Can you mix Tramadol and Vicodin

Can you take Tramadol and Vicodin together

Tramadol is a generic name for an opioid narcotic-like pain reliever that is used for relieving moderate to moderately severe acute and chronic pain.

According to European League Against Rheumatism, it is recommended for the treatment of chronic pain caused by medical condition called fibromyalgia.

Tramadol tablets are available in 50 mg and 100 mg and they are usually taken several times a day. Extended release tablets are available in doses of 100 mg, 150 mg, 200 mg, and 300 mg.

Common Brand names for medications containing tramadol are: Ultram, Ultram ER, ConZip, Rybix ODT and Ryzolt. Tramadol is available in the following dosage forms: tablet, tablet extended release, suspension, capsule extended release and disintegrating tablet.

Vicodin is a Brand named for opioid pain reliever tablets that contains a combination of two active substances – hydrocodone and acetaminophen (paracetamol).

It is available in three strengths as: Vicodin (5mg hydrocodone bitartrate, 300mg acetaminophen), Vicodin ES (7.5mg hydrocodone bitartrate, 300mg acetaminophen) and Vicodin HP (10mg hydrocodone bitartrate, 300mg acetaminophen).

Hydrocodone is an opioid (narcotic) very potent pain reliever while acetaminophen (paracetamol) is a less potent pain reliever substance that increases the effects of hydrocodone. Vicodin is used for the treatment of moderate to severe, acute, chronic or postoperative pain.

Other common Brand names for medications containing the combination of hydrocodone/acetaminophen are: Hycet, Lorcet, Lortab, Norco, Xodol, and Zolvit. Hydrocodone/acetaminophen combination is also available in the forms of: solutions, elixirs, syrups, capsules and liquids.

Tramadol and Vvicodin drug interactions

Tramadol has 2 different mechanisms of action. First, tramadol can bind with parent and M1 metabolite to μ-opioid receptors causing inhibition of ascending pain pathways in CNS, and secondly, tramadol can inhibit reuptake of norepinephrine and serotonin.

Tramadol’s inhibitory effects on the serotonins 5-HT2C receptors may cause the reduction of the seizure threshold. However, the seizure threshold reduction could be also attributed to tramadol’s inhibition of GABA receptors in CNS at high doses.

In addition, tramadol’s major active metabolite called O-desmethyltramadol, has a high affinity to the δ-opioid receptors in the brain, and interaction with these receptors can be involved in tramadol’s capability to provoke seizures in some individuals, because δ-opioid receptor agonists are well known seizure inducers.

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain. Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain.

Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Acetaminophen is a mild non-NSAID analgesic that inhibits prostaglandin synthesis through the inhibition of cyclooxygenase – COX (a highly selective COX- 2 inhibitor).

It also acts on the hypothalamic heat regulating centers to produce antipyresis. Acetaminophen’s reactive metabolite N-acetyl-p-benzoquinone imine (NAPQI) can cause a potentially fatal, hepatic necrosis through the process of lipid peroxidation if acetaminophen is overdosed (more than 4g daily).

Can patients take Tramadol and Vicodin together

Taking Vicodin and Tramadol together would be generally unnecessary, because the usage and effects of these two drugs are quite similar, and there is a high risk of serious side effects (seizures and respiratory depression) and other side effects to happen after using this combination.

In currently or previously patients addicted to opiates, alcohol or other drugs, tramadol and Vicodin, individually or together are not advised in most cases. However, reduced doses of tramadol can sometimes be suggested by doctors if the drug is being taken in conjunction with Vicodin.

Vicodin can interrupt breathing and high doses may lead to fatal respiratory depression, while tramadol can cause seizure attacks, so taking tramadol with Vicodin together can make both of these serious effects more likely to happen, so this is the main reason why this combination shouldn’t be advised from medical professionals.

If hydrocodone or tramadol are used for a long period of time, they may become habit-forming, causing physical or mental dependence. Mental dependence – addiction will not occur when these drugs are used for their purpose.

If treatment is stopped suddenly physical dependence may lead to withdrawal side effects such as: tingling, numbness, paresthesia, and tinnitus. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

The table below shows the incidence of side effects after tramadol or Vicodin administration in recommendable doses. This Incidence can be significantly increased if these drugs are taken together.


Side effects

10-40% (very common) Constipation, Dizziness, Vertigo, Nausea, Headache, Somnolence Vomiting, Agitation, Emotional lability, Anxiety, Hallucinations, Euphoria, Nervousness, Asthenia, Pruritus, Dyspepsia, Spasticity
1-10% (common) Diarrhea, Sweating, Dry mouth, Hypertonia, Malaise, Rash, Menopausal symptoms, Urinary frequency, Urinary retention, Visual disturbance, Vasodilation
< 1% (less common and rare) Abnormal gait, Amnesia, Depression, Difficulty in concentration,

Cognitive dysfunction, Fatigue, Menstrual disorder, Motor system weakness, Dysphoria, Dysuria, Orthostatic hypotension, Tremor, Tachycardia

 Special precautions and warnings

Patient who have severe asthma or breathing problems, stomach or intestines blockage, or patients who have recently use alcohol, sedatives, tranquilizers, or narcotic medications should not use tramadol and Vicodin.

Seizures can occur in some people taking tramadol. Patients who have epilepsy or other seizure disorder, a history of head injury, history of drug or alcohol addiction or metabolic disorder should talk with their doctors about seizure risk.

They should also tell them if they are using certain medications to treat migraine headaches, depression, muscle spasms, mental illness, nausea and vomiting. These medications can increase the risk of seizures if they are used with tramadol at the same time.

Tramadol and Vicodin are more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors.

These medicines should never be shared with another person, especially with someone who have a history of drug abuse or addiction.

Pregnant patients should never use these medicines; because their babies could become drug dependent, so life-threatening withdrawal symptoms can be caused after baby is born. Those babies may need medical treatment for several weeks. Patients should tell doctor if they are pregnant or plan to become pregnant.

Tramadol can pass into breast milk and harm a nursing baby. Patients should not breast-feed after administration of this medicine.

Vicodin should not be used together with Monoamine oxidase (MAO) inhibitor drugs such as: linezolid, isocarboxazid, selegiline, tranylcypromine, phenelzine, and rasagiline, and also with selective serotonin reuptake inhibitors (SSRIs) such as: fluoxetine, paroxetine and duloxetine, because dangerous drug interaction could occur.

An overdose of acetaminophen (more than 4g per day) can damage liver and even cause death. Patients should called doctor if they have pain in your upper stomach, loss of appetite, nausea, dark urine, clay-colored stools, itching or yellowing of skin and eyes, because those are typical symptoms of acetaminophens hepatotoxicity.

In rare cases, acetaminophen may cause a severe skin reaction. Patients should stop taking Vicodin and call their doctor if they have rash or skin redness that spreads and causes peeling and blistering.

Informations retrieved from:

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