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

Oxycodone | 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 • Dyspnea |
• 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 |
Oral bioavailability | 60-87% | 75% |
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 • Nausea • Sedation • Dizziness • Vomiting • Pruritus • Headache • Dry mouth • Asthenia • 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 • Dizziness • Nausea • Constipation • Headache • Somnolence • Vomiting • Pruritus |
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 • Quinidine • Serotonergic medications - serotonin syndrome risk |
• Monoamine oxidase inhibitors | ||
Pregnancy category | B | C |
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.
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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.
Knee osteoarthritis
Both tramadol and oxycodone are not cost-effective options for knee osteoarthritis 5.
Further reading
References
- 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
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