Oxycodone vs Tramadol for Pain

Name: Oxycodone vs Tramadol for Pain

Oxycodone vs. tramadol review

  • 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:
    • Constipation
    • Headache
    • Sweating
    • Dizziness
    • Dry mouth
  • 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.
    • Both oxycodone and tramadol are habit-forming, and patients may become addicted to the drug. If these drugs are discontinued abruptly, withdrawal symptoms may occur. Symptoms of withdrawal include:
    • Anxiety
    • Nausea
    • Vomiting
    • Diarrhea
    • Tremors
    • Hallucinations
    • Rigor
    • Pain
    • Insomnia
  • 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 brand names are available for oxycodone and tramadol?

  • OxyContin, Roxicodone, and Oxecta are brand names available for oxycodone in the US.
  • Ultram, Ultram ER, and ConZip are the brand names for tramadol available in the US. Discontinued brands include Reix ODT and Ryzolt.

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.

How should oxycodone vs. tramadol be taken (dosage)?

Oxycodone dosage

  • 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.

Tramadol dosage

  • 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.


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Reviewed on 12/14/2016 References REFERENCES:

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.