Tramadol vs. oxycodone: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Tramadol and Oxycodone are prescription pain relievers that may be prescribed to you for moderate to severe pain when other treatments have not worked. Tramadol and oxycodone interact with opioid receptors in the brain to reduce pain signal transmission. They may be used to treat a variety of pain types including musculoskeletal pain and post-surgical pain. While they may be used in similar pain types, these two drugs are unique and different from each other.

What are the main differences between tramadol and oxycodone?

Tramadol (Tramadol coupons | What is Tramadol?) is a prescription opioid analgesic used to treat pain described as moderate to severe for which over-the-counter or other non-opioid options have failed to help. It can also be used in acute traumatic pain such as post-operative pain where it is reasonable to assume that less potent options would leave the patient in unreasonable pain. Tramadol interacts with mu-opioid receptors in the central nervous system (CNS). This alters the body’s perception and response to pain through the ascending pain pathways. Tramadol also inhibits the reuptake of norepinephrine and serotonin neurotransmitters, which are also involved in the descending pathway.

When tramadol originally came to market, it was not classified as a controlled substance. In 2014, the Drug Enforcement Administration (DEA) re-classified tramadol as a Schedule IV controlled substance. Tramadol has the potential to be abused or misused, and its use should be monitored closely.

Tramadol is available as an oral tablet in both immediate-release and extended-release formulations. It is also available in a tablet in combination with acetaminophen, the active ingredient in over-the-counter Tylenol.

Oxycodone (Oxycodone coupons | What is Oxycodone?) is also a prescription opioid pain reliever. Oxycodone binds to opioid receptors in the CNS pathway causing inhibition in the ascending pain pathway. This alters perception and response to pain and causes generalized CNS depression.

Oxycodone is a Schedule II controlled substance. It has a very high potential for addiction, abuse, and misuse.

Oxycodone is available as an oral tablet in both immediate-release and extended-release formulations. It is also available in formulations that combine it with acetaminophen, aspirin, ibuprofen, naloxone, or naltrexone.

Conditions treated by tramadol and oxycodone

Tramadol is indicated in the management of pain classified as moderate to severe. It can be used in acute pain, such as postoperative pain, though its use should be limited to short-term use, typically three to seven days. Tramadol can be used in chronic pain management, though it is not typically a first choice for this indication.

Tramadol has been used for relief in restless leg syndrome in patients who have had little or no success with traditional treatments. This use is considered off-label, meaning it has not been approved by the Food and Drug Administration (FDA) for this type of use.

Oxycodone is also indicated in the management of pain classified as moderate to severe. It can be used in acute pain, but its use should be limited to three to seven days. Oxycodone can be used in chronic pain as well. Due to its severe CNS depressive effects, oxycodone must be titrated slowly up in dose.

Is tramadol or oxycodone more effective?

Oxycodone has long been regarded as more potent than tramadol. Pain relievers are commonly compared on the basis of morphine equivalent dosing. Oxycodone is 1.5 times more potent than morphine, while tramadol is a negligible potency compared to morphine.

One study compared pain control after facial surgery using tramadol and oxycodone. In this study, the drugs were administered intravenously through a patient-controlled device. Pain control was found to be similar between the two groups, with no statistical difference between the two. Tramadol does not cause respiratory depression to the degree that oxycodone does. However, patients experienced more nausea with tramadol. Researchers concluded that tramadol provided pain relief comparable to oxycodone without the risk of severe respiratory depression.

Coverage and cost comparison of tramadol vs. oxycodone

Tramadol is typically covered by Medicare and commercial drug insurance plans, though some limitations may apply. In response to the opioid epidemic, many prescribing limitations and guidelines went into effect in 2019. Medicare Part D beneficiaries who are opiate naive are limited to a seven-day prescription upon an initial fill of an opiate. (Opiate naive is defined as not having taken an opiate in the past 60 days.) After seven days, if additional medication is needed, prescribers may prescribe a longer-term. There are exceptions to these rules, such as hospice and cancer-related care. Some chronic pain diagnoses qualify for prescribing exceptions as well. Many commercial insurance plans have adopted similar limitations for their beneficiaries. Pharmacies may also have their own specific policies for the filling of opiate medications.

The cost for tramadol can cost as much cost more than $60 for 60 tablets of the 50 mg strength. With a coupon from SingleCare, you could purchase this prescription for just over $12.

The average retail price for Oxycodone can be more than $150 for 120 tablets of the 10 mg strength. With a coupon from SingleCare, you can fill this prescription for under $40 at select pharmacies.

Get the SingleCare prescription discount card

Common side effects of tramadol and oxycodone

The side effects of tramadol and oxycodone are primarily due to their interaction with the central nervous system. Both drugs are likely to cause headaches, drowsiness, and dizziness due to their CNS depressive effects. The adverse events can be severe and may inhibit normal daily activity.

Opiate pain relievers are known to cause constipation, sometimes severe. It may be necessary to take stool softeners while on pain relievers. Prolonged constipation may require more harsh laxatives.

The following chart is not intended to be a comprehensive list of side effects. Please consult a medical professional such as your doctor or pharmacist for a complete list.

Source: Tramadol (DailyMed) Oxycodone (DailyMed)

Drug interactions of tramadol vs. oxycodone

The use of tramadol and oxycodone with other CNS depressant drugs should be avoided when possible. Drugs such as alprazolam and diazepam, as well as other opiate painkillers, may cause a dangerous level of CNS depression when used with tramadol or oxycodone. Patients may exhibit severe respiratory depression, profound sedation, low blood pressure, coma, or death.

Drugs that affect the serotonergic receptors, such as fluoxetine or sertraline, should be used cautiously in patients who take tramadol or oxycodone. There is the potential for increased likelihood of serotonin syndrome, which can be characterized by increased heart rate, high blood pressure, confusion, and tremors.

The following table is not intended to be a complete list of potential drug interactions. Consult a medical professional for a complete list and advice on interactions.

Warnings of tramadol and oxycodone

Alcohol use should be avoided in patients who take oxycodone. Alcohol could increase the serum concentration of oxycodone and therefore enhance the CNS depressant effects. This could lead to dangerous levels of respiratory depression.

Prescribers may need to adjust the dose or dosing interval of both tramadol or oxycodone in patients who have liver damage or impaired kidney function.

Tramadol and oxycodone are pregnancy category C, meaning there are no human studies proving harm or safety in pregnant patients. The use of these drugs should be limited to only absolutely necessary use. Oxycodone is present in the breast milk of lactating mothers; as such, breastfeeding mothers should only use oxycodone when the benefit clearly outweighs the risk. Tramadol should not be used in breastfeeding mothers as its active metabolite is more potent and can result in opioid withdrawal in infants.

Tramadol and oxycodone each have high potential for abuse, misuse, physical dependence, and addiction. They should only be used when all other non-opiate treatment options have been exhausted. Their use should be limited to as short of a term as possible. If a patient has been taking opiate pain relievers for an extended period of time, they may be prone to withdrawal symptoms if they stop abruptly. Discontinuation after high dose and long term use of opioid analgesics should be done with physician oversight.

Opiate pain relievers should only be used in children when absolutely necessary; typically in an in-patient setting where they can be monitored. The severe risk of respiratory depression makes these drugs very dangerous in children.

Frequently asked questions about tramadol vs. oxycodone

What is tramadol?

Tramadol is a mu-opioid agonist pain reliever available by prescription only. It is a Schedule IV controlled substance. It is available as an oral tablet in immediate-release and extended-release formulations.

What is oxycodone?

Oxycodone is an opioid agonist pain reliever available by prescription only. It is a Schedule II narcotic and causes significant CNS depression. It is available as an oral tablet in immediate-release and extended-release formulations.

Are tramadol and oxycodone the same?

While both tramadol and oxycodone are opiate pain relievers, they are not the same. Oxycodone is a Schedule II narcotic and causes significant CNS depression, including respiratory depression. Tramadol is a Schedule IV controlled substance and does not cause a significant amount of respiratory depression.

Is tramadol or oxycodone better?

Oxycodone is 1.5 times the potency of morphine, while tramadol is only a fraction of the potency of morphine. However, a study done on post-surgical patients found similar pain relief with both drugs. Tramadol causes less respiratory depression, but other side effects, such as nausea, may be worse with Tramadol.

Can I use tramadol or oxycodone while pregnant?

The use of tramadol or oxycodone when pregnant should be limited to only when absolutely necessary as there have been no randomized, controlled human trials to prove their safety. The benefit of use must outweigh the risk, and infants should be monitored for opioid withdrawal syndrome if these drugs are used long-term.

Can I use tramadol or oxycodone with alcohol?

Patients taking tramadol or oxycodone should avoid alcohol use. Alcohol may enhance the CNS depressive effects of these drugs, which can lead to serious adverse events such as respiratory depression, coma, or death.

Is tramadol an opiate?

Yes. Tramadol interacts with the mu-opioid receptor to decrease pain signal transmission in the CNS. It is synthetically made, and it is thought to be less addictive than other opioid pain relievers.

Is tramadol a muscle relaxer?

No, tramadol is not a muscle relaxer. Its mechanism of action involves pain signal transmission but does not directly affect muscle function.