Tramadol vs. Hydrocodone: Pain Medication Comparison

Hydrocodone and tramadol are both strong opioid prescription pain medicines. ConZip (tramadol) is commonly prescribed to relieve moderate to moderately severe pain that's always present. Hydrocodone is a stronger opioid used to relieve severe pain.

Opioids and narcotic pain medicines can lead to opioid use disorder. Therefore, healthcare providers typically aim to prescribe just enough pain relief for your condition. Stronger pain medicines like hydrocodone are usually reserved for when other pain medicines, such as tramadol or codeine, don't work.

This article will compare tramadol and hydrocodone based on their side effects, uses, and dosages, as well as which is considered stronger.

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Basic Drug Differences: Tramadol vs. Hydrocodone 

Both tramadol and hydrocodone are opioids—strong pain-relieving drugs. These drugs change how the brain and nervous system respond to pain. They can also have "feel-good" effects due to releasing brain chemicals like dopamine and norepinephrine. 

Hydrocodone is a more potent opioid. It has a higher potency but a higher potential of being misused. The Drug Enforcement Administration (DEA) classifies hydrocodone as a Schedule II drug. Tramadol has a lower potential for misuse and is classified as a Schedule IV drug. It is also a less potent painkiller.

These drugs are both controlled substances. They are closely regulated, and healthcare providers closely monitor patients using them. If opioids are needed to control pain, the healthcare provider will start with low doses and keep the amounts as small as possible. That's because these drugs can be addictive. They treat severe pain after an operation or due to cancer.

Common brand names for tramadol include ConZip, FusePaq Synapryn, and Qdolo. When combined with acetaminophen, the active ingredient in Tylenol, tramadol is marketed as Ultracet.

Cost

Tramadol and hydrocodone pain medicines are generally affordable if a generic version works for your situation. Ask a healthcare provider about finding the cheapest options for you. The final cost will vary by insurance options and any coupons or discounts you can get from the pharmaceutical company or a third party.

Compare drug prices online to find the most cost-effective options for your situation.

Hydrocodone is used in many brands of prescription pain relievers and is commonly sold in combination with over-the-counter (OTC) pain relievers and decongestants, as follows:

Hydrocodone with acetaminophen is marketed under dozens of names, but the best-known may be Vicodin.
Hydrocodone with ibuprofen, the main ingredient in Advil and Motrin, is marketed as Ibudone, Vicoprofen, and Reprexain.

Hydrocodone is also marketed in extended-release formulations that only need to be taken once daily, including Zohydro ER and Hysingla ER.

What Kind of Pain They Treat: Tramadol vs. Hydrocodone

Both drugs are potent pain relievers for moderate to severe pain. Tramadol typically relieves short-lived pain of the muscles and joints, or pain due to a wound. Extended-release tramadol medications may be used for chronic pain like osteoarthritis.

Hydrocodone is a powerful pain reliever often used when other pain medicines are no longer working. Hydrocodone is only given to people with chronic, severe, around-the-clock pain who cannot be treated with other medicines or treatments.

Types of pain these two drugs treat include:

Acute: Tramadol is often used for acute pain, such as after surgery or a traumatic wound, like a broken bone.
Chronic: Extended-release tramadol may be a good option for chronic pain, especially if OTC pain medicines aren't working well. Hydrocodone is more commonly used for intractable chronic pain, especially when weaker opioids like tramadol are not working well.
Nerve: Opioids aren't the best option for treating nerve pain. A 2017 meta-analysis found insufficient evidence to determine if tramadol is a good option for nerve pain. More potent opioids like hydrocodone have side effects that make them a less-favorable choice for many.

Tramadol vs. Hydrocodone: How Strong Is the Dosage?

Opiates are compared using a morphine-equivalent dose. This is the amount of the drug needed to equal a dose of morphine. One 30-milligram (mg) dose of hydrocodone is equivalent to one 30 mg dose of morphine. But 300 mg of tramadol would be equivalent to one 30 mg dose of morphine or hydrocodone.

Tramadol is available in immediate-release doses of 50 mg and 100 mg tablets and extended-release capsules of 100 mg and 150 mg. Quantities are up to 300 mg given once daily for extended release. Immediate-release tramadol can be dosed up to 400 mg per day up to 75 years old and 300 mg per day above 75.

Hydrocodone usually is available at doses from 2.5 mg to 10 mg, often along with 300 or 325 mg of acetaminophen. The maximum daily amount of hydrocodone with acetaminophen should not exceed 60 mg of hydrocodone and 4,000 mg of acetaminophen.

Bioavailability 

Bioavailability is the amount of drug that makes it into the bloodstream when taken by mouth. The manufacturer of Ultram (tramadol hydrochloride) tablets reports that it has a bioavailability of 75%. A study of extended-release tramadol hydrochloride tablets reports a bioavailability of 85% to 90%.

The oral bioavailability of hydrocodone is reported to be 25%. The relative bioavailability when comparing extended-release hydrocodone products and combination hydrocodone bitartrate and acetaminophen tablets is unknown, so a healthcare provider should monitor the person closely when switching products.

Side Effects

Tramadol and hydrocodone are strong prescription pain relievers. They both have extensive lists of side effects. They are both addictive and can lead to opioid use disorder.

What Is Opioid Use Disorder?

Opioid use disorder is when someone misuses or overuses opioid medications or drugs, causing significant impairment or distress. They may take these drugs unprescribed, take more than prescribed, and experience withdrawal if they stop taking the drug.

Be careful when taking these medications. Always take them the same way (with food or without) at the same time of the day. Take them exactly as prescribed. Do not give them to other people, even if they ask you to try your medication.

Opioids like tramadol and hydrocodone can cause constipation. Talk to your healthcare provider about changing your diet and using other medications to treat or prevent constipation.

Tramadol

Annoying, but not necessarily serious, side effects of tramadol can include:

Sleepiness
Headache
Nervousness
Uncontrollable shaking of a part of the body
Muscle tightness
Changes in mood
Heartburn or indigestion
Dry mouth

Tell a healthcare provider if the side effects are severe or do not go away.

Some side effects of tramadol are more serious. It can cause life-threatening breathing problems, especially during the first few days of use or when the dose is increased.

The side effects listed below should be immediately reported to a healthcare provider. Seek emergency medical treatment if you're experiencing any of these symptoms:

Hives or a rash
Blisters
Hoarseness or difficulty swallowing or breathing
Swelling of the eyes, face, throat, tongue, lips, hands, feet, ankles, or lower legs
Agitation and hallucinations (seeing things or hearing voices that do not exist)
Fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
Loss of appetite, weakness, or dizziness
Headache, confusion or difficulty concentrating, loss of energy, drowsiness, fatigue, restlessness, irritability, muscle weakness, spasms or cramps
Loss of consciousness
Seizure

Hydrocodone 

Side effects of hydrocodone include:

Stomach pain
Dry mouth
Tiredness
Headache
Back pain
Tight muscles
Urination problems, including finding peeing difficult or painful 
Ringing in the ears
Sleep issues, including difficulties falling asleep or staying asleep
Swelling of the foot, leg, or ankle
Uncontrollable shaking of a part of the body
Inability to get or keep an erection
Irregular menstruation
Decreased sexual desire

Tell a healthcare provider if the side effects listed above are severe or do not go away.

Some side effects can be severe. If you experience any of these side effects, call a healthcare provider immediately or get emergency medical treatment:

Pain in your chest
Agitation, hallucinations
Fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
Loss of appetite, weakness, or dizziness
Swelling of your eyes, face, lips, tongue, or throat
Hoarseness or difficulty swallowing or breathing
Hives or itching

Can You Take Tramadol With Hydrocodone?

Your healthcare provider will prescribe either tramadol or hydrocodone. These two medications should not be used at the same time. Taking them together could cause an overdose or severe side effects that could threaten your life.

Overdosing on opioids causes shallow breathing that deprives the brain of oxygen. This leads to passing out and possible brain damage or death. Overdose can be reversed with a medicine called Narcan (naloxone).

Other Possible Drug Interactions 

People on opioids should not drink alcohol. This can cause serious life-threatening side effects.

Many other medications may interact with opioids, so careful monitoring is required if you also take other prescriptions regularly. Be sure to inform your healthcare provider of any other medicines you take, including those purchased over the counter, to avoid potential complications.

Herbal supplements like Saint-John's-wort and tryptophan can also cause adverse interactions.

Some examples of types of medications that may negatively interact with opioids include:

Prescription Pain Medication Special Considerations

Long-term use of opioids can also lead to tolerance, in which higher doses and more potent medicines are needed to have the same pain-relieving effect. This can lead to opioid use disorder or overdose. Opioid overdoses killed more than 100,000 Americans in 2021.

Formulations with acetaminophen can also cause dangerous toxicity that can permanently damage the liver if you take more than directed.

Not only can prescription opioid pain relievers cause overdose and lead to opioid use disorder, but they can have a rebound effect.

Opioid-induced hyperalgesia and allodynia are when the pain of everyday sensations strengthens after taking opioids. Hyperalgesia is pain felt more intensely than it should. Allodynia is pain from something that isn't usually painful, such as a light touch or fabric moving across your skin.

Summary

Hydrocodone and tramadol are two opioid (narcotic) pain relievers. They both work by changing how the body responds to pain. They come in fast-acting and extended-release formulas and are often sold combined with acetaminophen or ibuprofen. 

Tramadol is often given after surgery if you've suffered significant trauma. The extended-release capsule may be helpful for some chronic conditions like osteoarthritis. Hydrocodone is used if weaker drugs like tramadol do not work.

They have similar side effects and can cause reduced breathing and deadly overdose. You shouldn't take these two medicines together or with alcohol, many other prescription or OTC drugs, or herbs or supplements.

Frequently Asked Questions

Ultram is a brand name for tramadol but is no longer being sold in the United States.
The Drug Enforcement Administration (DEA) classifies tramadol as a Schedule IV controlled substance. It's considered to have a lower risk of misuse than hydrocodone. However, a study in 2019 found that people prescribed tramadol or hydrocodone after surgery had similar rates of prolonged opioid use.

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