulation of opioid receptors in the brain. Oxycodone does not eliminate the sensation of pain but decreases discomfort by increasing the tolerance to pain. In addition to tolerance to pain, oxycodone also causes sedation and depression of respiration. The FDA approved oxycodone in 1976.
- Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown, but it is similar to morphine. Like morphine, tramadol binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal anti-inflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs. The FDA approved tramadol in March 1995.
What brand names are available for oxycodone and tramadol?
What are the uses for oxycodone vs. tramadol?
Uses for oxycodone
- Oxycodone is prescribed for the management of pain severe enough to require daily, around-the-clock, long-term treatment with a narcotic, and for which alternative treatment options are inadequate for the relief of moderate to severe pain.
Uses for tramadol
- 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.
What are the side effects of oxycodone vs. tramadol?
Oxycodone side effects
The most frequent side effects of oxycodone include:
Other side effects of oxycodone include:
Oxycodone can depress breathing and is used with caution in elderly, debilitated patients and in patients with serious lung disease.
Oxycodone can impair thinking and the physical abilities required for driving or operating machinery.
Oxycodone is habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If oxycodone is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop. The dose of oxycodone should be gradually reduced in order to avoid withdrawal symptoms.
Tramadol side effects
Tramadol is generally well tolerated, and side effects are usually transient.
Commonly reported side effects include:
Less commonly reported side effects include:
Some patients who received tramadol have reported seizures. It may cause serotonin syndrome when combined with other drugs that also increase serotonin (see drug interactions section).
Abrupt withdrawal of tramadol may result in symptoms such as:
Tramadol can cause psychological or physical dependence similar to other narcotics. Tramadol is a schedule IV medication on the federal list of controlled substances.
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What is the dosage for oxycodone vs. tramadol?
- The usual starting dose using immediate release oxycodone tablets is 5 to 30 mg every 4 to 6 hours. Patients who have never received opioids should start with 5-15 mg every 4 to 6 hours. Some patients may require 30 mg or more every 4 hours.
- The usual starting dose using extended release tablets is 10 mg every 12 hours. Extended release tablets are used when around the clock treatment is required for an extended period of time. Extended release tablets should not be broken, crushed or chewed but should be swallowed whole. Braking, crushing or chewing extended release tablets may lead to rapid absorption of the drug and dangerous levels of oxycodone.
- The 60 and 80 tablets or single doses greater than 40 mg should only be used by patients who have been using opioids and have become tolerant to opioid therapy. Administration of large doses to opioid-naïve patients may lead to profound depression of breathing.
- The usual adult dose of the oral concentrate (20 mg/ml) is 5 mg every 6 hours.
- The usual adult dose for the oral solution (5 mg/5 ml) is 10-30 mg every 4 hours.
- 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.
Which drugs interact with oxycodone vs. tramadol?
Oxycodone drug interactions
- Oxycodone, like other narcotic pain-relievers, increases the effects of drugs that slow brain function, such as:
- Combined use of the above drugs and oxycodone may lead to increased respiratory depression.
- Oxycodone 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. Oxycodone should not be administered within 14 days of stopping an MAOI.
- Since oxycodone causes constipation, the use of antidiarrheals, for example, diphenoxylate and atropine (Lomotil) and loperamide (Imodium), in persons taking oxycodone, can lead to severe constipation.
- Drugs that stimulate and also block opioid receptors, for example, pentazocine, nalbuphine (Nubain), butorphanol (Stadol), and buprenorphine (Subutex) may reduce the effect of oxycodone and may precipitate withdrawal symptoms.
- Combining oxycodone with drugs that affect the activity of certain liver enzymes or discontinuing such drugs may result in fatal oxycodone overdose.
- A fatty meal may increase the absorption of oxycodone by 27%.
Tramadol drug interactions
- 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.
- Tramadol may increase the central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers, or sedative-hypnotics. This can reduce the level of consciousness or lead to respiratory insufficiency.
Are oxycodone and tramadol safe to take during pregnancy or while breastfeeding?
- Safety during pregnancy has not been established. Children born to mothers who were taking oxycodone for a prolonged period may exhibit respiratory depression or withdrawal symptoms.
- Small amounts of oxycodone are secreted in breast milk and may cause side effects in the newborn.
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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.
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Related Disease Conditions
Acute injuries, medical conditions, and chronic use conditions are causes of knee pain. Symptoms and signs that accompany knee pain include redness, swelling, difficulty walking, and locking of the knee. To diagnose knee pain, a physician will perform a physical exam and also may order X-rays, arthrocentesis, blood tests, or a CT scan or MRI. Treatment of knee pain depends upon the cause of the pain.
Lower Back Pain (Lumbar Spine Pain)
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis, and abdomen, and the skin covering the lumbar area.
Shoulder and Neck Pain
Shoulder and neck pain may be caused by bursitis, a pinched nerve, whiplash, tendinitis, a herniated disc, or a rotator cuff injury. Symptoms also include weakness, numbness, coolness, color changes, swelling, and deformity. Treatment at home may incorporate resting, icing, and elevating the injury. A doctor may prescribe pain medications and immobilize the injury.
Foot pain may be caused by injuries (sprains, strains, bruises, and fractures), diseases (diabetes, Hansen disease, and gout), viruses, fungi, and bacteria (plantar warts and athlete's foot), or even ingrown toenails. Pain and tenderness may be accompanied by joint looseness, swelling, weakness, discoloration, and loss of function. Minor foot pain can usually be treated with rest, ice, compression, and elevation and OTC medications such as acetaminophen and ibuprofen. Severe pain should be treated by a medical professional.
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.
Ankle Pain (Tendonitis)
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Neck Pain (Cervical Pain)
Neck pain (cervical pain, cervicalgia) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Arthritis, bursitis, IT band syndrome, fracture, and strain are just some of the causes of hip pain. Associated symptoms and signs include swelling, tenderness, difficulty sleeping on the hip, and loss of range of motion of the hip. Treatment depends upon the cause of the hip pain but may include anti-inflammatory medications and icing and resting the hip joint.
Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Treatment for elbow pain depends upon the nature of the patient's underlying disease or condition.
What Causes Neck Pain in Seniors?
Neck pain can affect your employment, social life, and personal relationships. The causes of neck pain in seniors include muscle spasms, arthritis, poor posture, cervical spondylosis, cervical spinal stenosis and disk problems.
Pelvic Pain (in Women and Men)
Pelvic pain is described as pain, usually in the lower pelvic area. Causes of acute and chronic pelvic pain in women include endometriosis, ectopic pregnancy, miscarriage, menstrual cramps, ovarian cysts, tumors, or fibroids, ovulation, and pelvic inflammatory disease (PID) or congestion syndrome, vulva pain, and rarely cancer. Pelvic pain during pregnancy may be caused by miscarriage, ectopic pregnancy (tubal pregnancy), preterm or premature labor, and placental abruption. Causes of pelvic pain in men include prostate problems, testicular pain, and groin pain. Causes of pelvic pain in men and women include kidney stones, appendicitis, UTIs, IBD, and STDs. Signs and symptoms associated with pelvic pain depend on the cause, but man include pain during or after sexual intercourse, abdominal pain, distension, and tenderness, diarrhea, constipation, vaginal discharge or bleeding, blood, pus, in the urine, cloudy urine, blood in the stool, stool color changes, and low back pain. The cause of pelvic pain is diagnosed by a physical exam, blood tests, and imaging procedures. Treatment for pelvic pain depends on the cause.
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.
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.
Cancer pain results from the tumor pressing on nerves or invading bones or organs. Cancer treatments like chemotherapy, radiation, or surgery can also cause pain. Over-the-counter pain relievers, prescription medications, radiation, biofeedback, and relaxation techniques are just some treatments for cancer pain.
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).
Treatment & Diagnosis
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Pain Management Resources
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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.
Drug Enforcement Administration. "Drug Facts Sheet: Oxycodone."
Drug Enforcement Administration. "Drug Schedules."
Drug Enforcement Administration. "TRAMADOL (Trade Names: Ultram®, Ultracet®)." Updated: Jul 2014.<https://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf>
U.S. National Library of Medicine. "Tramadol (By mouth)." Updated: Dec 01, 2016.