Although both tramadol and oxycodone are opioids, the drugs differ in many key ways, including their potency and addiction potential.

Article at a Glance:

  • Tramadol and oxycodone are the generic names of opioids used to treat pain.
  • Oxycodone is a Schedule II controlled substance, while tramadol is Schedule IV.
  • Oxycodone is stronger at relieving pain but also more likely than tramadol to lead to addiction and dependence.
  • Tramadol has mood-boosting properties but a lower risk of respiratory depression than oxycodone. Tramadol also carries the risk of seizure.

Tramadol and oxycodone have several similarities, along with a few differences. While both drugs are opioids that are often prescribed for pain, they differ in potency, dosing and risk for abuse, dependence and addiction.

What Are the Main Differences Between Tramadol and Oxycodone?

Although tramadol and oxycodone are both opioids, they differ in terms of chemical structure. This translates into differences in potency and addiction potential. One of the big differences in tramadol vs. oxycodone is that oxycodone is around 1.5 times more potent than morphine, while tramadol is only 10% as strong as morphine.

Drug NameTramadolOxycodone
Drug TypeOpioidOpioid
Drug ScheduleSchedule IV controlled substanceSchedule II controlled substance
Prescription RequiredYesYes
Risk of Dependence / AddictionYesYes
Overdose RiskYesYes
Withdrawal SymptomsYesYes
Length of WithdrawalUp to 10 days for short-acting formulations, up to 20 days for long-acting formulationsUp to 10 days for short-acting formulations, up to 20 days for long-acting formulations
Brand NamesConZip, Ultram, QdoloOxyContin, Xtampza ER, Oxaydo, RoxicodoneCombined with acetaminophen: Endocet, Nalocet, Percocet, Prolate
DosageStarting dose of 50 mg every 4–6 hours as needed, up to a max dose of 400 mg a dayStarting dose of 5 mg every 4–6 hours as needed
UsesMild to moderate painModerate to severe pain
Comes in a short- or long-acting dosage formAvailable in both formsAvailable in both forms
Comes as a combination agent with other drugsYes, with acetaminophenYes, with either acetaminophen, ibuprofen, aspirin or naloxone

What Is Tramadol?

Tramadol is a prescription pain reliever that is slightly weaker than most other opioids. When someone takes tramadol, it binds to their opioid receptors and influences their central nervous system. The interaction of tramadol and other opioids with the central nervous system lowers how people perceive pain.

While tramadol isn’t necessarily as potent as some other opioids, it still works well as a pain reliever, even for severe pain. An extended-release version of the drug is available for severe pain requiring around-the-clock treatment and chronic pain.

Drug propertiesOpioid (atypical)
Brand namesConZip, Ultram, Qdolo
Type of pain it can treatMild to moderate
Short-acting or long-actingComes in both short and long-acting dosage forms
Drug ScheduleIV
Side effectsConstipation (up to 46%)
Nausea (up to 40%)
Dizziness (up to 33%)
Headache (up to 32%)
Drowsiness (up to 25%)
Vomiting (up to 17%)
Dry mouth (up to 13%)
Indigestion (up to 13%)
How long it takes to start workingWithin one hour
How long it takes to have its peak effectShort-acting: within two hours
Long-acting: within 12 hours
Duration of effectShort-acting: 4–6 hours
Long-acting: 24 hours
DosageShort-acting: 50, 100 mg
Long-acting: 100, 200, 300 mg

One of the rare but riskiest side effects of tramadol is seizures. Seizures have been reported even with minimal prescribed doses. People with a history of epilepsy or seizures should avoid tramadol.

Some of the side effects both tramadol and oxycodone have in common include headache, sweating, constipation, dizziness and dry mouth. These side effects are common among opioids in general.

What Is Oxycodone?

Oxycodone is a strong, semi-synthetic opioid that is closely regulated by the DEA because of the risk of addiction and abuse. Much like tramadol, oxycodone works on the user’s central nervous system, altering how they perceive pain. Unlike tramadol, oxycodone doesn’t inhibit norepinephrine and serotonin reuptake.

Drug propertiesOpioid (phenanthrene)
Brand namesOxyContin, Xtampza ER, Oxaydo, RoxicodoneCombined with acetaminophen: Endocet, Nalocet, Percocet, Prolate
Type of pain it can treatModerate to severe
Short-acting or long-actingComes in both short and long-acting dosage forms
Drug ScheduleII
Side effectsDrowsiness (up to 23%)
Nausea (up to 23%)
Constipation (up to 23%)
Vomiting (up to 21%)
Headache (up to 14%)
Dizziness (up to 13%)
Itching (up to 13%)
How long it takes to start workingShort-acting: within 15 minutes
Long-acting: unclear
How long it takes to have its peak effectShort-acting: within two hours
Long-acting: within five hours
Duration of effectShort-acting; 4–6 hours
Long-acting: 12 hours
Tablet strengthShort-acting: 5, 7.5, 10, 15, 20, 30 mg
Long-acting: 9, 10, 13.5, 15, 18, 20, 27, 30, 36, 40, 60, 80 mg

Oxycodone functions as a pure opioid agonist, and it has a more rapid onset time than tramadol. For example, short-acting oxycodone will usually start working within 15 minutes, with peak effects occurring in around 2 hours. Meanwhile, tramadol may take up to an hour to feel the effects.

These numbers are important because they highlight some of the reasons for a lower risk of abuse with tramadol vs. oxycodone. Usually, the more fast-acting an opioid is, the more likely it is to be abused. Of course, tramadol can be abused and can become addictive, but the risk is lower. In general, oxycodone has a high risk of physical and psychological dependence, while tramadol has a lower risk. That’s one reason why oxycodone is regulated as Schedule II, and tramadol is Schedule IV.

To further compare tramadol vs. oxycodone:

  • Regarding effectiveness as a painkiller, oxycodone is more potent, and oxycodone has a more rapid onset of pain-relieving effects.
  • Tramadol does have a higher risk of seizures than oxycodone, particularly in people who already have a history of seizures.
  • Oxycodone has a higher potential for abuse and addiction than tramadol.

To sum up the comparison of tramadol vs. oxycodone: oxycodone is stronger at relieving pain but also more likely to lead to addiction and dependence. Tramadol has mood-boosting properties but a lower risk of respiratory depression. Tramadol also carries the risk of seizure.

Pill Identifier: What Does Tramadol Look Like? What Does Oxycodone Look Like?

Because tramadol and oxycodone are available as generic drugs, they are each produced by dozens of different manufacturers. Each manufacturer will give the drug its own pill size, shape, color and imprint. The best way to identify whether or not a pill in your possession is tramadol or oxycodone is to go to an online pill identifier, like the Drugs.com Pill Identifier Wizard, and enter the description.

Is Tramadol or Oxycodone More Effective?

Both tramadol and oxycodone are effective drugs for treating pain. However, because oxycodone is so much more potent than tramadol, it is more effective for more severe pain. Tramadol is generally used for less severe pain than oxycodone for this reason.

Common Side Effects of Tramadol and Oxycodone

Because they are both opioids, tramadol and oxycodone have similar side effects. Like most opioids, the most common side effects tend to be gastrointestinal in nature.

Common tramadol side effectsCommon oxycodone side effects
Drowsiness (up to 25%)
Nausea (up to 40%)
Constipation (up to 46%)
Vomiting (up to 17%)
Headache (up to 32%)
Dizziness (up to 33%)
Dry mouth (up to 13%)
Indigestion (up to 13%)
Drowsiness (up to 23%)
Nausea (up to 23%)
Constipation (up to 23%)
Vomiting (up to 21%)
Headache (up to 14%)
Dizziness (up to 13%)
Itching (up to 13%)

Drug Usage & Risks

Because tramadol and oxycodone are both controlled substances, they both carry a risk of dependence, abuse and addiction. For this reason, both drugs should only be taken exactly as prescribed by your doctor. You should not take a higher dose than prescribed or take the drugs more often than prescribed.

Both drugs also carry a risk of a fatal overdose. This is especially true when they are combined with other central nervous system depressants like benzodiazepines or alcohol. Both drugs carry an FDA Black Box Warning for overdose risk for this reason.

FAQs

Can I use tramadol or oxycodone with alcohol?

You should avoid taking tramadol or oxycodone with alcohol. Both tramadol and oxycodone carry an FDA Black Box Warning about taking them with other central nervous system depressants, including alcohol. It increases your risk of a potentially fatal overdose.

Can I use tramadol or oxycodone while pregnant?

You should only use tramadol or oxycodone while pregnant if specifically told to do so by your doctor. Both drugs have an FDA Black Box Warning for causing neonatal opioid withdrawal syndrome in infants whose mothers took the drugs prior to delivery.

Is tramadol stronger than oxycodone?

No, oxycodone is much more potent than tramadol.

Can you take oxycodone with tramadol?

Because oxycodone is so much more potent than tramadol, doctors do not usually prescribe them together. Because tramadol is so weak, it would usually not confer an added benefit when used alongside a stronger drug like oxycodone.

Can you alternate tramadol and oxycodone?

Because tramadol and oxycodone are not usually prescribed together due to the differences in their potencies, you should not alternate them unless specifically told to do so by your doctor.

Can you take tramadol with Percocet?

Percocet is a combination drug that includes oxycodone and acetaminophen. Because oxycodone is a much more potent drug than tramadol, you should not take them together unless instructed to do so by your doctor.

Melissa Carmona
Editor – Melissa Carmona
As the content manager at Advanced Recovery Systems, Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
Jessica Pyhtila
Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more
Sources

Centers for Medicare and Medicaid Services. “Opioid Oral Morphine Milligram Equivalent (MME) Conversion Factors.” Accessed June 1, 2021.

Trescot, Andrea M.; Datta, Sukdeb; Lee, Marion; Hansen, Hans. “Opioid Pharmacology,” Pain Physician, 2008. Accessed June 1, 2021.

Drugs.com. “Tramadol.” August 17, 2020. Accessed June 1, 2021.

Drugs.com. “Tramadol Pill Images.” Accessed June 1, 2021.

Drugs.com. “Oxycodone.” August 8, 2020. Accessed June 1, 2021.

Drugs.com. “Oxycodone Pill Images.” Accessed June 1, 2021.

World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” 2009. Accessed June 1, 2021.

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.