Because codeine and tramadol are both opioids, it is not recommended to take these two medications together. Doing so may amplify the side effects and risk of overdose.

What are the differences in codeine vs. tramadol? Can you take codeine and tramadol together? These are frequently asked questions about these two opioids. Here is more information about how codeine and tramadol compare and if they can be taken together.

Article at a Glance:

  • Codeine and tramadol are similar opioid prescription medications given to patients to treat pain.
  • Both have a lower risk profile than many other opioids, and both are considered less habit-forming than more potent opioids. There are still risks associated with both, including addiction, physical dependence, and overdose.
  • One of the most significant differences is that codeine is a naturally-derived pain medicine, while tramadol is synthesized.
  • Combining these two drugs would potentially amplify the side effects and increase overdose risks, so it’s not recommended to combine them.

What Is Codeine?

Codeine is a naturally occurring opioid that is present in poppy plants. Naturally occurring opioids are also called “opiates.” Codeine has a variety of medical uses and is sold as a prescription product by itself and mixed with other medications. It has a lower addiction potential when mixed with other medications, so the DEA’s scheduling is lower. Mixed products like codeine syrup with promethazine are often Schedule V.

Codeine works by binding to opioid receptors in the central nervous system (CNS). Opioid receptors naturally occur in the brain and spinal cord and help regulate feelings of pain. Codeine “overexcites” opioid receptors, reducing the sensation of pain. It can suppress cough and is used for this purpose.

What Is Codeine Used For?

Codeine is used to treat pain and prevent excessive coughing, usually during infections. Codeine is more commonly used for a cough than pain because it is not very potent. Other opioids are generally chosen for pain control because they do not require such large dosages.

Tylenol with Codeine

When prescribed for pain, Tylenol with Codeine is often used. This combination is used for acute pain and not usually for chronic pain. Examples include after surgeries and minor traumatic injuries. Tylenol is another painkiller that increases the pain-killing effects of the combination without increasing the risk of opioid side effects.

What Is Tramadol?

Tramadol has not always been considered an opioid because of its unique mechanism of action. These days, it is widely considered a mild opioid, but it also has additional effects similar to some antidepressants. Tramadol is synthetic, meaning it does not occur in nature.

Tramadol works similarly to codeine and other opioids. It binds to mu-opioid receptors in the nervous system. Its primary effects happen in the brain and spinal cord. Activating opioid receptors reduces feelings of pain and is useful for the short-term treatment of pain.

A unique property of tramadol compared to other opioids is that it also increases levels of serotonin and norepinephrine. This is a similar effect to certain antidepressants that can treat neuropathic (nerve) pain.

What Is Tramadol Used For?

Tramadol is used for the management of short-term and long-term pain. It comes in an immediate-release (IR) formulation taken every 4–6 hours as needed for pain. This type of formulation is commonly used for postoperative pain.

Extended-release (ER) formulations are also available to treat long-term around-the-clock chronic pain. Tramadol ER is not the drug of choice for most people with chronic pain but might be ideal in people who are very sensitive to stronger opioids. The ER formulation is dosed once daily.

Tylenol and Tramadol

Tramadol is available in a formulation with Tylenol (acetaminophen). This version is not very commonly used. The combination of these two drugs can provide better pain control than either ingredient alone. It is usually used to control short-term pain.

Codeine vs. Tramadol

There are more similarities between codeine and tramadol than differences. First and foremost, both are opioids and narcotics. They can both be used to treat moderate pain, and codeine is about twice as potent. One of the primary differences is that codeine is derived from the poppy plant, just like morphine. Tramadol is a synthesized opioid, which means it has a chemical structure similar to codeine, but it’s made in a lab.

Codeine and tramadol are considered less potent than other opioids. This means that more is needed for the same effect as other opioids. Also, they may have less of a risk of addiction and withdrawal, but both can still lead to physical and psychological addiction and dependence.

Along with the possibility of addiction, they have similar side effects. Common side effects of both can include sedation, dizziness, and constipation.

There are also identical interactions between codeine and tramadol. For example, you shouldn’t drink alcohol with either of these prescription medicines. If you drink alcohol with any opioid, it can lead to a more profound central nervous system depression, and breathing can become so slow that it’s at a dangerous or deadly level.

Both codeine and tramadol can affect pain sensation, the brain’s reward system, the gastrointestinal system, and respiratory function because of how they occupy the brain’s mu-opioid receptors when they’re taken.

For the most part, both are considered relatively benign pain relievers, especially compared to other opioids, as long as they’re taken as instructed.

Should You Take Codeine and Tramadol Together?

While many opioids are combined with other substances to increase effectiveness, they wouldn’t be combined with another opioid unless under the supervision of a healthcare professional. For example, codeine and tramadol shouldn’t be used together in a combination because it could increase the risks and side effects, including the possibility of an overdose occurring.

Other FAQs about Tramadol and Codeine

Is there codeine in tramadol?

No, there is no codeine in tramadol. Although codeine and tramadol are similar drugs, they are not equivalent. There is no codeine in tramadol and vice versa.

Is codeine a depressant?

Codeine, like other opioids, is a central nervous system depressant. It is possible to feel high or a sense of euphoria when using codeine, particularly at higher doses. Still, this effect tends to be less pronounced compared to many other opioids.

Is codeine addictive?

Because codeine can make people feel high, it can become addictive. It’s also possible to develop a physical dependence on it. If you were to stop taking it suddenly, you may have withdrawal symptoms.

Can you take tramadol with Tylenol?

Yes, and some formulations of tramadol even have Tylenol in them. However, you should always speak with your doctor to make sure it is safe to use these drugs together. Both tramadol and Tylenol can be hard on the liver, so your doctor may want to check liver function.

How much codeine is in Tylenol 3?

Tylenol #3 is an older, discontinued brand name for a formulation of codeine and acetaminophen. Whether branded or generic, this drug contains 300 mg of acetaminophen and 30 mg of codeine. Do not take extra Tylenol if you take this medicine because it can be hard on the liver.

Does tramadol make you sleepy?

Yes, drowsiness and dizziness are common side effects of tramadol. The side effects worsen when increasing the dose, when more tramadol is taken than prescribed, in older adults and in people who haven’t taken opioids before. When starting tramadol, you should never drive a car or operate machinery until you know how it affects you.

How much codeine is too much?

Do not take more codeine than your healthcare provider prescribed for you. If you take it for longer than two weeks, you should ask if you still need to continue because it can be habit-forming. Depending on the formulation, the maximum recommended dose is 360 mg/day.

Is tramadol a controlled substance?

Yes, tramadol is a federally controlled substance. It is a Schedule IV controlled substance, meaning it has an accepted medical use and a low potential for abuse and addiction.

How long does it take for tramadol to work?

Tramadol will begin working in about 30–60 minutes for most people. The effects will then continue to work for about 4–6 hours.

How often can you take tramadol?

Tramadol is commonly prescribed to be taken by mouth every 4–6 hours as needed for pain. The extended-release (ER) formulation should only be dosed once daily. Your doctor may prescribe tramadol with a different set of directions.

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Editor – Erica Weiman
Erica Weiman graduated from Pace University in 2014 with a master's in Publishing and has been writing and editing ever since. Read more
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Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP
Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more

U.S. Food and Drug Administration (FDA). “Codeine and Promethazine.” May 21, 2008. Accessed March 7, 2022.

U.S. National Library of Medicine. “Acetaminophen and Codeine.” DailyMed, September 13, 2018. Accessed March 7, 2022.

U.S. National Library of Medicine. “Ultram Package Insert.” DailyMed, October 14, 2019. Accessed March 7, 2022.

National Library of Medicine. “’Weak’ opioid analgesics. Codeine, d[…]ky than morphine.” Prescrire International, February 2016. Accessed March 7, 2022.

Waitemata District Health Board. “Palliative Care: Opioid Conversion Guide.” April 2020. Accessed March 7, 2022.

National Health Service. “How and when to take tramadol.” January 19, 2022. Accessed March 16, 2022.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.