Tramadol vs. Oxycodone: The Drug Similarities and Differences

Last Updated: April 13, 2021

Authored by Roger Weiss, MD

Reviewed by Michael Espelin APRN

Tramadol and Oxycodone are both opioid medications. They are milder in effect than other drugs in their class, such as fentanyl and morphine, and find a lot of use in the treatment of moderate pain.

Despite the similarities they share as drugs in the same class and with similar potency, there are also many differences. This article will put Tramadol vs. Oxycodone to discuss the differences these medications have.

Similarities Between Tramadol and Oxycodone

Tramadol and Oxycodone are both opioid drugs. They are used in treating health conditions that cause moderate pain as one of the symptoms, though they can also treat severe pain in some cases.

Both of these are medications prescribed very frequently in the United States. However, they both carry a risk of addiction, which is why neither can be procured over-the-counter.

When comparing Tramadol vs. Oxycodone, there are some similarities between the two by being in the same drug class. Tramadol and Oxycodone have a short onset of action as the effects are felt relatively quickly. The primary use for both of these drugs is in the treatment of pain, though there are some indications for which they might also find use.

Man experiencing pain sitting on the couch at home.

Although these drugs have a similar onset of action, their duration in the system is different. Tramadol half-life is approximately 7 hours, while Oxycodone has a half-life of 3.2 hours. Once they leave a person’s body, the user will experience opioid withdrawal. The difference between withdrawal from these medications is that Tramadol withdrawal symptoms are divided into two categories: typical and atypical opioid withdrawal. This is due to its action not only on opioid receptors, but also on reuptake of serotonin and norepinephrine.

Is Tramadol Stronger than Oxycodone?

Comparing the effects of Tramadol vs. Oxycodone involves comparing their potencies. This typically involves studies that will aim to produce a specific intensity of effect with different doses of two drugs. Once the desired effect is achieved, the dosage used will be compared with the dosage required to produce that same effect with the drug being compared. From here, relative potency can be assessed.

Tramadol compared to Oxycodone shows that the latter is the more potent between the two. A study done on 54 patients in pain from recently concluded surgery found that Oxycodone is about eight times more powerful than Tramadol.

It means that with Oxycodone vs. Tramadol, a smaller dosage of Oxycodone is required for the same effect. Similar to its potency, it also possesses a much higher risk of resulting in addiction. For this reason, it is a Schedule II substance as opposed to Tramadol being a Schedule IV substance under the Drug Enforcement Agency.

Indications for Use

The FDA approves Tramadol for a single indication, which is the treatment of moderate to moderately severe pain. A wide array of conditions can cause this, but that single indication is not specific to any of them.

Doctor writing a prescription.

Similarly, Oxycodone is approved in the treatment of severe pain that requires around-the-clock treatment and for which alternatives are inadequate. However, there is one key difference: the FDA also approves this drug for use in opioid-tolerant children over 11 years old. For the comparison of Oxycodone vs. Tramadol, it makes Oxycodone a more versatile drug in terms of the demographic it can be used for.

Post-surgical and cancer pain are the two reasons why any of these drugs tend to be prescribed. For post-surgical pain, Tramadol is preferred thanks to its relative safety. In many cases of cancer pain, the patient’s comfort is paramount, which results in a more potent opioid — Oxycodone — being used. It all comes down to the medical doctor who has to weigh the benefits of Tramadol vs. Oxycodone.

Off-label, Tramadol is also used in the treatment of premature ejaculation and restless leg syndrome that is not responding to medication. There are no prominent off-label uses of Oxycodone.

Side Effects

Like any medication, Oxycodone and Tramadol can have adverse effects when they are used. Considering that both of these are opioids, they share some of these effects.

The most noticeable side effect that these drugs share is the risk of addiction. The development of dependence is dependent on how long the drug is used for, the dosage, and other factors.

Besides That, Other Side Effects That These Medications Share Include:

  • Nausea
  • Vomiting
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Constipation
  • Headache
  • Abdominal pain
  • Difficulty breathing/respiratory depression

Despite their similarities, these drugs are different enough to have some distinct side effects.

Some of the Oxycodone Adverse Effects Are:

  • Irregular menstruation
  • Reduced libido
  • Mood changes
  • Loss of appetite
  • Fainting

The Adverse Effects of Tramadol Include:

  • Agitation
  • Nasal sores
  • Throat sores
  • Vertigo
  • Indigestion
  • Tremors

Drug Interactions

The chemistry behind any medication is complex, and this complexity means that their presence in the body can affect the way some other drugs work. These are known as drug interactions. These both have some interactions in common.

As a Result, You Should Avoid Using Any of These Medications With:

  • Cytochrome P450 inhibitors: The clearance of Oxycodone and Tramadol from the body is dependent on enzymes from the cytochrome P450 family. If the specific enzymes in this family responsible for metabolizing these drugs are inhibited, it can effectively increase the amount of the drug in the body and increase the risk of adverse effects. Inhibitors that should be avoided include fluoxetine, paroxetine, quinidine, ketoconazole, and erythromycin.
  • Cytochrome P450 inducers: These will do the opposite of the inhibitors by speeding up how fast the drug is cleared from the body. While this won’t cause adverse effects, it will reduce the efficacy of the drug. As a result, the patient will still suffer from the pain they are using it for, even at a therapeutic dose. Pain that was previously well-controlled will suddenly come back. These inducers include carbamazepine, rifampin, phenytoin.
  • Serotonergic drugs: Opioids drugs result in an increase of serotonin in the CNS. If the levels of serotonin get dangerously high, it can cause what is known as serotonin syndrome. This occurs when the drug is used with other medications, which cause an increase in serotonin levels. This includes drugs such as several antidepressant classes, including SSRIs (fluoxetine, sertraline), SNRIs (venlafaxine, duloxetine), and MAOIs (tranylcypromine, isocarboxazid).

When comparing Oxycodone vs. Tramadol, the latter has fewer interactions. As a milder medication, the interactions that Tramadol can have are mostly limited to the ones above. However, there are some drugs you should avoid when using Oxycodone specifically.

These Include:

  • CNS depressants: Potent opioids already act to depress the CNS, so combining it with drugs that do this, such as benzodiazepines, muscle relaxants, or alcohol, can cause dangerous levels of sedation.
  • Diuretics: It can cause the release of antidiuretic hormone, a hormone that helps to keep fluid in the body. It directly counteracts the effect of diuretics and can make them less effective.
  • Anticholinergic drugs: Pairing this drug with those can cause an increased risk of urinary retention or constipation.

These numerous drug interactions show why it is essential to provide all necessary drug information to your doctor.

Drug Contraindications

There are some circumstances where you should entirely avoid the use of Oxycodone and Tramadol.

These Are:

  • Allergies: Tramadol and Oxycodone should be avoided entirely in any individual who has shown allergic reactions to any opioid drug.
  • In any patient suffering from respiratory depression, these drugs may only make things worse and should be kept far away.
  • Cases of drug intoxication on alcohol, opioids, narcotics should completely rule out the use of either, as these will only make everything worse.

Oxycodone should be avoided in patients with gastrointestinal obstruction because it can promote constipation, which will reduce the motility of the tract. Patients with bronchial asthma, especially if severe, should also avoid it.

Can They Be Used Together?

There are essentially no instances that will necessitate using these medications together. If pain is not responding to one of these drugs, it is unlikely that the doctor will add one more opioid instead of another analgesic class. A doctor may also upgrade to a more potent opioid entirely.

Avoiding the Risks of Opioids

Tramadol, compared to Oxycodone, is a milder opioid, but despite this, either of these drugs can have potentially fatal side effects when not taken with care. Mixing these drugs simply increases that risk.

Opioid drugs should be completely avoided if they are not prescribed, and if they are, it is essential to inform your doctor before adding any over-the-counter drugs to them.

This is one way to keep safe and keep being drug safe.

Hope Without Commitment

Find the best treatment options. Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

Page Sources

  1. Silvasti, M., Tarkkila, P., Tuominen, M., Svartling, N., & Rosenberg, P. H. (1999). Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. European journal of anaesthesiology, 16(12), 834–839. https://pubmed.ncbi.nlm.nih.gov/10747212/
  2. United States Drug Enforcement Agency, Drug Scheduling, https://www.dea.gov/drug-scheduling
  3. United States Food and Drug Administration, Tramadol Information, 2017, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tramadol-information
  4. United States Food and Drug Administration, Oxycontin Prescribing Information, 2018, https://www.fda.gov/media/131026/download
  5. Dhesi M., Maldonado K. A., Maani C. V. (2020). Tramadol, https://www.ncbi.nlm.nih.gov/books/NBK537060/
  6. Drugs.com, Drug Interactions between Percocet and tramadol, https://www.drugs.com/drug-interactions/percocet-with-tramadol-72-1135-2221-0.html

Published on: April 13th, 2021

Updated on: April 13th, 2021

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.