Tramadol alternatives: What can I take instead of tramadol?

In this article:

• What can I take in place of tramadol?
• Top 5 tramadol alternatives
• Compare tramadol alternatives
• Natural alternatives to tramadol
• How to switch to a tramadol alternative

In this article

• What can I take in place of tramadol?
• Top 5 tramadol alternatives
• Compare tramadol alternatives
• Natural alternatives to tramadol
• How to switch to a tramadol alternative

Tramadol is a commonly prescribed opioid pain medication. It is approved by the Food and Drug Administration (FDA) in adults to treat pain that is severe enough to require an opioid medication. It’s typically used when non-opioid medicines are not expected to work (or do not work), or cannot be tolerated. Because of its risk for misuse and abuse, tramadol is classified as a Schedule IV controlled substance by the DEA. However, tramadol is not the best drug for everyone. Some people may be interested in exploring alternative drugs—perhaps due to side effects or concerns around Tramadol’s status as a controlled substance. The good news is that there are various alternatives that you can discuss with your healthcare provider.

What can I take in place of tramadol?

In addition to typical side effects seen with opioids, such as sedation and respiratory depression (breathing problems), possible side effects of tramadol also include seizures and low blood sugar, among others. Also, as a controlled substance, tramadol poses risks of abuse, diversion, dependence, and withdrawal. For these reasons, alternative painkillers may be more appropriate in certain cases. 

Other options are available to manage pain that either does not improve with tramadol, if side effects like drowsiness and constipation become intolerable, or if drug interactions pose problems. Alternative prescription medications include other opioid analgesics, NSAIDs, acetaminophen, and antidepressant serotonin-norepinephrine reuptake inhibitors (SNRIs). These options may be more suitable for certain individuals.

Top 5 tramadol alternatives

The following are some of the most common alternatives to tramadol.

1. Belbuca (buprenorphine)

Belbuca is a buccal film that dissolves inside the cheek and contains the active ingredient buprenorphine. It is used to treat pain that is severe and persistent, requiring daily treatment with opioid medicine, and is used when other medicines cannot be used or tolerated. Because Belbuca dissolves in the cheek, it may be an appropriate alternative for people who have trouble swallowing pills. However, it is used every day and is not meant to be taken as needed. The most common side effects of Belbuca include nausea, vomiting, constipation, headache, dizziness, and sleepiness. Belbuca is a Schedule III controlled substance, which means it may have a higher potential for abuse and misuse than tramadol.

2. Cymbalta (duloxetine)

Cymbalta is classified as an SNRI. Although it is an antidepressant, it is commonly prescribed for certain pain conditions, such as fibromyalgia, chronic musculoskeletal pain, and diabetic peripheral neuropathic pain. Cymbalta is not an opioid medicine, and is not a controlled substance. As with all antidepressants, Cymbalta has a black box warning for increased suicidal thoughts and behavior. When initiating Cymbalta, close monitoring for the emergence of such thoughts and behaviors is important. Common side effects of Cymbalta include nausea, constipation, dry mouth, decreased appetite, sleepiness, and excess sweating.

3. Aleve (naproxen)

Naproxen is a type of NSAID and may be a good alternative to opioid pain medications like tramadol in certain situations. Naproxen is available over the counter in a lower dose and by prescription at higher doses. Since it’s a nonopioid drug, it doesn’t have the common side effects specific to opioids, like constipation and drowsiness. 

NSAIDs like Aleve do come with their own set of potential side effects, though. NSAID use is associated with an increased risk of cardiovascular events, including the development of high blood pressure. Risk factors for the development of cardiovascular events include age 65 or older, higher doses, longer duration and frequency of use, and pre-existing cardiovascular disease or the presence of other risk factors for cardiovascular disease. NSAIDs can also increase bleeding event risk, so while not an opioid, they remain a medication with some risk associated with their use.

4. Celebrex (celecoxib)

NSAID use can result in gastrointestinal (GI) ulceration and bleeding. Celebrex, though, has been found to be associated with as much as a 20% lower risk of bleeding compared to other NSAIDs, and it may be safer than other NSAIDs in patients requiring long-term use (greater than six months). Celebrex is FDA approved for osteoarthritis, rheumatoid arthritis, acute pain, painful menstrual periods, and ankylosing spondylitis. Common side effects include stomach pain, indigestion, gas, diarrhea, and dizziness.

5. Voltaren gel (diclofenac 1%)

A topical pain reliever alternative to tramadol is Voltaren gel. Voltaren is an NSAID, like naproxen or celecoxib, and it is now available over the counter. The topical application allows for the avoidance of some of the safety concerns observed with oral NSAIDs, but it does carry the same NSAID warnings as the oral agents regarding increased risk of gastrointestinal and cardiovascular adverse events, so it should always be used at the lowest dose for the shortest duration of time possible. The gel may work as well as oral NSAIDs for arthritis pain and acute musculoskeletal pain (like sprains and strains). However, it comes with a higher risk of localized adverse events, such as rash, compared to oral NSAIDs.

NSAID prices and pain management resources

Compare tramadol alternatives
Drug name	Uses	Savings options
Tramadol	Pain that is severe enough to require an opioid pain medicine, when other medicines cannot be used	Tramadol coupons
Belbuca (buprenorphine)	Pain that is severe and persistent that requires extended treatment with a daily opioid pain medicine, when other medicines cannot be used	Belbuca coupons
Cymbalta (duloxetine)	Fibromyalgia Generalized anxiety disorder Major depressive disorder Chronic musculoskeletal pain Neuropathic pain associated with diabetes mellitus	Cymbalta coupons
Aleve (naproxen)	Anti-inflammatory Dysmenorrhea (painful menstrual periods) Fever Gout pain	Aleve coupons
Celebrex (celecoxib)	Osteoarthritis Rheumatoid arthritis Pain and inflammation Dysmenorrhea  Ankylosing spondylitis	Celebrex coupons
Voltaren gel (diclofenac 1% gel)	Osteoarthritis Pain	Voltaren coupons
Hydrocodone/ acetaminophen (APAP)	Pain management	Hydrocodone/APAP coupons
MS Contin (extended-release morphine)	Chronic pain (including chronic cancer pain) in opioid-tolerant individuals	MS Contin coupons
Dilaudid  (hydromorphone)	Pain that is severe enough to require an opioid pain medicine, when other medicines cannot be used	Dilaudid coupons
Roxicodone (oxycodone)	Pain that is severe enough to require an opioid pain medicine, when other medicines cannot be used	Roxicodone coupons
Percocet  (oxycodone/acetaminophen)	Pain that is severe enough to require an opioid pain medicine, when other medicines cannot be used	Percocet coupons
OxyContin  (extended-release oxycodone)	Persistent and severe pain that requires extended treatment with a daily opioid pain medicine, when other medicines cannot be used	Oxycontin coupons
Motrin, Advil (ibuprofen)	Anti-inflammatory Dysmenorrhea Fever Migraine Pain	Ibuprofen coupons
Tylenol (acetaminophen)	Pain Fever	Tylenol coupons
Meloxicam	Osteoarthritis Rheumatoid arthritis	Meloxicam coupons
Indocin (indomethacin)	Ankylosing spondylitis Osteoarthritis Rheumatoid arthritis  Bursitis/tendinitis Gout	Indocin coupons
Lidoderm (lidocaine patch)	Pain (localized) Postherpetic neuralgia	Lidoderm coupons
Feldene (piroxicam)	Osteoarthritis Rheumatoid arthritis	Feldene coupons

Natural alternatives to tramadol

The management of pain should be approached from all angles, and non-pharmacologic and more natural approaches may provide some real relief. Depending on the source of the pain, physical therapy may be one way to help manage it, especially for chronic pain after injuries or surgeries. By employing therapeutic exercise, physical therapy aims to achieve optimal neuromuscular and skeletal function. Other holistic approaches, such as acupuncture or the use of aromatherapy with different essential oils like peppermint oil or lavender oil, may also provide some pain relief and are generally safe, natural options to try. Turmeric is a spice with an active component known to have anti-inflammatory properties, and turmeric supplements may provide natural pain relief. Other natural products, such as magnesium supplements or topical capsaicin, may also reduce inflammation over time. Talk to your healthcare provider before trying any natural remedies. 

RELATED: 13 home remedies for pain relief

How to switch to a tramadol alternative

If you find it necessary to switch to a tramadol alternative, whether because of side effects or because treatment isn’t working, it’s important to taper your dosage under the direct supervision of a healthcare provider. This will help you avoid unwanted side effects and minimize withdrawal symptoms—particularly if you’ve been taking opioids long-term. Chronic opioid use can cause increased pain sensitivity, which is another reason why tapering doses slowly under the guidance of your healthcare provider is so important.