Tramadol (Ultram) vs Hydrocodone/Acetaminophen (Vicodin)

Based on "Essential Pain Pharmacology"
written by Howard S. Smith, MD; Marco Pappagallo, MD

Vicodin vs Lortab vs Norco

What is the difference between these three drugs? As you will learn from the brief info below, the only difference is that Vicodin® tablets contain 5 mg of acetaminophen less than Lortab® or Norco®. Also, each of these brands is produced by different pharmaceutical companies.

They all contain the same active analgesic ingredients, and provide the same amount of the most potent active component - hydrocodone bitartrate.

Vicodin® is manufactured by AbbVie Pharmaceuticals, and is available in three strengths:

  • Hydrocodone bitartrate 5 mg/ Acetaminophen 300 mg (Vicodin®)
  • Hydrocodone bitartrate 7.5 mg/ Acetaminophen 300 mg (Vicodin ES®)
  • Hydrocodone bitartrate 10 mg/ Acetaminophen 300 mg (Vicodin HP®)

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Lortab® is manufactured by UCB Company and is sold in three strengths:

  • Hydrocodone bitartrate 5 mg/Acetaminophen 325 mg
  • Hydrocodone bitartrate 7.5 mg/ Acetaminophen 325 mg
  • Hydrocodone bitartrate 10 mg/ Acetaminophen325 mg

Norco® is manufactured by Allergan and is available in three strengths:

  • Hydrocodone bitartrate 5 mg/Acetaminophen 325 mg
  • Hydrocodone bitartrate 7.5 mg/ Acetaminophen 325 mg
  • Hydrocodone bitartrate 10 mg/ Acetaminophen325 mg

How much Tramadol equals Hydrocodone?

Tramadol potency is about one-tenth that of morphine. So approximate equi-analgesic dose of morphine 1 mg is tramadol 10-15 mg.

Oral hydrocodone 1 mg is equal to oral morphine 1 mg4.

So tramadol 10-15 mg equals to hydrocodone 1 mg.

Is Hydrocodone stronger than Tramadol?

Hydrocodone is a more potent opioid analgesic than tramadol.

Can you take Tramadol and Hydrocodone together?

Concomitant use of two different opioids for pain management is acceptable5. You can take hydrocodone and tramadol at the same time if such is prescribed by a doctor.

Difference between Tramadol and Hydrocodone chart

Tramadol Hydrocodone/APAP
Brand names
• Ultram ® • Vicodin®
• Vicodin ES®
• Vicodin HP®
Drug class
• Synthetic opioid analgesic • Combination of semisynthetic opioid analgesic and non-opiate, non-salicylate analgesic
Chemistry
• Tramadol is a synthetic 4-phenylpiperidine analogue of codeine
• Chemically tramadol is not an opioid
• Hydrocodone is a 3-methoxy derivative of hydromorphone
Potency
• Tramadol 50 mg ~ morphine 5-10 mg
• About one-fifth that of morphine
• Tramadol is equipotent with codeine
• Hydrocodone 10 mg ~ morphine 10 mg
• Equianalgesic to morphine,
sometimes suggested that hydrocodone is even more potent than morphine
Dose formulations
• Tablets
• Capsules, extended release
• Solution for injection or infusion
• Tablets
Legal status
• Rx only
Schedule IV
Controlled substance
• Rx only
Schedule II*
Controlled substance
- * In 2014 DEA rescheduled hydrocodone combination products from federal Schedule III to the more restrictive federal Schedule II
FDA-approved indications
• Moderate to moderately severe pain
• Moderate to moderately severe chronic pain (extended-release formulation)
• Moderate to severe pain
"Off-label" uses
• Fibromyalgia
• Neuropathic pain
• Chronic daily headaches
• Cough suppressant
• Dyspnea
Mechanism of action
• Weak µ-opioid receptor agonism
• Weak norepinephrine and serotonin reuptake inhibition
• Mild to moderate μ-opioid receptor agonism
• Hydrocodone can interact with other opioid receptors at higher doses
• Suppresses the cough reflex by direct effect on the cough center in the medulla
• Acetaminophen inhibits prostaglandin synthesis via inhibition of the COX-3 isoform
Onset of action
• 1 hour • 10-20 minutes
Duration of action
• 4-6 hours • 4-8 hours
Half-life
• 6.3 hours • Hydrocodone 3.8 ± 0.3 hours
• Acetaminophen 1.25 to 3 hours, but half-life may be increased following overdosage and id persons with liver damage
Oral bioavailability
• 75% • Hydrocodone 50–60%
Metabolism, Elimination
• Undergoes CYP3A4 and CYP2D6 metabolism in the liver. Tramadol has a pharmacologically active metabolite O-desmethyltramadol (M1).
• Excreted primarily through liver metabolism and the metabolites are eliminated primarily by the kidneys.
• Hydrocodone is metabolized by liver CYP2D6 enzyme to its active metabolite hydromorphone3. Hydrocodone and its metabolites are cleared mainly by renal excretion.
• Acetaminophen undergoes rapid first-pass metabolism by liver. Excreted renally.
Contraindications
• Hypersensitivity to tramadol or other opioids
• Acute intoxication with alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs
• Hypersensitivity to hydrocodone or acetaminophen
• Hypersensitivity to other opioids may trigger cross sensitivity to hydrocodone
Side effects
• Dizziness
• Nausea
• Constipation
• Headache
• Somnolence
• Vomiting
• Pruritus
• Tramadol can lower seizure threshold
• Lightheadedness
• Dizziness
• Sedation
• Nausea
• Vomiting
• Decreased urination
• Respiratory depression
• Acetaminophen overdose is the leading cause of drug-induced liver damage
Drug interactions
• CYP2D6 and CYP3A4 inhibitors
• Carbamazepine significantly increases tramadol metabolism
• Quinidine
• Serotonergic medications - serotonin syndrome risk
• Drug interactions with CYP2D6 inhibitors and genetic enzyme deficiencies may affect the analgesic efficacy.
Pregnancy category
C C
Abuse, dependence potential
• Both tramadol and hydrocodone can lead to development of physical and psychological dependence with prolonged use.
• Tramadol abuse potential is significantly less than for hydrocodone 1.

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Tramadol vs Hydrocodone/Acetaminophen (Vicodin) for Pain

Both drugs are powerful pain relievers effective for pain caused by medical procedures or injuries.

Hydrocodone-acetaminophen provides better analgesia than tramadol in patients with acute musculoskeletal pain resulting from minor injury such as sprains or strains 2.

Is Tramadol better than Vicodin?

Tramadol advantages over Vicodin

  • Tramadol is useful in treating neuropathic pain due to its serotonergic effects.
  • Tramadol is less toxic than Vicodin®, Lortab®, or Norco®. Hydrocodone/acetaminophen combination products have a risk of hepatotoxicity due to acetaminophen component.
  • Compared with opioid analgesics, tramadol does not induce significant respiratory depression, cardiac adverse effects, and constipation.

Is Vicodin better than Tramadol?

Vicodin advantages over Tramadol

  • Combining hydrocodone with the medicine that achieves analgesia via different mechanism of action, results in an additive cumulative effect. As a result lower overall total doses of each medicine are needed for sufficient pain relief.
  • Hydrocodone is very effective cough suppressant.
  • Hydrocodone has equal potency mg to mg to morphine.

Further reading

References

  • 1. 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
  • 2. 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
  • 3. Smith HS. Opioid metabolism. Mayo Clin Proc. 2009 Jul;84(7):613-24. PubMed
  • 4. Opiate Equianalgesic Dosing Chart PDF
  • 5. Mercadante S. Opioid combination: rationale and possible clinical applications. Ann Palliat Med. 2013 Oct;2(4):189-96.

Published: March 05, 2018
Last updated: April 05, 2018

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