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Key takeaways
Tramadol and hydrocodone are prescription opioids used to treat moderate to severe pain, with tramadol being a Schedule IV drug indicating lower abuse potential, and hydrocodone a Schedule II drug indicating higher abuse potential.
Tramadol may have milder side effects and lower potential for abuse compared to hydrocodone. Still, its effectiveness in pain relief can vary based on individual conditions, and both have the potential for dependency.
Common side effects of both medications include dizziness, nausea, and constipation, with tramadol also potentially causing indigestion and sweating, while hydrocodone might cause fluid buildup and muscle spasms.
Both drugs interact with other medications that affect liver enzymes and CNS effects, and they carry risks of severe side effects such as respiratory depression and death, especially if misused or combined with alcohol.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Tramadol and hydrocodone are two medications used to treat pain that is not easily relieved with a non-opioid analgesic. Both medications can treat moderate to severe pain after surgery or in chronic conditions such as cancer. However, for many cases of pain, non-opioid therapy is usually tried first.
Both tramadol and hydrocodone work by binding to mu opioid receptors to change how a person responds to pain. As prescription opioids, they are more potent than your average over-the-counter pain reliever. Therefore, these drugs require a visit with a doctor to assess your pain.
What are the main differences between Tramadol and Hydrocodone?
Tramadol is the generic name for Ultram, Ultram ER, and ConZip. It is a Schedule IV narcotic according to the DEA which means it has some potential for abuse. While it binds to mu opioid receptors, it can also increase the activity of other brain neurotransmitters such as norepinephrine and serotonin.
Hydrocodone is the generic name for Zohydro ER and Hysingla ER. Hydrocodone is also taken as a combination tablet with acetaminophen under the brand names Vicodin or Lortab. Unlike tramadol, hydrocodone is a Schedule II DEA controlled medication which has a higher risk of abuse.
| Main differences between Tramadol and Hydrocodone | ||
|---|---|---|
| Tramadol | Hydrocodone | |
| Drug class | Opioid | Opioid |
| Brand/generic status | Generic version available | Generic version available |
| What is the generic name? What is the brand name? |
Generic: Tramadol Brand: Ultram, Ultram ER |
Generic: Hydrocodone Brand: Zohydro ER, Hysingla ER, Vicodin (combined with acetaminophen), Lortab (combined with acetaminophen), Norco (combined with acetaminophen) |
| What form(s) does the drug come in? | Oral tablet Oral tablet, extended-release Oral capsule Oral suspension |
Oral tablet Oral tablet, extended-release Oral capsule Oral solution |
| What is the standard dosage? | Ultram: 50 to 100 mg every 4 to 6 hours as needed Ultram ER: 100 mg every 24 hours |
Zohydro ER:10 mg every 12 hours Hysingla ER: 20 mg every 24 hours Vicodin, Lortab, Norco (combination with acetaminophen): 5 to 10 mg every 4 to 6 hours as needed |
| How long is the typical treatment? | Daily as needed. Treatment duration depends on your doctor’s instruction. |
Daily as needed. Treatment duration depends on your doctor’s instruction. |
| Who typically uses the medication? | Adults 18 years and older | Adults 18 years and older |
Conditions treated by Tramadol and Hydrocodone
Tramadol and hydrocodone are both indicated for pain management. They are usually prescribed if you have moderate to severe chronic pain, especially from conditions such as cancer. Both medications are also typically used for pain after injury and surgery.
| Condition | Tramadol | Hydrocodone |
| Moderate to severe pain | Yes | Yes |
| Chronic pain | Yes | Yes |
| Pain from injury or after surgery | Yes | Yes |
| Cancer Pain | Yes | Yes |
Is Tramadol or Hydrocodone more effective?
Tramadol and hydrocodone are both effective prescription opioids for pain. There are several studies comparing their effectiveness. Because hydrocodone is a Schedule II opiate, it may be considered more potent although it comes with a higher potential for abuse. Tramadol may have a lower abuse potential as well as milder side effects.
In one multicenter study, tramadol with acetaminophen was compared with hydrocodone with acetaminophen in patients experiencing pain from an ankle sprain. Around 400 patients were split into two groups receiving one drug or the other. Results found that both medications provide comparable pain relief within four hours versus placebo.
In another clinical trial, hydrocodone with acetaminophen was compared with tramadol in 68 patients. These patients had arrived at an emergency department for musculoskeletal pain in their joints, bones, or muscles. Results found that hydrocodone with acetaminophen provides more pain relief compared to tramadol based on pain scores with a visual analog scale (VAS).
In a double-blind trial, hydrocodone with acetaminophen was compared to tramadol in 118 patients with chronic pain from cancer. Tramadol showed pain relief in 62% of patients compared to 56.5% of patients with hydrocodone. However, pain relief was similar in both groups. Tramadol was also found to produce milder side effects versus hydrocodone.
Whether you are prescribed tramadol or hydrocodone is highly dependent on the level of your pain. When assessing your pain, your doctor will look at your complete medical history, any history of substance abuse, and any medications that could cause drug interactions. Therefore, pain medications are highly individualized and require a doctor’s consultation to determine which will be more effective for you.
Coverage and cost comparison of Tramadol vs. Hydrocodone
Tramadol is available as a generic drug. It is typically covered by Medicare and most insurance plans. The average cost of a supply of sixty 50 mg tramadol tablets is around $40. You save more with a SingleCare coupon for generic tramadol at your local pharmacy.
Hydrocodone is a generic drug that is often covered by Medicare and most insurance plans. The cost of hydrocodone varies between different insurance plans. Norco which contains hydrocodone and acetaminophen can run at an average cost of $317. With a SingleCare coupon, you can expect to save more on a prescription for hydrocodone with acetaminophen.
| Tramadol | Hydrocodone | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare? | Yes | Yes |
| Standard dosage | 50 mg tablets (supply of 60) Depends on your doctor’s prescription |
5-325 mg tablets (supply of 100) Depends on your doctor’s prescription |
| Typical Medicare copay | $40 | $317 |
| SingleCare cost | $15 | $18 |
Common side effects of Tramadol and Hydrocodone
Tramadol and hydrocodone can cause similar side effects. Because they both affect the central nervous system (CNS), they can both cause dizziness, sleepiness, and fatigue. These medications can also cause gastrointestinal side effects such as constipation or stomach ache. Nausea, vomiting, dry mouth, and headache are other shared side effects.
Tramadol can also cause diarrhea, indigestion, and sweating in some people. On the other hand, hydrocodone can also cause fluid buildup (edema) or muscle spasms in some people. Overall, common side effects can overlap between these two drugs since they are in the same class.
Other rare but serious side effects of tramadol and hydrocodone can include anxiety, depression, or other psychiatric disturbances. Allergic reactions are also possible and can include rash, flushing, and chest pain.
| Tramadol | Hydrocodone | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Constipation | Yes | 24-46% | Yes | 11% |
| Dizziness | Yes | 26-33% | Yes | 3% |
| Nausea | Yes | 24-40% | Yes | 10% |
| Headache | Yes | 18-32% | Yes | 4% |
| Drowsiness | Yes | 16-25% | Yes | 5% |
| Vomiting | Yes | 9-17% | Yes | 3% |
| Itching (Pruritus) | Yes | 8-11% | Yes | 3% |
| Weakness | Yes | 6-12% | Yes | 4% |
| Sweating | Yes | 6-9% | No | – |
| Indigestion | Yes | 5-13% | No | – |
| Dry mouth | Yes | 5-10% | Yes | 3% |
| Diarrhea | Yes | 5-10% | No | – |
| Edema | No | – | Yes | 1% |
| Respiratory infection | No | – | Yes | 1% |
| Muscle spasms | No | – | Yes | 1% |
| Back pain | No | – | Yes | 1% |
*Consult a doctor or pharmacist for all possible side effects.
Source: DailyMed (Tramadol HCl), DailyMed (Zohydro ER).
Drug interactions of Tramadol vs. Hydrocodone
Tramadol and hydrocodone have similar interactions with other drugs. Because they are metabolized in the liver, they tend to interact with other drugs that affect liver enzymes.
Drugs that inhibit CYP3A4 and CYP2D6 liver enzymes include erythromycin, ketoconazole, and ritonavir which can increase the level of opioids in the body and increase the risk of side effects. Drugs that induce CYP3A4 liver enzymes include carbamazepine and phenytoin which can decrease the level of opioids in the body and decrease their effectiveness.
Tramadol and hydrocodone can also interact with other drugs that have CNS side effects. These types of drugs include antidepressants, anticonvulsants, benzodiazepines, muscle relaxers, and many more. Taking opioids with antidepressants that increase serotonin can increase the risk of serotonin syndrome, a serious condition that requires emergency medical attention.
According to the FDA drug label, tramadol can also interact with digoxin and warfarin. Reports have found rare instances of digoxin toxicity and altered warfarin effects. The FDA label for hydrocodone also mentions that strong laxatives may decrease the effects of hydrocodone in the body.
It is not recommended to drink alcohol while using opioids. Alcohol may compound the side effects of opioids such as drowsiness and dizziness.
| Drug | Drug Class | Tramadol | Hydrocodone |
| Erythromycin Clarithromycin Telithromycin Rifampin |
Antibiotic | Yes | Yes |
| Ketoconazole Itraconazole |
Antifungal agent | Yes | Yes |
| Ritonavir Atazanavir Darunavir Indinavir Lopinavir Saquinavir |
Protease inhibitor | Yes | Yes |
| Phenytoin Carbamazepine |
Anticonvulsant | Yes | Yes |
| Escitalopram Fluoxetine Paroxetine Sertraline Citalopram |
Selective serotonin reuptake inhibitor (SSRI) antidepressant | Yes | Yes |
| Venlafaxine Milnacipran Duloxetine Desvenlafaxine |
Serotonin-norepinephrine reuptake inhibitor (SSNRI) antidepressant | Yes | Yes |
| Doxepin Amitriptyline Clomipramine Desipramine Imipramine Nortriptyline |
TCA antidepressant | Yes | Yes |
| Naratriptan Rizatriptan Sumatriptan Zolmitriptan |
Triptan | Yes | Yes |
| Alprazolam Clonazepam Diazepam Lorazepam |
Benzodiazepine | Yes | Yes |
| Rasagiline Isocarboxazid Phenelzine Selegiline Tranylcypromine |
Monoamine oxidase inhibitor (MAOI) | Yes | Yes |
| Cyclobenzaprine Metaxalone |
Muscle relaxant | Yes | Yes |
| Lactulose | Strong laxative | No | Yes |
| Digoxin | Cardiac glycoside | Yes | No |
| Warfarin | Anticoagulant | Yes | No |
*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.
Warnings of Tramadol and Hydrocodone
Tramadol and hydrocodone carry a warning for addiction and abuse if not used as prescribed. Addiction can lead to physical dependence which can result in withdrawal symptoms if the drug is stopped for any reason. Withdrawal symptoms can include anxiety, insomnia, and agitation.
Taking more than the prescribed dose of opioids can increase the risk of overdose, coma, and death. Life-threatening side effects such as severe respiratory depression and stupor can occur with overdose. For this reason, opioids are not recommended in children due to the increased risk of breathing problems and death.
It is not recommended to drink alcohol or take other CNS drugs with opioids. This is because they increase the risk of CNS effects like sedation, slow breathing, coma, and death. Although more data is needed, new research suggests that tramadol may have a higher risk of overall death compared to anti-inflammatory medications.
Both tramadol and hydrocodone are in pregnancy category C. Therefore, they are not typically recommended for women who are pregnant or breastfeeding due to the risk of harm to the unborn baby. Seek medical advice if you are pregnant or planning pregnancy.
Frequently asked questions about Tramadol vs. Hydrocodone
What is tramadol?
Tramadol is an opioid medication used to treat moderate to severe pain. It is a Schedule IV drug that requires a prescription and a pain assessment by a doctor. It is available in an immediate-release and extended-release form depending on pain severity.
What is hydrocodone?
Hydrocodone is an opioid medication that can treat moderate to severe pain. It is a Schedule II drug that may have a high potential for abuse and dependence. It is available in an extended-release form as well as a combination pill with acetaminophen.
Are tramadol and hydrocodone the same?
Although they are both opioids, tramadol and hydrocodone are not the same. They have similar uses depending on the pain you are experiencing. But they also come in different dosage forms and have some different side effects and drug interactions.
Is tramadol or hydrocodone better?
Studies show that tramadol and hydrocodone are both comparatively effective for pain. Some reports show that tramadol has milder side effects compared to hydrocodone. However, other studies show that hydrocodone is more potent and produces more pain relief in some people.
Is tramadol stronger than codeine?
Both tramadol and codeine can relieve pain and they are both considered relatively weak opioids. However, they may differ in their side effects and uses. Unlike tramadol, codeine can also be used as a cough suppressant.
Is tramadol an opiate?
Yes. Tramadol is an opiate narcotic. It is synthetically made and is in the same drug class as other opioid pain relievers. As a Schedule IV drug, it has less potential for abuse and dependence compared to other opioids.
Is hydrocodone an opioid?
Yes. Hydrocodone is an opioid. It is a semi-synthetic opioid that has similar effects to other natural opioids like morphine or codeine.