Oxycodone (Oxycontin) versus Tramadol (Ultram)

Difference between Oxycodone and Tramadol

Table 1. Comparison of oxycodone and tramadol

  Oxycodone Tramadol
Brand names Oxycontin®, Oxecta®, Tylox®, Percodan® Ultram®, Ultram® ER
Drug class Semi-synthetic opioid analgesic Centrally acting synthetic analgesic
Legal status Controlled Substance Schedule II Controlled Substance Schedule IV
Combination products • Oxycodone and acetaminophen (Percocet®)
• Oxycodone and aspirin (Percodan®)
• Oxycodone and ibuprofen (Combunox®)
• Tramadol and acetaminophen (Ultracet®)
FDA-approved Indications • Acute and chronic moderate to severe pain • Moderate to moderately severe pain
• Moderate to moderately severe chronic pain (extended-release formulation)
"Off-label" uses • Cough
• Dyspnea
• Premature ejaculation
Mechanism of action Oxycodone is a pure opioid agonist and is relatively selective for the µ-opioid receptors.
Studies have shown that oxycodone acts as a weak agonist at kappa opioid receptors8 as well.
Dual mechanism of action:
weak µ-opioid receptor agonism,
and norepinephrine and serotonin reuptake inhibition
Onset of action 20-30 minutes, peak effect at 1-1.5 hours 1 hour
Duration of action 4-6 hours 4-6 hours
Analgesic potency 1.5 times more potent than morphine one tenth to one sixth the potency of morphine
Half-life 3.5 to 4 hours 6.3 hours
Oral bioavailability 60-87% 75%
Metabolism, Elimination • Extensively metabolized in the liver to noroxycodone, oxymorphone, and noroxymorphone, which are subsequently glucuronidated.
• Oxycodone and its metabolites are eliminated by the kidneys
• Undergoes CYP3A4- and CYP2D6 metabolism in the liver.
• Excreted primarily through liver metabolism and the metabolites are eliminated primarily by the kidneys.
Contraindications • Hypersensitivity to oxycodone
• Respiratory depression
• Paralytic ileus
• Acute or severe bronchial asthma or hypercarbia
• Hypersensitivity to tramadol
• Acute intoxication with alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs
Side effects • Opioid-induced constipation
• Nausea
• Sedation
• Dizziness
• Vomiting
• Pruritus
• Headache
• Dry mouth
• Asthenia
• Respiratory depression
• Seizures risk - seizures have been reported with the recommended dosages
• Minor delaying effect on gastrointestinal motor function2
• Not associated with clinically significant respiratory depression3
• Dizziness
• Nausea
• Constipation
• Headache
• Somnolence
• Vomiting
• Pruritus
Abuse potential High risk of physical/psychological dependence Relatively low risk of physical/psychological dependence
Drug interactions • CNS depressants - increased risk respiratory depression, hypotension
• Anticholinergics - increased risk of urinary retention, severe constipation
• Potent CYP3A4 inhibitors
• Potent CYP3A4 inducers
• CYP2D6 and CYP3A4 inhibitors
• Carbamazepine significantly increases tramadol metabolism
• Quinidine
• Serotonergic medications - serotonin syndrome risk

• Monoamine oxidase inhibitors
Pregnancy category B C

Oxycodone advantages over Tramadol:

  • Oxycodone is a more potent pain killer than tramadol.
  • Oxycodone provides more rapid onset of analgesic effect.
  • Tramadol may cause seizures, especially in patients predisposed to seizures.

Tramadol advantages over Oxycodone:

  • Unlike oxycodone tramadol is not associated with significant respiratory depression and doesn't depress breathing3.
  • Oxycodone is a Schedule II drug, which means a high potential for abuse and addiction. Tramadol is a Schedule IV drug, which means a lower potential for abuse and addiction.

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Head-to-head comparative studies

Postoperative pain after maxillofacial surgery

The potency ratio of tramadol to oxycodone is approximately 8:1. There was no significant difference in the Visual Analogue Scale scores for pain. Tramadol provided satisfactory analgesia after maxillofacial surgery 4.

Knee osteoarthritis

Both tramadol and oxycodone are not cost-effective options for knee osteoarthritis 5.

Further reading

References
  • 1. Ross FB, Smith MT. The intrinsic antinociceptive effects of oxycodone appear to be kappa-opioid receptor mediated. Pain. 1997 Nov;73(2):151-7. PubMed
  • 2. Wilder-Smith CH, Bettiga A. The analgesic tramadol has minimal effect on gastrointestinal motor function. Br J Clin Pharmacol. 1997 Jan;43(1):71-5. PubMed
  • 3. Tarkkila P, Tuominen M, Lindgren L. Comparison of respiratory effects of tramadol and oxycodone. J Clin Anesth. 1997 Nov;9(7):582-5. PubMed
  • 4. Silvasti M, Tarkkila P, Tuominen M, Svartling N, Rosenberg PH. Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol. 1999 Dec;16(12):834-9. PubMed
  • 5. Smith SR, Katz JN, Collins JE, et al. Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. Arthritis Care Res (Hoboken). 2017 Feb;69(2):234-242 PubMed

Published: April 01, 2017
Last updated: April 01, 2017

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