Is tramadol more potent than oxycodone?

From the Guidelines

Tramadol is less potent than oxycodone.

Comparison of Potency

• The conversion factor for tramadol is 0.2, while for oxycodone it is 1.5, indicating that oxycodone is approximately 7.5 times more potent than tramadol 1.
• Tramadol is considered to be approximately one tenth as potent as morphine, which has a conversion factor of 1.0 1.

Clinical Implications

• The potency difference between tramadol and oxycodone should be taken into account when converting between these opioids or when selecting an opioid for pain management 1.
• Tramadol's lower potency may make it less effective for severe pain, but it may also be associated with fewer side effects, such as constipation and respiratory depression, compared to more potent opioids like oxycodone 1.

Evidence Quality

• The evidence for the potency comparison between tramadol and oxycodone is based on established conversion factors and clinical guidelines, which are considered to be of moderate to high quality 1.

From the FDA Drug Label

Average daily doses of approximately 250 mg of tramadol hydrochloride in divided doses were generally comparable to five doses of acetaminophen 300 mg with codeine phosphate 30 mg (TYLENOL with Codeine #3) daily, five doses of aspirin 325 mg with codeine phosphate 30 mg daily, or two to three doses of acetaminophen 500 mg with oxycodone hydrochloride 5 mg (TYLOX® ) daily

The FDA drug label does not directly compare the potency of tramadol to oxycodone. However, it does provide a comparison of the daily doses of tramadol to combination products containing codeine or oxycodone. Based on this information, tramadol 250 mg daily is comparable to acetaminophen 500 mg with oxycodone 5 mg two to three times daily. This suggests that tramadol may be less potent than oxycodone on a per-dose basis, but this is not a direct comparison of potency. Therefore, no conclusion can be drawn about the relative potency of tramadol and oxycodone. 2

From the Research

Comparison of Tramadol and Oxycodone Potency

• The potency of tramadol and oxycodone has been compared in several studies, with varying results 3, 4, 5, 6, 7.
• A study published in 2017 found that oxycodone and tramadol were equivalent in terms of analgesia, with no significant difference in pain relief between the two groups 3.
• Another study published in 1999 found that the potency ratio of tramadol to oxycodone was approximately 8:1, but there was no significant difference in pain relief between the two groups 4.
• A 2023 study found that tramadol and oxycodone provided similar levels of postoperative pain relief in pediatric patients, with no significant differences in pain scores or analgesic consumption 5.
• A 2007 study found that single-dose tramadol did not impair oxycodone clearance, suggesting that the two drugs can be used together without affecting each other's potency 6.
• A 2024 study found that oxycodone may be preferred over tramadol for safety reasons in older adults with acute locomotor pain, due to a higher prevalence of nausea and other adverse events in the tramadol group 7.

Analgesic Efficacy

• Tramadol and oxycodone have been shown to be effective analgesics in various studies, with significant reductions in pain scores compared to baseline 3, 4, 5, 7.
• The analgesic efficacy of tramadol and oxycodone has been compared in different patient populations, including adults and pediatric patients, with similar results 3, 4, 5.
• The choice of analgesic may depend on individual patient factors, such as age, medical history, and comorbidities, as well as the specific clinical context 7.

Safety and Adverse Events

• Tramadol and oxycodone have been associated with various adverse events, including nausea, vomiting, and sedation 4, 5, 7.
• A 2024 study found that oxycodone may be preferred over tramadol for safety reasons in older adults with acute locomotor pain, due to a higher prevalence of adverse events in the tramadol group 7.
• The safety and tolerability of tramadol and oxycodone should be carefully monitored in all patients, particularly in vulnerable populations such as older adults and pediatric patients 5, 7.