Tramadol (Ultram) versus ...
- Tramadol vs Hydrocodone
- Tramadol vs Buprenorphine
- Tramadol vs Pentazocine
- Tramadol vs Oxycodone
- Tramadol vs Ketorolac
- Tramadol vs Diclofenac
- Tramadol vs Lornoxicam
- Tramadol vs Morphine
- Tramadol vs Codeine
- Tramadol vs Meperidine
- Tramadol vs Tapentadol
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:
|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|
|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.
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.
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 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.
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.
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.||Tramadol||Lornoxicam|
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 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.
- 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
- 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
- 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: March 24, 2016