Tramadol (Ultram) versus Other
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, constipation, or have significant
Tramadol vs. Morphine
- Postoperative analgesia after tonsillectomy: Both analgesics
are effective for postoperative pain relief in children after tonsillectomy.
However, morphine may give better postoperative pain relief 1.
Tramadol is better tolerated.
- Postoperative analgesia after urological surgery: In the
postoperative period, pain scores and the average time for analgesic
requirement are similar for both. However, the incidences
of allergic rash, itching, respiratory depression and sedation score
are greater with the morphine 19.
- Posttraumatic pain: Analgesia is similar with both tramadol
and morphine for the management of pain in trauma 2.
- Pain after abdominal surgery: Tramadol given by intramuscular
injection has postoperative analgesic activity similar to morphine.
In multicenter trial comparing tramadol and morphine for pain after
abdominal surgery after the first dose, pain intensity was reduced
36.2% with tramadol, and 51% with morphine 3.
- Postoperative pain: Tramadol shows pain relief similar
to morphine 4.
- Severe pain: For patients with severe pain, morphine is superior.
- Chronic pancreatitis: Tramadol and morphine are potent
analgesics in severe chronic pancreatitis pain when individually
titrated. However, in clinical study tramadol interfered significantly
less with gastrointestinal function and was more often rated as
an excellent analgesic than morphine 17.
- Intraoperative analgesia: In clinical study there was no
difference between the use of tramadol and morphine to treat pain
after laparoscopic cholecystectomy from 90 min after the end of
surgery. Morphine was more effective than tramadol as an intraoperative
- Side effects and tolerability:
Tramadol appeared to cause more nausea and vomiting than morphine.
Morphine produces more sleepiness 18.
Tramadol has smaller inhibitory effect on gastric emptying compared
with morphine 14.
Tramadol vs. Metamizole
A randomized double-blind design on
10 volunteers compared tramadol (50 and 100 mg) and metamizole (500 and 1,000
mg); both were given orally.
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 the 100-mg
dose of tramadol. The mean relative
potencies of metamizole and tramadol were found to be 1:23 in agreement
with clinical studies 5.
Tramadol vs. Buprenorphine
Buprenorphine appears to produce more
potent and longer acting analgesic effect compared to tramadol, although
slightly delayed 27.
Tramadol vs. Pentazocine
- Postoperative pain: In clinical trial the first dose of tramadol
was significantly more effective than pentazocine after the 1st h
and throughout the subsequent 5 h. Final judgments on efficacy and
acceptability were in favor of tramadol 28.
- 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
- Acute pain: Tramadol (50 mg) has shown to have an analgesic
effect about equal to that of the pentazocine (50 mg). The incidence of side effects
from tramadol appears to be less than that with the pentazocine 29.
Tramadol vs. Pethidine
- Labour pain: Tramadol 100 mg is as effective as pethidine
75 mg 6.
- Analgesia for adenotonsillectomy: The results of comparative
study suggest that pethidine given with induction of anaesthesia
provides better analgesia during and after tonsillo-adenoidectomy
than does tramadol. The delay to recovery of spontaneous respiration
with pethidine suggests a greater safety profile of tramadol 20.
- Side effects and tolerability:
Tramadol has superior safety profile. Pethidine is associated with
a significantly higher frequency of adverse events and a significantly
lower respiratory rate in the neonates 6.
In comparative study tramadol was shown not to be associated
with respiratory depression, unlike equipotent dose of pethidine 9.
Tramadol vs. Acetaminophen-Propoxyphene
- Postoperative pain: The 75 mg dose of tramadol is generally
more effective than the acetaminophen-propoxyphene (650/100
mg). The tramadol 150 mg is significantly superior to the
- Side effects and tolerability: Tramadol is
associated with higher frequency of dizziness 7.
Tramadol vs. Meperidine
- Postoperative pain: Meperidine and tramadol produce comparable
analgesia, with a different time course profile 11.
- Postoperative pain relief after tonsillectomy: Meperidine
appears to be more effective for pain relief and provides better
emergence characteristics than tramadol after tonsillectomy in children
- Side effects and tolerability:
Meperidine induces sedation and respiratory depression while tramadol
does not. Incidence of nausea and vomiting is higher with tramadol
Tramadol vs. Oxycodone
- 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
Oxycodone causes significant respiratory depression. On the contrary,
Tramadol is not associated with respiratory depression 10.
Tramadol vs. Clonidine
Heroin withdrawal management: Comparative study indicates that
tramadol is more effective in managing withdrawal than clonidine, and
may be especially useful in outpatient detoxification 12.
Tramadol vs. Hydrocodone/Acetaminophen
Tramadol provides inferior
analgesia to hydrocodone-acetaminophen in patients with acute musculoskeletal
potencial is significantly less than for hydrocodone 13.
Tramadol vs. Ketorolac
- Renal colic: 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 low cost postoperative
analgesia during maxillofacial surgery 22.
- Laparoscopic procedure: Tramadol is a better analgesic
compared to ketorolac for patients undergoing day care gynaecological
laparoscopic procedure 23.
- Side effects and tolerability: Tramadol is associated
with higher incidence of vomiting 22.
Tramadol vs. Diclofenac sodium
Acute migraine attacks: The comparative study evaluated
the efficacy of intramuscular tramadol 100 mg in
acute migraine attack and compared it with that of IM diclofenac
sodium 75 mg.
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.
Posttonsillectomy analgesia: Oral tramadol can deliver
the same analgesic efficacy as oral diclofenac for posttonsillectomy
pain relief, which might be beneficial for avoiding the adverse
effects of NSAIDs 30
Tramadol vs. Lornoxicam
- Postoperative pain: The randomized double-blind study compared intramuscular lornoxicam
and tramadol in 76 patients with moderate to unbearable pain following
arthroscopic reconstruction of the anterior cruciate ligament using
the patella bone-tendon-bone technique. Patients receiving a single
dose of lornoxicam 16 mg experienced significantly greater total
pain relief than patients receiving tramadol 100 mg over the following
8 hours. Lornoxicam had greater analgesic efficacy than tramadol
in patients with moderate baseline pain but was of equivalent efficacy
in those with severe/unbearable baseline pain. Fewer patients in
the lornoxicam group required rescue analgesic (58% vs. 77%, respectively).
Patients' global impression of efficacy showed lornoxicam to be
superior to tramadol with 82% and 49% of patients, respectively,
rating treatment as good, very good, or excellent. Following multiple-dose
administration of lornoxicam (8 mg tid) or tramadol (100 mg tid)
for 3 days, efficacy profiles similar to those following a single
dose were obtained. Thus, slightly fewer patients in the lornoxicam
group required rescue drug, and patients' global impression
of efficacy again favored lornoxicam 16.
- Side effects and tolerability: Significantly fewer
patients reported one or more adverse events with lornoxicam than
with tramadol (14 vs. 24, respectively) 16.
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Published: March 31, 2008
Last updated: April 09, 2011