Can you take Hydrocodone and Tramadol together

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

What is Hydrocodone

What is Tramadol

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.

What is Tramadol

How does Hydrocodone and Tramadol work in the body

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. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain. 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.

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.

Can patients take Hydrocodone and Tramadol together

Taking Hydrocodone 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 such as seizures, respiratory depression to happen after using this combination.

In currently or previously patients addicted to opiates, alcohol or other drugs, tramadol and Hydrocodone 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 Hydrocodone

Hydrocodone can interrupt breathing and high doses may lead to fatal respiratory depression, while tramadol can cause seizure attacks, so taking tramadol with hydrocodone 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 side effects after Hydrocodone and Tramadol administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Constipation, Dizziness, Vertigo, Nausea, Headache, Somnolence Vomiting, Agitation, Emotional lability, Anxiety, Hallucinations, Euphoria, Nervousness, Asthenia, Pruritus, Dyspepsia, Spasticity
Common side effects 1-10% Diarrhea, Sweating, Dry mouth, Hypertonia, Malaise, Rash, Menopausal symptoms, Urinary frequency, Urinary retention, Visual disturbance, Vasodilation
Less common and rare side effects < 1% 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 during Hydrocodone and Tramadol administration:

  • 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 hydrocodone.
  • Tramadol and Hydrocodone are more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors.
  • 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.
  • These medicines should never be shared with another person, especially with someone who has 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.
  • Hydrocodone 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.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients using hydrocodone should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone, medications for irritable bowel disease, Parkinson’s disease, ulcers, haloperidol, azithromycin, amiodarone, butorphanol;chlorpromazine; citalopram, laxatives such as lactulose; nalbuphine; or pentazocine and levofloxacin.
  • Patients using hydrocodone should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • If patients are taking hydrocodone extended-release tablets, they should tell their doctor if they have or have ever had difficulties with swallowing, colon cancer, esophageal cancer, heart failure or heart rhythm problems such long QT syndrome.
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