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Tramadol (Ultram) versus ...

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.

Tramadol vs. Hydrocodone

Difference between Tramadol and Hydrocodone chart:

 
Tramadol
Hydrocodone
Drug class 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
Formulations, preparations Oral, parenteral 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.
Abuse/dependence potential 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.
Half-life 5 - 7 hours 2-4 hours
Bioavailability 68–72% >50%
Potency About one-tenth that of morphine Equianalgesic to morphine,
sometimes suggested that hydrocodone is even more potent than morphine.
Comments   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 pain 17.

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.

Postoperative analgesia

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.

Postoperative pain

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 tramadol 4.

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.

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 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 depression 18.

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.

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 inexpensive postoperative analgesia during maxillofacial surgery 6.

Laparoscopic procedure

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.

Posttonsillectomy analgesia

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.

Tramadol vs. Lornoxicam

Post-tonsillectomy pain

Preoperatively administered intravenously lornoxicam is more effective than tramadol with respect to early postoperative tonsillectomy pain in adult patients19.

Postoperative pain

Results of randomized double-blind study comparing lornoxicam versus tramadol in postoperative pain 16.
Tramadol
Lornoxicam
Regimen
100 mg intramuscularly
16 mg intramuscularly
Pain relief the following 8 hours after injection
significantly greater
Analgesic efficacy in patients with moderate baseline pain
greater
Analgesic efficacy in patients with severe/unbearable baseline pain
equivalent
Rescue medication requirement
77%
58%
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.

Tramadol vs. Metamizole

A randomized double-blind design on 10 volunteers compared tramadol (50 and 100 mg orally) and metamizole (500 and 1,000 mg orally).

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.

Further reading

References
  • 1. Hoskin PJ, Hanks GW. Drugs. 1991 Mar;41(3):326-44.
  • 2. Alemanno F, Westermann B, Bettoni A, Candiani A, Cesana BM. Buprenorphine versus tramadol as perineural adjuvants for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair under middle interscalene block. Minerva Anestesiol. 2014 Feb 25. PubMed
  • 3. Richter W, von Arnim B, Giertz H. Double-blind clinical trial of tramadol. Comparison with pentazocine and placebo. MMW Munch Med Wochenschr. 1981 Mar 27;123(13):517-20. PubMed
  • 4. Magrini M, Rivolta G, Bolis C, Furiosi D. Analgesic activity of tramadol and pentazocine in postoperative pain. Int J Clin Pharmacol Res. 1998;18(2):87-92. PubMed
  • 5. Rohdewald P, Granitzki HW, Neddermann E. Comparison of the analgesic efficacy of metamizole and tramadol in experimental pain. Pharmacology. 1988;37(4):209-17. PubMed
  • 6. Zackova M, Taddei S, Calo` P, Bellocchio A, Zanello M. Ketorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery. Minerva Anestesiol. 2001 Sep;67(9):641-6. PubMed
  • 7. Ali A, Chohan U, Atiq F. Intravenous tramadol vs ketorolac in laparoscopic dye test. J Coll Physicians Surg Pak. 2006 Jan;16(1):3-6. PubMed
  • 8. Nicola's Torralba JA, Rigabert Montiel M, Ban~o'n Pe'rez V, Valdelvira Nadal P, Pe'rez Albacete M. Intramuscular ketorolac compared to subcutaneous tramadol in the initial emergency treatment of renal colic. Arch Esp Urol. 1999 Jun;52(5):435-7. PubMed
  • 9. Mishra H, Khan FA. A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain. J Anaesthesiol Clin Pharmacol. 2012 Apr;28(2):221-5 PubMed
  • 10. Tarkkila P, Tuominen M, Lindgren L. Comparison of respiratory effects of tramadol and oxycodone. J Clin Anesth. 1997 Nov;9(7):582-5. PubMed
  • 11. Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg. 2001 Apr;127(4):385-8. PubMed
  • 12. Beaulieu AD, Peloso PM, Haraoui B, Bensen W, Thomson G, Wade J, Quigley P, Eisenhoffer J, Harsanyi Z, Darke AC. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis: a randomized controlled trial. Pain Res Manag. 2008 Mar-Apr;13(2):103-10. PubMed
  • 13. Adams EH, Breiner S, Cicero TJ, Geller A, Inciardi JA, Schnoll SH, Senay EC, Woody GE. A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. J Pain Symptom Manage. 2006 May;31(5):465-76. PubMed
  • 14. Alon E, Schulthess G, Axhausen C, Hossli G. A doubleblind comparison of tramadol and buprenorphine in the control of postoperative pain. Anaesthesist. 1981 Dec;30(12):623-6. PubMed
  • 15. Engindeniz Z, Demircan C, Karli N, Armagan E, Bulut M, Aydin T, Zarifoglu M. Intramuscular tramadol vs. diclofenac sodium for acute migraine attacks in emergency department: a prospective, randomised, double-blind study. J Headache Pain. 2005 Jun;6(3):143-8. PubMed
  • 16. Staunstrup H, Ovesen J, Larsen UT, Elbaek K, Larsen U, Kroner K. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol. 1999 Aug;39(8):834-41. PubMed
  • 17. Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial. Ann Emerg Med. 1998 Aug;32(2):139-43. PubMed
  • 18. Silvasti M, Tarkkila P, Tuominen M, Svartling N, Rosenberg PH. Tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol. 1999 Dec;16(12):834-9. PubMed
  • 19. Işik B, Arslan M, Ozsoylar O, Akçabay M. Effects of preoperative lornoxicam versus tramadol on postoperative pain and adverse effects in adult tonsillectomy patients. Agri. 2009 Jul;21(3):113-20. PubMed

Published: March 31, 2008
Last updated: August 07, 2014

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