Oxycodone (Oxycontin) versus Tramadol (Ultram)
Based on "Essential Pain Pharmacology"
written by Howard S. Smith, MD; Marco Pappagallo, MD
Difference between Oxycodone and Tramadol
Table 1. Comparison of oxycodone and 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
|• 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|
|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
• Dry mouth
• 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
|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
• Serotonergic medications - serotonin syndrome risk
|• Monoamine oxidase inhibitors|
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. Oxycodone is one of the most highly abused medications. Tramadol is a Schedule IV drug, which means a lower potential for abuse and addiction.
- Tramadol is available for parenteral administration. Oxycodone is not available in parenteral preparation.
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.
Both tramadol and oxycodone are not cost-effective options for knee osteoarthritis 5.
- 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: October 16, 2017