Compared with NSAIDs, Tramadol does not aggravate hypertension or congestive heart failure, nor does
it have the potential to cause peptic ulcers.
Compared with opioid analgesics, Tramadol does not induce
significant respiratory depression, cardiac side effects, constipation, or have significant abuse potential.
Difference between Tramadol and Hydrocodone chart:
||Schedule IV Opioid,
Synthetic, centrally active analgesic
|Schedule II Opioid.
Formulations containing less than or equal to 15 mg of hydrocodone per dosage unit in combination with acetaminophen or another non-controlled drug are classified as Schedule III drugs.
in combined preparations with ibuprofen or acetaminophen.
Semisynthetic opiate derived from codeine
||Hydrocodone is NOT commercially available in pure form in the United States.
Available in oral formulations with acetaminophen (Vicodil, Lortab) and other non-opioid analgesics.
||Tramadol abuse potential is significantly less than for hydrocodone 13.
|Mechanism of action
||Weak mu opioid receptors agonist.
Inhibition of norepinephrine and serotonin reuptake.
|Moderate agonist at opiate receptors (primarily mu receptors).
Hydrocodone acts as a prodrug metabolizing to hydromorphone.
||5 - 7 hours
||About one-tenth that of morphine
|| Equianalgesic to morphine,
sometimes suggested that hydrocodone is even more potent than morphine.
||Drug interactions with CYP2D6 inhibitors and genetic enzyme deficiencies may affect the analgesic efficacy.
Tramadol vs. Hydrocodone/Acetaminophen (Vicodin, Lortab)
Tramadol provides inferior analgesia to hydrocodone-acetaminophen in patients with acute musculoskeletal
Tramadol vs. Buprenorphine (Subutex®)
Buprenorphine is a very potent, but partial, mu agonist with an analgesic potency between 25- and 40-fold that of morphine.
Buprenorphine appears to produce more potent and longer acting analgesic effect compared to tramadol, although
slightly delayed 14.
Buprenorphine provides a longer postoperative analgesia than tramadol 2.
Tramadol vs. Pentazocine (Talwin®)
Pentazocine, a benzomorphan derivative, is a mixed agonist-antagonist opioid analgesic, and acts as an agonist on kappa receptors and is a weak antagonist at mu and delta receptors. Pentazocine is one-sixth to one-third as potent as morphine. Oral pentazocine is closer in analgesic efficacy to aspirin and acetaminophen than to the weak opioid analgesics such as codeine 1.
In clinical trial the first dose of tramadol was significantly more effective than pentazocine after the first hour
and throughout the subsequent 5 h. Final judgments on efficacy and acceptability were in favor of
Postoperative pain following prolapsed intervertebral disc repair
Results of the comparative study showed both treatments provide equivalent analgesia for the six hours observation
period. The global assessment of analgesia by patient and observer was not significantly
different, although less additional analgesic was required in the pentazocine group. Side effects were quite common
in both groups, and occurred more frequently in the pentazocine group 3.
Tramadol (50 mg) has shown to have an analgesic effect about equal to that of the pentazocine (50 mg). The incidence of
side effects with tramadol appears to be less than that with the pentazocine 3.
Tramadol vs. Oxycodone (Oxycontin®)
Oxycodone is a strong semi-synthetic opioid and is approximately twice as potent as morphine.
Postoperative pain after maxillofacial surgery
In comparative study the potency ratio of tramadol to oxycodone was found to be
approximately 8:1. There was no significant difference in the VAS scores for pain. Tramadol was found to provide
adequate analgesia after maxillofacial surgery without risk of respiratory
Side effects and tolerability
Incidence of nausea is slightly greater with tramadol than with oxycodone 18.
Oxycodone causes significant respiratory depression. On the contrary,
Tramadol is not associated with respiratory depression 10.
Tramadol vs. Ketorolac (Toradol®)
Dental extraction pain
Oral tramadol and oral ketorolac are equally effective in relieving pain in the first 6 h after molar extraction 9. However, postoperative tramadol has been found to be more effective than preoperative in relieving the pain, whereas the preoperative ketorolac has been found to be better than postoperative.
Both ketorolac (30 mg intramuscular) and tramadol (1 mg/kg subcutaneous) are effective in renal colic. Both
have an efficacy greater than 80% when used separately and almost 100% when used in combination. The analgesic
effect of ketorolac is observed earlier than that of tramadol 8.
Postoperative pain during maxillofacial surgery
Ketorolac and tramadol produce comparable, effective and inexpensive postoperative
analgesia during maxillofacial surgery 6.
Tramadol is a better analgesic compared to ketorolac for patients undergoing day care gynaecological
laparoscopic procedure 7.
Side effects and tolerability
Tramadol is associated with higher incidence of vomiting 6.
Tramadol vs. Diclofenac sodium
Acute migraine attacks
The randomised, double-blind study compared the efficacy of intramuscular tramadol 100 mg with intramuscular diclofenac sodium 75 mg in
acute migraine attacks 15.
Two-hour pain response rate was 80% for both tramadol and diclofenac
groups. There were no statistically significant differences among
groups in terms of 48-h pain response, rescue treatment, associated
symptoms' response, headache recurrence and adverse event rates.
Fifteen (75%) patients in the tramadol group and 16 (80%) patients
in the diclofenac group stated that they may prefer the same drug for future admissions 15.
Oral tramadol provides the same analgesic efficacy as oral diclofenac for posttonsillectomy pain relief. Tramadol is
beneficial for patients in whom NSAIDs are contraindicated 11.
Osteoarthritis chronic pain
Tramadol controlled-release is as effective as diclofenac sustained-release in the treatment of pain due to knee or hip osteoarthritis12.
Tramadol has been associated with a higher incidence of nausea, whereas diclofenac has been associated with a high rate of abdominal pain.
Side effects and tolerability
Unlike diclofenac, tramadol does not irritate the gastrointestinal mucosa. On the other hand, tramadol may produce physical dependence during chronic use.
Preoperatively administered intravenously lornoxicam is more effective than tramadol with respect to early postoperative tonsillectomy pain in adult patients19.
|Results of randomized double-blind study comparing lornoxicam versus tramadol in postoperative pain 16.
100 mg intramuscularly
16 mg intramuscularly
|Pain relief the following 8 hours after injection
|Analgesic efficacy in patients with moderate baseline pain
|Analgesic efficacy in patients with severe/unbearable baseline pain
|Rescue medication requirement
|Conclusion: Patients' global impression of efficacy favored lornoxicam. Intramuscular lornoxicam is an effective alternative to tramadol for the treatment of moderate to severe postoperative pain.
A randomized double-blind design on 10 volunteers compared tramadol (50 and 100 mg orally) and metamizole (500 and 1,000
Constant painful stimuli were applied by controlled electrical stimulation of tooth pulp.
Analgesia was monitored by verbal pain rating, by measurement of the
current necessary to evoke sensation in a tooth and with the aid of
the amplitude of somatosensory evoked potential. All 3 algesimetric
methods showed in complete agreement higher analgesia by tramadol 100 mg. The mean relative potencies of metamizole and tramadol were found to be 1:23 in agreement
with clinical studies 5.
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Published: March 31, 2008
Last updated: January 14, 2015