Oxycodone vs. Tramadol for Pain

• 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.

• Oxycodone is a strong narcotic pain-reliever and cough suppressant similar to morphine, codeine, and hydrocodone. The precise mechanism of action is not known but may involve stimulation of opioid receptors in the brain. Oxycodone does not eliminate the sensation of pain but decreases discomfort by increasing the tolerance to pain. In addition to tolerance to pain, oxycodone also causes sedation and depression of respiration. The FDA approved oxycodone in 1976.
• Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown, but it is similar to morphine. Like morphine, tramadol binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal anti-inflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs. The FDA approved tramadol in March 1995.

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.

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.

Oxycodone side effects

The most frequent side effects of oxycodone include:

• Lightheadedness
• Dizziness
• Sedation
• Nausea
• Vomiting
• Headache
• Rash
• Constipation
• Dry mouth
• Sweating

Other side effects of oxycodone include:

• Faintness
• Heart attack
• Rash
• Itching
• Depression
• Abnormal heartbeats

Oxycodone can depress breathing and is used with caution in elderly, debilitated patients and in patients with serious lung disease.

Oxycodone can impair thinking and the physical abilities required for driving or operating machinery.

Oxycodone is habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If oxycodone is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop. The dose of oxycodone should be gradually reduced in order to avoid withdrawal symptoms.

Tramadol side effects

Tramadol is generally well tolerated, and side effects are usually transient.

Commonly reported side effects include:

• Nausea
• Constipation
• Dizziness
• Headache
• Euphoria
• Indigestion
• Spasticity
• Weakness
• Drowsiness
• Vomiting

Less commonly reported side effects include:

• Itching
• Sweating
• Dry mouth
• Diarrhea
• Rash
• Visual disturbances
• Vertigo

Some patients who received tramadol have reported seizures. It may cause serotonin syndrome when combined with other drugs that also increase serotonin (see drug interactions section).

Abrupt withdrawal of tramadol may result in symptoms such as:

• Anxiety
• Sweating
• Insomnia
• Rigors
• Pain
• Nausea
• Diarrhea
• Tremor
• Hallucinations

Tramadol can cause psychological or physical dependence similar to other narcotics. Tramadol is a schedule IV medication on the federal list of controlled substances.

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.

Oxycodone drug interactions

• Oxycodone, like other narcotic pain-relievers, increases the effects of drugs that slow brain function, such as:
  • Alcohol
  • Barbiturates
  • Skeletal muscle relaxants, for example, carisoprodol (Soma), cyclobenzaprine (Flexeril)
  • Benzodiazepines, for example, lorazepam (Ativan)
• Combined use of the above drugs and oxycodone may lead to increased respiratory depression.
• Oxycodone should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Oxycodone should not be administered within 14 days of stopping an MAOI.
• Since oxycodone causes constipation, the use of antidiarrheals, for example, diphenoxylate and atropine (Lomotil) and loperamide (Imodium), in persons taking oxycodone, can lead to severe constipation.
• Drugs that stimulate and also block opioid receptors, for example, pentazocine, nalbuphine (Nubain), butorphanol (Stadol), and buprenorphine (Subutex) may reduce the effect of oxycodone and may precipitate withdrawal symptoms.
• Combining oxycodone with drugs that affect the activity of certain liver enzymes or discontinuing such drugs may result in fatal oxycodone overdose.
• A fatty meal may increase the absorption of oxycodone by 27%.

Tramadol drug interactions

• Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body.
• Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50% to 60%.
• Combining tramadol with monoamine oxidase inhibitors or MAOIs (for example, tranylcypromine [Parnate]) or selective serotonin inhibitors (SSRIs), for example, fluoxetine (Prozac), may result in severe side effects such as seizures or a condition called serotonin syndrome.
• Tramadol may increase the central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers, or sedative-hypnotics. This can reduce the level of consciousness or lead to respiratory insufficiency.

Oxycodone safety

• Safety during pregnancy has not been established. Children born to mothers who were taking oxycodone for a prolonged period may exhibit respiratory depression or withdrawal symptoms.
• Small amounts of oxycodone are secreted in breast milk and may cause side effects in the newborn.

Tramadol safety

• The safety of tramadol during pregnancy has not been established.
• The safety of tramadol in nursing mothers has not been established.