Tramadol vs. Hydrocodone: Which Is Stronger for Pain Management?

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Tramadol falls under the group of medicines called narcotic analgesics. It can change the way the nervous system and brain respond to pain. Tramadol is mostly used to manage moderate-to-severe pain, including chronic pain conditions. 

This product is available in capsules, tablets, and a solution. Brand names it is sold under are Ultram, Ultram ER, Ryzolt, and ConZip. Its extended-release tablets or capsules are for the use of chronic ongoing pain and not prescribed to be used on an as-needed basis.

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. Some patients may be started on 25 mg of the drug, and their dosage increased over time by their prescribing physician.

Tramadol, like all narcotic analgesic medications, is available only under the restricted distribution program called the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program. This program is just “one strategy among multiple national and state efforts to reduce the risk of abuse, misuse, addiction, overdose, and deaths due to prescription opioid analgesics,” according to the US Food and Drug Administration.

What Are Possible Side Effects of Tramadol?

Tramadol does have some side effects, which you should know about in case you experience them. They are usually not severe and are mostly well-tolerated.

  • Constipation
  • Dry Mouth
  • Drowsiness
  • Headache
  • Heartburn
  • Itching or skin rash
  • Redness of the face, neck, arms, and occasionally, upper chest
  • Irritability
  • Muscle aches and pains
  • Feeling warm
  • Feeling unusually cold
  • General not feeling well

What Is Hydrocodone?

Hydrocodone is an opioid analgesic most often prescribed for severe chronic pain or severe pain from injury or post-surgery. It comes as an extended-release capsule and an extended-release tablet to be taken orally. 

The extended-release capsule is usually taken once every 12 hours, and the extended-release tablet is usually taken once daily. People who cannot tolerate any opioid or find other pain-relieving medication insufficient may be prescribed hydrocodone to alleviate severe pain.

Hydrocodone, when in combination with acetaminophen, may be sold under the brand names Vicodin HO, Lorcet, Lortab, and others.

What Are the Possible Side Effects?

There are some commonly reported side effects to be aware of in case they need to be eased. These include:

  • Malaise
  • Constipation
  • Generalized weakness
  • Nausea
  • Dizziness
  • Drowsiness
  • Fainting
  • Feeling relaxed
  • Low blood pressure
tramadol-vs-hydrocodone

What Are the Differences between Tramadol and Hydrocodone?

There are differences between these two drugs, which are essential to note and understand before deciding which prescription painkiller to ask your doctor to prescribe.

Tramadol is a pure single-component painkiller, as noted by MedicineNet. Vicodin is a combination drug painkiller, fever reducer, and cough suppressant.

Tramadol is considered to be a milder painkiller than hydrocodone, so therefore, usually prescribed for less severe pain than hydrocodone.

Hydrocodone can be taken for severe cough in adults because it decreases the activity in the brain that produces coughing.

Tramadol is available in generic form, while hydrocodone is not.

Tramadol has immediate-release doses, while hydrocodone immediate-release tablets are only available in combination products, like acetaminophen (Vicodin).

Tramadol has side effects that are different than hydrocodone:

  • Flushing
  • Itching
  • Headache
  • Congestion
  • Sore Throat
  • Weakness
  • Seizures (though rare)

Hydrocodone also has side effects, but they are much different:

  • Confusion
  • Low blood pressure
  • Gastric obstruction
  • Respiratory obstruction

However, both drugs have some like side effects:

  • Constipation
  • Drowsiness
  • Loss of appetite
  • Nausea and vomiting
  • Dizziness

Tramadol and Vicodin: Uses

As previously mentioned, tramadol is usually prescribed to alleviate mild-to-moderate pain. Vicodin, the hydrocodone and acetaminophen combination, is prescribed for more moderate to severe pain, such as from injury or after surgery, or for specific types of coughing, like from lung cancer.

Is Tramadol Better or Worse Than Vicodin?

 The best answer for this question depends on the reason an individual takes tramadol or Vicodin.

Tramadol

Tramadol is a less potent drug than Vicodin. It is an opioid-like medication. It does not contain opioids, but it binds to the same opioid receptors as hydrocodone and Vicodin do. The drug does not cause the person taking it to feel sedated or euphoric. It can be taken with or without food, though it is better to have food in your stomach when taking it to prevent nausea. 

It is usually prescribed to treat moderate pain and pain from chronic conditions, such as severe osteoarthritis. Tramadol can be habit-forming if misused or abused. Withdrawal effects are generally mild and go away rather quickly.

Vicodin

It is composed of hydrocodone, which is an opioid, and acetaminophen (Tylenol). Vicodin is prescribed for moderate to severe pain and can cause some people to feel sedated and/or euphoric. It is wise to take Vicodin after you have had something substantial to eat. Taking it on an empty stomach can cause nausea and vomiting. Vicodin is a potent painkiller. It can also be habit-forming and lead to addiction. Withdrawal effects from it are more severe than tramadol.

How Does Tramadol Compare to Hydrocodone?

When comparing these two prescription medications, it is vital to know that hydrocodone is the more potent of the two. It is also important to know that tramadol may be better for overall pain management.

Why You Should Not Mix Hydrocodone and Tramadol

It is never a good idea to take hydrocodone and tramadol at the same time. Mixing these two painkillers could lead to increased sedation, slower heart rate, and a slower respiratory rate. Nonetheless, there are unique medical circumstances when both drugs are prescribed at the same time, although the drugs are prescribed to be taken hours apart and certainly not at the same time.

Which Is Better for Pain Management: Tramadol or Hydrocodone?

Tramadol is classified as a Schedule IV controlled substance, meaning it has a “low potential for abuse,” as defined by the US Drug Enforcement Administration (DEA).

Vicodin is classified as a Schedule II controlled substance, meaning it has “a high potential for abuse which may lead to severe psychological or physical dependence.”

It is critical to note the above as it pertains to how the drugs can affect people.

Both drugs are effective for pain management. Tramadol, though less strong than hydrocodone, is a beneficial medicine for pain management. The dosage prescribed may be useful in alleviating pain for chronic pain conditions. However, some people may not get any benefit from tramadol.

Hydrocodone is a strong opioid medication that can be helpful for those who need pain management. Vicodin may also be prescribed for pain management but for shorter lengths of time.

Both drugs can cause mental and physical dependence and can lead to addiction. How the drugs are used may determine if a person is subject to dependence. Dependence is known when withdrawal side effects are felt after ending use of the drug abruptly. Addiction can occur if the drugs are misused or abused, and the individual is engaging in compulsive drug-seeking behavior despite negative consequences occurring.

Medication for pain management is a discussion one should have with their physician. One drug may work better than the other for some people, and vice versa.

Dependence or Addiction to Tramadol or Hydrocodone

What do dependence and addiction to tramadol and hydrocodone look like? What should you know to get help for yourself or someone you care about.

Dependence is when a person needs more and more of the substance to feel the same effects. Addiction occurs when a person cannot stop using the substance despite adverse outcomes.

Tramadol addiction can occur if a person abuses the drug to get high and feel euphoric. People who abuse tramadol may crush the tablet and inhale the powder or mix the powder with water to inject it, thus, getting high quicker. Others may abuse the drug by taking more than prescribed.

Hydrocodone addiction can happen in the same way. However, it is a more potent drug, and it may take less of it to feel the relaxing or euphoric effects. Vicodin is also very potent and can be abused.

If you feel you have become dependent or addicted to either tramadol or hydrocodone, it is best to contact the prescribing doctor. They may taper the dose to a smaller amount and eventually safely and completely off of the drug. If you feel you have become addicted to the drug, there are evidence-based treatment programs to help you find the root of your addiction and guide you on your road to living life without drugs.

Sources

Mayo Clinic. (2021, February 21) Tramadol. (Oral Route) from https://www.mayoclinic.org/drugs-supplements/tramadol-oral-route/description/drg-20068050

US Food and Drug Administration. (2018, September 27) Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS). from https://www.fda.gov/drugs/information-drug-class/opioid-analgesic-risk-evaluation-and-mitigation-strategy-rems

US National Library of Medicine. (2021, January 15) MedlinePlus. Hydrocodone. from https://medlineplus.gov/druginfo/meds/a614045.html

MedicalNewsToday. (2018, September 26) What is the difference between tramadol and hydrocodone? Berry, J. from https://www.medicalnewstoday.com/articles/323173

MedicineNet. Tramadol vs. Vicodin. (Cunha, J., DO, FACOEP.) from https://www.medicinenet.com/tramadol_vs_vicodin/article.htm#tramadol_vs_vicodin_comparison

US Drug Enforcement Administration. Diversion Control Division. Controlled Substances Schedules. Definition of Controlled Substance Schedules. from https://www.deadiversion.usdoj.gov/schedules/#define

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