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Tramadol vs Codeine: Drug Interactions, Side Effects & Treatment

Table of Contents

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 consideredless 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?

Codeineis 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 oftenSchedule 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.

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What Is Codeine Used For?

Codeine is used to treatpain 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 Codeineis 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?

Tramadolhas 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.

Tramadolworks similarlyto 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 alsoincreases 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 ofshort-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 areopioidsand narcotics. They can both be used to treat moderate pain, and codeine isabout twiceas potent. One of the primary differences is that codeine is derived from the poppy plant, just likemorphine. 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 consideredless potentthan 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 bothcan includesedation, 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 youdrink 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 anoverdoseoccurring.

Other FAQs about Tramadol and Codeine

Is there codeine in tramadol?

Is codeine a depressant?

Is codeine addictive?

Can you take tramadol with Tylenol?

How much codeine is in Tylenol 3?

Does tramadol make you sleepy?

How much codeine is too much?

Is tramadol a controlled substance?

How long does it take for tramadol to work?

How often can you take tramadol?

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Sources

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.

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