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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Norco and tramadol are prescription pain medications used to treat moderate to severe pain. These medications may be prescribed if you experience acute pain after surgery or a traumatic injury. They may also be prescribed for chronic pain in cancer patients.
Norco and tramadol both contain opioids, which work by binding to opioid receptors and altering your body’s response to pain. As narcotic pain relievers, these drugs are more potent than the average over-the-counter pain reliever. They are controlled substances that also have a higher risk of abuse and dependence.
Despite having similar uses, Norco and tramadol are different medications.
What are the main differences between Norco and tramadol?
Norco is the brand name for the combination of hydrocodone and acetaminophen. Other brand names for this combination include Vicodin and Lortab.
Hydrocodone is a semi-synthetic opioid and acetaminophen is an analgesic and antipyretic agent. On its own, acetaminophen (APAP) is a common OTC drug used for mild pain and fevers. When combined, hydrocodone and acetaminophen can treat moderate to severe pain that doesn’t respond to other pain relievers. Norco is a Schedule II drug, according to the DEA, which means it has a high potential for psychological and physical dependence.
Tramadol is the generic name for Ultram and ConZip. Ultram is an immediate-release form of tramadol while ConZip is an extended-release version of tramadol. Tramadol is a synthetic opioid medication for moderate pain and discomfort. Compared to Norco, tramadol is a Schedule IV drug that has a lower risk of dependence and abuse.
| Main differences between Norco and tramadol | ||
|---|---|---|
| Norco | Tramadol | |
| Drug class | Opioid analgesic | Opioid analgesic |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the generic name? | Hydrocodone-Acetaminophen | Tramadol is the generic name.
Brand names of tramadol include Ultram and ConZip. |
| What form(s) does the drug come in? | Oral tablet | Oral tablet |
| What is the standard dosage? | Hydrocodone 5 mg/APAP 325 mg: 1 tablet every 4 to 6 hours as needed for pain not to exceed 8 tablets per day.
Other strengths of Norco include Hydrocodone 7.5 mg/APAP 325 mg and Hydrocodone 10 mg/APAP 325 mg. Dosage may vary according to your doctor’s instructions. |
50 to 100 mg every 4 to 6 hours as needed for pain not to exceed 400 mg per day |
| How long is the typical treatment? | Opioid treatment is only recommended for short-term use unless directed by your doctor | Opioid treatment is only recommended for short-term use unless directed by your doctor |
| Who typically uses the medication? | Adults 18 years and older | Adults and adolescents 16 years and older |
Conditions treated by Norco and Tramadol
Norco and tramadol are FDA approved to treat pain severe enough to warrant the use of an opioid. These drugs are often prescribed after a procedure or injury for pain that isn’t relieved with an over-the-counter pain reliever, such as naproxen. Norco or tramadol may be recommended in combination with lifestyle measures or physical therapy to help relieve acute or chronic pain.
| Condition | Norco | Tramadol |
| Moderate to severe pain | Yes | Yes |
Is Norco or tramadol more effective?
Norco and tramadol are both effective treatment options for pain. Compared to tramadol, Norco is considered a more potent opioid pain reliever.
In a randomized, double-blind clinical trial, patients received either tramadol or hydrocodone-acetaminophen for acute musculoskeletal pain. Mean pain scores were significantly lower in those who were administered hydrocodone-acetaminophen. After evaluating 68 patients who presented to the emergency department with pain, hydrocodone-acetaminophen was found to be more effective than tramadol.
Another randomized, double-blind clinical trial studied how effective hydrocodone-acetaminophen and tramadol are for pain in cancer patients. Results from the study found that hydrocodone-acetaminophen relieved pain in 56.5% of patients at a dose of 25 mg – 2500 mg per day while tramadol relieved pain in 62% of patients at a dose of 200 mg per day. However, patients taking tramadol experienced more mild side effects than those taking hydrocodone-acetaminophen.
Consult your healthcare provider on the best pain medication for you. Your doctor may recommend a pain medication based on your overall symptoms and condition.
Coverage and cost comparison of Norco vs. Tramadol
Norco is a controlled substance that can only be purchased with a prescription from your doctor. It is covered by most Medicare and insurance plans as a common opioid medication. Depending on the number of tablets, you could be paying an average retail price of $20 for Norco tablets without insurance. SingleCare offers a Norco discount coupon that can lower the price to about $4 to $8 depending on the pharmacy.
Tramadol, like other opioid analgesics, can only be purchased with a prescription. Tramadol is often covered by Medicare and insurance plans. Without insurance, tramadol can cost an average retail price of $31. At participating pharmacies, a SingleCare tramadol coupon can reduce the price to approximately $10 per prescription.
| Norco | Tramadol | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Standard dosage | One 5 mg-325 mg tablet every 4 to 6 hours as needed | One 50 mg or 100 mg tablet every 4 to 6 hours as needed |
| Typical Medicare copay | $0–$1 | $0–$47 |
| SingleCare cost | $4-$8 | $10+ |
Common side effects of Norco vs. tramadol
The most common side effects of Norco are drowsiness or sleepiness, dizziness, nausea, and vomiting. Other side effects might include constipation, difficulty urinating (urinary retention), itching, and mood changes.
The most common side effects of tramadol are dizziness, nausea, vomiting, constipation, headache, and drowsiness. Tramadol may also cause itching, indigestion, and dry mouth.
Serious side effects of opioid medications include severe sedation and slowed breathing (respiratory depression). An emergency supply of Narcan (naloxone) may be needed in case of an opioid overdose.
| Norco | Tramadol | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Drowsiness | Yes | * | Yes | 16% |
| Dizziness | Yes | * | Yes | 26% |
| Nausea/Vomiting | Yes | * | Yes | 24% |
| Constipation | Yes | * | Yes | 24% |
| Headache | No | * | Yes | 18% |
| Itching | Yes | * | Yes | 8% |
| Sweating | No | * | Yes | 6% |
| Indigestion | No | * | Yes | 5% |
| Dry mouth | No | * | Yes | 5% |
This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more. *not reported
Source: DailyMed (Norco), DailyMed (Tramadol)
Drug interactions of Norco vs. tramadol
Norco and tramadol are processed in the liver by the CYP3A4 enzyme. CYP3A4 inhibitors and CYP3A4 inducers are drugs that interfere with the metabolism of these opioid medications. Combining a CYP3A4 inhibitor, like ketoconazole, with Norco or tramadol can increase the risk of adverse effects from the opioid. Combining a CYP3A4 inducer, like rifampin, with Norco or tramadol can reduce how well the opioid works.
Drugs that have CNS depressant effects can also interact with Norco and tramadol. Drugs like benzodiazepines, antidepressants, and muscle relaxants can increase the risk of severe drowsiness and sedation. Drugs that are used as sleeping pills should be avoided while taking opioids like Norco or tramadol.
Monoamine oxidase (MAO) inhibitors can increase the risk of serotonin syndrome or opioid toxicity when combined with Norco or tramadol. Opioids are not recommended to be taken while on an MAO inhibitor or within 14 days of stopping an MAO inhibitor.
See the chart below for an overview of drug interactions with Norco and tramadol.
| Drug | Drug class | Norco | Tramadol |
| Ketoconazole Itraconazole Erythromycin Ritonavir |
CYP3A4 inhibitors | Yes | Yes |
| Rifampin Carbamazepine Phenytoin |
CYP3A4 inducers | Yes | Yes |
| Lorazepam Diazepam Alprazolam |
Benzodiazepines | Yes | Yes |
| Sertraline Fluoxetine Paroxetine Citalopram Amitriptyline |
Antidepressants | Yes | Yes |
| Cyclobenzaprine Metaxalone |
Muscle relaxants | Yes | Yes |
| Phenelzine Tranylcypromine |
Monoamine oxidase (MAO) inhibitors | Yes | Yes |
| Chlorthalidone Hydrochlorothiazide |
Diuretics | Yes | Yes |
Consult a healthcare professional for other possible drug interactions
Warnings of Norco and Tramadol
Opioid pain relievers like Norco and tramadol can cause life-threatening respiratory depression. Respiratory depression and breathing problems are more likely to occur when abusing opioids. Narcan is an opioid antagonist that comes in different formulations and can help reverse opioid toxicity. Only take opioids as prescribed by your healthcare provider.
There is a risk of addiction, abuse, and dependence while on opioid therapy. Opioids should only be used under the guidance of a healthcare provider.
Prescription opioids can cause withdrawal symptoms such as nausea, vomiting, and anxiety, if treatment is abruptly stopped. Therefore, opioid treatment should be tapered off slowly, especially after long-term use.
Do not take Norco or tramadol if you’ve experienced allergic reactions from other opioid medications. Allergic reactions can manifest as a severe rash or trouble breathing (anaphylaxis).
Acetaminophen can cause liver damage, especially in high doses. Acetaminophen doses should not exceed 4,000 mg in a day. Only take Norco in the prescribed doses to prevent the risk of liver injury.
Frequently asked questions about Norco vs. tramadol
What is Norco?
Norco is a brand-name opioid drug used for pain relief that can’t be achieved with non-opioid pain relievers. Norco contains a combination of hydrocodone bitartrate and acetaminophen. Hydrocodone is a semi-synthetic opioid analgesic and acetaminophen is a non-opioid analgesic and antipyretic agent.
What is Tramadol?
Tramadol is a generic opioid medication used for pain management. Tramadol can treat moderate to severe pain after a surgical procedure or injury. In some cases, it may also be prescribed for chronic pain. Brand names for tramadol hydrochloride include Ultram (immediate-release) and ConZip (extended-release).
Are Norco and Tramadol the same?
Norco and tramadol are not the same. Although they work in similar ways, they have different ingredients, formulations, and dosages. Norco is a Schedule II drug while tramadol is a Schedule IV drug. In other words, Norco has a higher potential for abuse than tramadol.
Is Norco or Tramadol better?
The better pain reliever is the one that effectively treats your pain. Norco is considered a more potent pain reliever than tramadol. However, compared to tramadol, Norco may have more severe side effects. Those who take Norco also have a higher risk of becoming dependent on the drug for pain relief.
Can I use Norco or Tramadol while pregnant?
Opioid medications are sometimes used during pregnancy. However, opioid use has been linked to fetal harm and birth defects. Opioids like Norco and tramadol can also cause life-threatening withdrawal syndrome in babies. Therefore, opioid use is not generally recommended while pregnant.
Can I use Norco or tramadol with alcohol?
It is not recommended to consume alcohol while taking Norco or tramadol. Drinking alcohol can amplify the adverse effects of opioids. If you drink alcohol while on an opioid medication, you may experience increased drowsiness and sedation. Combining opioids and alcohol can also increase the risk of overdose and life-threatening respiratory depression, coma, or death.
Is Tramadol more powerful than hydrocodone?
Tramadol is not considered to be more powerful than hydrocodone. Tramadol is a synthetic, or man-made, opioid while hydrocodone is a semi-synthetic opioid. Hydrocodone is a more potent pain reliever than tramadol. However, both hydrocodone and tramadol are less potent than certain opiates, such as fentanyl and morphine.
What pain medicine is equal to Tramadol?
Tramadol is generally less potent than other opioids like hydrocodone and oxycodone. Even so, pain relief from higher doses of tramadol may be similar to pain relief from lower doses of stronger opioids. Tapentadol, or generic Nucynta, works similarly to tramadol and also has a low potential for abuse.
Is Tramadol an anti-inflammatory?
Tramadol is not an anti-inflammatory drug. Tramadol differs from nonsteroidal anti-inflammatory drugs (NSAIDs) in that it’s in the opioid class of pain relievers. Compared to NSAIDs, tramadol has a lower risk of stomach ulcers and gastrointestinal bleeding.
