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Tramadol HCL (Ultram)

tramadol hcl 50 mg
  • Generic name: Tramadol Hydrochloride
  • Trade names: Tramal, Rybix, Ryzolt, Ultram, Ultram ER
  • Drug class: Synthetic opioid analgesic
  • Dosages: 50 mg tablets;
    100 mg, 200 mg, 300 mg ER tablets


Tramadol Hydrochloride (Ultram) is a centrally acting, synthetic opioid analgesic of the aminocyclohexanol group. It is chemically unrelated to the opiates. Tramadol is not classified as a narcotic or controlled substance, and is sold by a normal prescription.

Tramadol hcl has a unique powerful double mechanism of action: weakly binds to opioid (mu) receptors (opiate-like effect) and inhibits re-uptake of serotonin and norepinephrine (antidepressant-like effect).

Tramadol is prescribed to relieve moderate to moderately severe pain, including acute and chronic pain, back and neck pain, fibromyalgia, arthritis and osteoarthritis pain, migraine headaches.

Ultram ER (tramadol extended-release tablets) is used for chronic pain in people who need continuous treatment for an extended period.


  • Reasonable balance of effectiveness, potency, safety and cost.
  • Suitable option for people who have contraindications for NSAIDs use but are reluctant to take opioid analgesics.


  • Although tramadol is not a controlled substance, it has the potential to produce physical dependence and to be abused. For this reason, it is not appropriate for people with a tendency to abuse drugs or alcohol, or with a history of chronic opioid use.
  • Tramadol has potential to interact with other substances and prescription medications, including alcohol, hypnotics, narcotics, analgesics, and psychotropic drugs.
  • The most common side effects include nausea, vomiting, dizziness, sweating, tremor, and headache.

Tramadol potency

Tramadol is more potent analgesic than NSAIDs and weak opioids. The analgesic potency of tramadol is considered to be medium: it has one-tenth to one-fifth the potency of morphine, one-fifth the potency of nalbuphine and the equivalent of pethidine, oxycodone and at least the equivalent of NSAIDs.

Comparison with NSAIDs

Unlike NSAIDs, tramadol is not associated with serious gastrointestinal problems, such as ulcers, bleeding and perforation, and does not negatively affect kidney function. On the other hand, tramadol doesn't reduce inflammation.

Bromfenan and lornoxicam proved to be more effective than tramadol in randomised controlled trials.

Tramadol vs Ketorolac

Tramadol is more effective than ketorolac for the pain relief after tooth extraction, providing prolonged analgesia and minimal side effects.

Tramadol vs Diclofenac

Intramuscular diclofenac is proven to be superior to tramadol for pain relief in patients with renal colic. Tramadol could be used as an alternative when contraindications preclude the use of diclofenac. The study results showed: response rate of 87.5% to Diclofenac and only 61.2% response rate to Tramadol group [5].

Tramadol and diclofenac are equally effective in the treatment of pain due to knee or hip osteoarthritis [6].

Tramadol vs Naproxen

Tramadol 50 mg works better than naproxen sodium 550 mg on pain during insertion of an intrauterine device [7].

Comparison with Opioids

Tramadol binds to the mu-opioid receptors considerably weaker than do morphine and similar opioids. So it is less likely that patients will experience euphoria, develop tolerance, or suffer withdrawal when tramadol is discontinued. It lacks typical opioid side effects, such as respiratory depression and constipation.

Tramadol vs Codeine

Tramadol 100 mg relieves pain better than codeine sulfate 60 mg, but not as well as the combination of 650 mg of aspirin with 60 mg of codeine sulfate.

Tramadol vs Vicodin (Hydrocodone/Acetaminophen)

Compared with hydrocodone-acetaminophen (Lorcet, Lortab, Norco, Vicodin, Zydone), tramadol is an inferior analgesic for the treatment of acute pain due to trauma.

Tramadol hydrochloride (100 mg) was compared to hydrocodone/acetaminophen (5/500 mg) in acute musculoskeletal pain caused by trauma. Participants in both groups rated initial pain at 69 (on a 100-point visual analog pain scale). The pain score in the tramadol group decreased to 54 at one hour and stayed at this level. In contrast, the pain score in the hydrocodone/acetaminophen group decreased steadily over a three-hour period to 23 [1].

The prevalence of abuse and dependence for tramadol is significantly less than for hydrocodone.

  • 1. Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial. Ann Emerg Med. 1998 Aug;32(2):139-43
  • 2. Adams EH, Breiner S, Cicero TJ et al. A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone. J Pain Symptom Manage. 2006 May;31(5):465-76. PDF
  • 3. MM Shaik, J Kumar, S Mobina, N Satyanarayana, P Sunitha. Comparative study of tramadol and ketorolac in the pain management of third molar tooth extraction. Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 35-43
  • 4. Salameh S. et al. Diclofenac versus tramadol in the treatment of renal colic. The Open Emergency Medicine Journal, 2011, 4, 9-13
  • 5. Beaulieu AD, Peloso PM, Haraoui B, et al. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis: a randomized controlled trial. Pain Res Manag. 2008;13:103–110.
  • 6. Beaulieu AD, Peloso PM, Haraoui B, et al. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis. Pain Res Manag. 2008 Mar-Apr;13(2):103-10. PubMed
  • 7. Karabayirli S, Ayrim AA, Muslu B. Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion. J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):581-4

Last Updated: September 04, 2014

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