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Tramadol vs. Oxycodone (Immediate Release and Controlled Release)

Introduction

If you’re in pain, you want a drug that’s going to help you feel better. Three prescription pain drugs you may have heard of are tramadol, oxycodone, and oxycodone CR (controlled release). These drugs are used to treat moderate to severe pain. They belong to a class of drugs called opioid analgesics, which work in your brain to change how your body feels and responds to pain.

If your doctor prescribes one of these drugs for you, they’ll tell you what to expect with your treatment. But if you’re curious about how these drugs compare to each other, this article looks at tramadol, oxycodone, and oxycodone CR side-by-side. It gives you detailed information you can discuss with your doctor. Together, you and your doctor can explore if one of these drugs is a good match for your pain treatment needs.

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Drug features

Tramadol vs. oxycodone IR and CR

The table below provides basic information about tramadol, oxycodone, and oxycodone CR. Oxycodone comes in two forms: an immediate-release (IR) tablet and a controlled-release (CR) tablet. The IR tablet releases the medication into your body right away. The CR tablet releases the medication over a 12-hour period. Oxycodone CR tablets are used when you need continuous pain medication for a long period of time.

Generic name Tramadol Oxycodone Oxycodone CR
What are the brand-name versions? Conzip, Ultram, Ultram ER (extended release) Oxaydo, Roxicodone Oxycontin
Is a generic version available? Yes Yes Yes
Why is it used? Treatment of moderate to moderately severe pain Treatment of moderate to severe pain Treatment of moderate to severe pain when continuous pain management is needed
What form(s) does it come in? Immediate-release oral tablet, extended-release oral tablet, extended-release oral capsule Immediate-release oral tablet Controlled-release oral tablet
What are the strengths? Immediate-release oral tablet:
• 50 mg

Extended-release oral tablet:
• 100 mg
• 200 mg
• 300 mg

Extended-release oral capsule:
• 100 mg
• 150 mg
• 200 mg
• 300 mg
• 5 mg
• 10 mg
• 15 mg
• 20 mg
• 30 mg
• 10 mg
• 15 mg
• 20 mg
• 30 mg
• 40 mg
• 60 mg
• 80 mg
What dosage will I take? Determined by your doctor Determined by your doctor based on your history of opioid use Determined by your doctor based on your history of opioid use
How long will I take it? Determined by your doctor Determined by your doctor Determined by your doctor
How do I store it? Stored at a temperature between 59°F and 86°F (15°C and 30°C) Stored at a temperature between 68°F and 77°F (20°C and 25°C) Stored at 77°F (25°C)
Is this a controlled substance? Yes* Yes* Yes*
Is there a risk of withdrawal? Yes† Yes† Yes†
Does it have potential for misuse? Yes¥ Yes¥ Yes¥
 
* A controlled substance is a drug that is regulated by the government. If you take a controlled substance, your doctor must closely supervise your use of the drug. Never give a controlled substance that your doctor has prescribed for you to anyone else.
† If you’ve been taking this drug for longer than a few weeks, do not stop taking it without talking to your doctor. You will need to taper off the drug slowly to avoid withdrawal symptoms such as anxiety, sweating, nausea, and trouble sleeping.
¥ This drug has a high potential for misuse. This means you can get addicted to this drug. Be sure to take this drug exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.

Learn more: Opioid misuse and addiction »

Dosage

Dosage notes

For each of these drugs, your doctor will check your pain control and side effects throughout your treatment. If your pain gets worse, your doctor may increase your dosage. If your pain gets better or goes away, your doctor will slowly lower your dosage. This helps prevent withdrawal symptoms.

Withdrawal symptoms
Stopping any of these drugs too quickly can cause withdrawal symptoms, such as restlessness, crying, runny nose, yawning, sweating, and chills. Symptoms can also include muscle pain, anxiety, nausea, vomiting, and diarrhea. Withdrawal can also increase blood pressure, breathing rate, and heart rate.

Tramadol

Your doctor will likely start you at the lowest possible dosage and increase it slowly. This helps reduce side effects.

Oxycodone IR

Your doctor may start you on the lowest dosage of oxycodone. They may increase your dosage slowly to help reduce side effects and to find the lowest dosage that works for you.

If you need to take oxycodone around-the-clock to manage chronic pain, your doctor may switch you to oxycodone CR twice a day instead. Breakthrough pain may be managed as needed with low-dose oxycodone or tramadol.

Oxycodone CR

Oxycodone CR can only be used for continuous, long-term pain management. You can’t use it as an as-needed pain medication. This is because taking doses too closely together can spike the amount of drug in your body. This can be fatal (cause death).

You must swallow oxycodone CR tablets whole. Do not break, chew, or crush the tablets. Taking broken, chewed, or crushed oxycodone CR tablets leads to a rapid release of the medication that your body absorbs quickly. This can cause a dangerous dose of oxycodone that can be fatal.

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Side effects

Side effects

Like other drugs, tramadol, oxycodone, and oxycodone CR can cause side effects. Some of these side effects are more common and may go away after a few days. Others are more serious and can require medical care. You and your doctor should consider all side effects when deciding if a drug is a good choice for you.

Examples of side effects from tramadol, oxycodone, and oxycodone CR are listed in the table below.

Tramadol Oxycodone Oxycodone CR
More common side effects • Nausea
• Vomiting
• Constipation
• Dizziness
• Drowsiness
• Headache
• Itching
• Lack of energy
• Sweating
• Dry mouth
• Nervousness
• Indigestion
• Nausea
• Vomiting
• Constipation
• Dizziness
• Drowsiness
• Headache
• Itching
• Lack of energy
• Trouble sleeping
• Nausea
• Vomiting
• Constipation
• Dizziness
• Drowsiness
• Headache
• Itching
• Weakness
• Sweating
• Dry mouth
Serious side effects • Slowed breathing
• Seizures
• Serotonin syndrome

Allergic reaction, with symptoms such as:
• itching
• hives
• narrowing of your airway
• rash that spreads and blisters
• skin peeling
• swelling of your face, lips, throat, or tongue
• Slowed breathing
• Shock
• Low blood pressure
• Not being able to breathe
• Cardiac arrest (heart stops beating)

Allergic reaction, with symptoms such as:
• itching
• hives
• trouble breathing
• swelling of your face, lips, or tongue
• Slowed breathing
• Shock
• Low blood pressure
• Not being able to breathe
• Breathing that stops and starts, typically during sleep
 

Keep reading: Serotonin syndrome symptoms, treatment, and more »

Drug interactions

Interactions of tramadol, oxycodone, and oxycodone CR

An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. This can help your doctor prevent possible interactions.

Examples of drugs that may interact with tramadol, oxycodone, or oxycodone CR are listed in the table below.

Tramadol Oxycodone Oxycodone CR
Drug interactions • Other pain medications such as morphine, hydrocodone, and fentanyl
• Phenothiazines (drugs used to treat serious mental disorders) such as chlorpromazine and prochlorperazine
• Tranquilizers such as diazepam and alprazolam
• Sleeping pills such as zolpidem and temazepam
• Quinidine
• Amitriptyline
• Ketoconazole
• Erythromycin
• Monoamine oxidase inhibitors (MAOIs) such as isocarboxazid, phenelzine, and tranylcypromine
• Serotonin norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine
• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine
• Triptans (drugs that treat migraines/headaches) such as sumatriptan and zolmitriptan
• Linezolid
• Lithium
• St. John’s wort
• Carbamazepine
• Other pain medications such as morphine, hydrocodone, and fentanyl
• Phenothiazines (drugs used to treat serious mental disorders) such as chlorpromazine and prochlorperazine
• Tranquilizers such as diazepam and alprazolam
• Sleeping pills such as zolpidem and temazepam
• Butorphanol
• Pentazocine
• Buprenorphine
• Nalbuphine
• Monoamine oxidase inhibitors (MAOIs) such as isocarboxazid, phenelzine, and tranylcypromine
• Skeletal muscle relaxants such as cyclobenzaprine and methocarbamol
• Other pain medications such as morphine, hydrocodone, and fentanyl
• Phenothiazines (drugs used to treat serious mental disorders) such as chlorpromazine and prochlorperazine
• Tranquilizers such as diazepam and alprazolam
• Sleeping pills such as zolpidem and temazepam
• Butorphanol
• Pentazocine
• Buprenorphine
• Nalbuphine
 
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Warnings

Use with other medical conditions

Your overall health is a factor when considering if a drug is a good choice for you. For instance, a particular drug may worsen a certain condition or disease you have. Below are medical conditions you should discuss with your doctor before taking tramadol, oxycodone, or oxycodone CR.

Tramadol Oxycodone Oxycodone CR
Medical conditions to discuss with your doctor • Respiratory (breathing) conditions such as chronic obstructive pulmonary disease (COPD)
• Metabolic disorders such as thyroid problems and diabetes
• History of misuse of drugs or alcohol
• Current or past alcohol or drug withdrawal
• Infections of the area around your brain and spinal cord
• Risk of suicide
• Epilepsy, a history of seizures, or risk of seizures
• Kidney problems
• Liver problems
• Respiratory (breathing) conditions such as chronic obstructive pulmonary disease (COPD)
• Low blood pressure
• Head injuries
• Pancreatic disease
• Biliary tract disease
• Respiratory (breathing) conditions such as chronic obstructive pulmonary disease (COPD)
• Low blood pressure
• Head injuries
• Pancreatic disease
• Biliary tract disease
 
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Takeaway

Talk with your doctor

Tramadol, oxycodone, and oxycodone CR are powerful prescription pain medications. One of these drugs may be a good fit for you. Talk with your doctor about:

  • your pain needs
  • your health history
  • any medications and supplements you take
  • if you’ve taken opioid pain medications before or if you’re taking them now

Your doctor will consider all of these factors to assess your pain needs and choose the drug that’s best-suited for you.

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