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Tramadol will not be the right choice for everyone. Unfortunately, there aren’t many substitutes for opioids like tramadol, as tramadol has a different mechanism of action than most other substitutes. Therefore, you should always discuss your options with your doctor in great detail to determine the best way to manage your pain.

Potential Alternatives for Tramadol


Tramadol is a synthetic (man-made) drug that is similar to codeine, which is derived from poppies. Both are considered opioids, although they are both less potent than other drugs in this class. So, they are considered to have less of a risk of dependency and overdose than other opioids. However, it’s important to note that dependency and overdose can still happen when using these drugs even if they are taken correctly.

Which is deadlier?

It’s hard to say. One study showed that codeine and tramadol had similar mortality rates.

What are they used for?

Tramadol is used for the treatment of both chronic and acute cases of moderate to severe pain; research also suggests it might work well as an antidepressant, since it may affect levels of the neurotransmitters serotonin and norepinephrine.

Codeine is used for the treatment of pain as well as for cough relief.

Which is stronger?

According to the World Health Organization (WHO), these drugs are roughly of the same strength.


Some research suggests that morphine may be a viable alternative for managing pain than tramadol. However, this alternative must be administered with extreme care, as morphine is highly addictive.


Tapapentadol (Nucynta, Nucynta ER) is becoming an alternative drug of choice in some cases where tramadol is not advisable. This drug, however, cannot quite replace tramadol in all cases as there are a few differences between them, including:

  • Tapentadol is stronger than tramadol
  • Tramadol (Schedule IV) is easier to acquire in the U.S. than tapentadol (Schedule II) due to their classifications
  • Tapentadol results in greater norepinephrine uptake inhibition

Other Opioid Medications

Please note this list may not include all potential opioid alternatives to tramadol. Other opioid alternatives may include:

  • Oxycodone
  • Hydrocodone
  • Hydromorphone

Other non opioid alternatives for pain relief include: acetaminophen (Tylenol), ibuprofen, meloxicam, naproxen, ketorolac, celecoxib, etc.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.

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