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What Is the Interaction between Codeine and Tramadol?

By Drue Tibbits
Updated May 17, 2024
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Codeine and tramadol are analgesics used to treat moderate to moderately severe pain. The two drugs do not interact with each other, but they should not be taken together. Taking these substances at the same time increases the risk of respiratory depression. The use of both drugs at the same time also increases the risk of seizures, particularly in people already disposed to seizure activity.

Codeine is an opiate drug. It can be derived directly from the opium poppy or synthesized from morphine. Tramadol is a synthetic compound that is not chemically related to drugs in the opiate class. Neither drug has anti-inflammatory properties. Codeine and tramadol have similar pain-relieving properties and can usually be used interchangeably.

Tramadol’s analgesic action is not fully understood, although studies have revealed some of the ways the drug can control pain. Tramadol does not contain opioids, but it works similar to codeine in mimicking the body’s natural endorphins. Endorphins bind to the opoid receptors in the brain, blocking the transmission of pain signals from nerves to the brain. Tramadol also enhances the effects of serotonin, thereby moderating pain.

Both codeine and tramadol cause the same constellation of side effects related to opioids. Dizziness, nausea, and constipation are common when using either drug. Taking the two drugs together can increase their severity. There is also a higher incidence of serious side effects when codeine is taken with tramadol.

Tramadol has been shown to decrease the seizure threshold, causing seizure activity in predisposed patients using recommended dosages. Codeine has the same effect, although not as much as tramadol. The simultaneous use of both drugs together has been shown to significantly decrease the seizure threshold, even in patients not predisposed to seizures. In addition, there is an increased risk of respiratory depression associated with the use of codeine. Tramadol has a minimal risk of respiratory depression, but using codeine and tramadol together aggravates the effect and can cause serious risks to patients with breathing problems.

The use of tramadol can reinitiate opoid dependency in patients previously addicted to opioids. Although tramadol does not contain opioids, it is considered an opoid drug as it binds to opoid receptors. Tramadol produces effects similar to codeine and should not be used as a substitute for codeine in patients with dependency issues. Both tramadol and codeine are addictive drugs. The level of addiction is dependent on the dosage prescribed and length of time the drug is administered.

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Discussion Comments
By MindyFred333 — On Apr 03, 2015

My friend has taken at least 20 tramadol capsules and 20 codeine tablets over the last four hours. He's a little high, staggering a little and is going through alcohol withdrawal. Should I be concerned?

By bagley79 — On Dec 20, 2011

Working as a nurse, I am never surprised at some of the reactions a patient may have to pain medications.

It would be much simpler if this were not the case, but this is something I am always aware of. Some people have both a tramadol and codeine allergy, so you have to give them another type of pain medication.

At least there are enough of them, that you can usually find one that suits a patient well. There is nothing worse than struggling with pain and having bad side effects on top of the pain.

Never be afraid to ask for something different if one pain medication gives you an uneasy feeling every time you take it.

By Mykol — On Dec 19, 2011

I really don't like to take prescription pain medication unless absolutely necessary. Even then, I usually have to ask for a tramadol medication prescription.

Any kind of codeine, even when it is used with something else like Tylenol, makes me very sick to my stomach.

It took me awhile before I figured out this is what the problem was. If I have to take something for pain after any kind of procedure, this is what I always ask for.

Both of them do a good job of relieving the pain, but it is nice to not have an upset stomach as well.

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