Both tramadol, now a generic opioid painkiller, and Vicodin, a combination of hydrocodone and acetaminophen, are prescription painkillers that act on the opioid receptors in the brain. They are both prescribed for moderate to severe pain, such as pain after surgery or an injury. They both come as tablets or capsules. On the surface, there appear to be many similarities between the two drugs.
Tramadol and Vicodin’s Similarities
The drugs have many similarities.
- Side effects: Sleepiness or fatigue, constipation, nausea or vomiting, appetite changes, and stomach upset are all common side effects from both tramadol and Vicodin.
- Prescription painkillers: Both drugs contain opioids, so they must be used with a doctor’s supervision.
- Similar interactions: Neither tramadol nor Vicodin should be taken while a woman is pregnant or breastfeeding; both drugs interact poorly with alcohol, benzodiazepines, sedative hypnotics, and muscle relaxers.
- Addiction risk: Both tramadol and Vicodin have a risk of addiction, physical tolerance, and dependence associated with them. Both are popular “gateway drugs” for those who develop an addiction to opioid drugs; people who struggle with prescription narcotic addiction are more likely to switch to heroin or illicit versions of potent prescription opioids like oxycodone or fentanyl.
Dramatic Differences between Tramadol and Vicodin
Despite their similarities, there are numerous differences between Vicodin – a brand name – and tramadol.
- Names: Tramadol was originally approved in 1995, but in 2002, the drug became a generic. Vicodin, a combination of two types of painkiller, is a brand name; although there are generic versions, many people still refer to all types of the prescription drug as “Vicodin.”
- What is in the pills: Tramadol contains an opioid, and different companies use different types of inactive ingredients in their formulas. Vicodin is specifically a combination of hydrocodone, an opioid painkiller, and acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID). In both drugs, the opioid reduces pain sensations; however, in Vicodin, the NSAID also reduces inflammation and fever.
- Schedule: Hydrocodone has been the second most frequently prescribed opioid medicine in the US since 2009. In 2012, the substance was moved to Schedule II from Schedule III because it was found to be as potentially addictive as oxycodone drugs like OxyContin. In contrast, tramadol is not as tightly regulated; the drug was approved without federal control in 1995, and it was not moved into a scheduling bracket per the Controlled Substances Act (CSA) until 2014. Tramadol is still not considered very addictive by many in the medical community, and it is only listed as Schedule IV.
- Half-life: Hydrocodone has a short half-life for an opioid of 2-4 hours, which is similar to heroin; tramadol, on the other hand, stays in the body longer, with a half-life of 5-7 hours.
- Potency: The potency of opioids is measured in relation to morphine, the first synthetic form of opium that was developed in the 19th Hydrocodone is considered to be equianalgesic to morphine, meaning it has essentially the same potency. Tramadol, on the other hand, is only one-tenth the potency of morphine.
- Bioavailability: The potency of an opioid is important when understanding the drug’s addiction risk; however, the amount of the opioid that becomes available to the body and brain after it is ingested can also indicate how risky the drug may be. Although hydrocodone has a similar potency to morphine, only about half of it (50 percent) is bioavailable; in contrast, tramadol, which is much less potent than morphine, is 68-72 percent bioavailable. This means the body can use more of the drug.
- Reinforcement: Addictive substances are considered to be reinforcing, meaning they act on the reward system in the brain to release dopamine, serotonin, and other neurotransmitters that make the individual feel good and rewarded for the action. Hydrocodone does change how neurotransmitters are released in the brain, but not directly; instead, the action occurs through analgesic and relaxing properties moderated by the opioid receptors. Tramadol, on the other hand, directly changes how much serotonin and norepinephrine are available to the brain by preventing the reuptake of these neurotransmitters. Currently, tramadol is being examined as a potential antidepressant due to these properties; unfortunately, this ability makes tramadol a risky drug for some.
While there are some similarities and many differences between Vicodin and tramadol, ultimately, both of these drugs contain opioids, which are addictive substances. People who receive a prescription for either of these medications, or other opioid painkillers, from their physician should discuss concerns about their addiction potential. Numerous people have been hospitalized due to overdoses on these drugs and struggle with opioid addiction because they started with a prescription to one of these two substances.
Although the opioid addiction and overdose epidemic is devastating, there are many rehabilitation programs available that use evidence-based therapies to treat addiction. In fact, several of these programs have options that focus specifically on treating opioid addictions.