July 01, 2020

Is tramadol safer than other opioid pain medications?

Q: Is tramadol safer than other opioid pain medications?

A: There are two key risks with tramadol (Ultram) and other short-acting opioid pain medications such as oxycodone (Roxicodone) and hydrocodone plus acetaminophen (Norco, Vicodin). One is the risk of side effects — such as constipation or sedation leading to falls or accidents — and the other is risk of addiction and inappropriate use.

Tramadol has historically been considered a "weak" opioid pain medication. Although it has some effect on opioid receptors in the brain, the effect is generally minimal compared with that of other short-acting opioid pain medications, though variables such as dosing and individual metabolism can complicate this generalization. As such, tramadol is classified at a lower level of misuse risk than other opioid medications.

However, one recent Mayo Clinic study found that people prescribed tramadol and those prescribed another short-acting opioid for short-term, postsurgical pain were at comparable risk of unnecessarily prolonged use. Although misuse potential was similar between the different drugs in this study, Mayo Clinic experts noted that an older adult without a history of substance misuse is unlikely to begin misusing tramadol or other short-acting opioids.

Regarding potential side effects, the evidence is less clear. Still, Mayo Clinic experts generally view side effects as less of a problem with tramadol compared with the others. However, side effects can occur, and tramadol can interact with certain drugs — such as antidepressants — in ways that other short-acting opioids don't. In addition, older adults are more vulnerable to side effects with any pain medication. Tramadol still needs to be used...