Tramadol and codeine are both opiates that are very effective for mild to moderate pain suppression. However, Tramadol is considered to be stronger than codeine. Tramadol is about 10% stronger than codeine over-the-counter medication but not as strong as oxycodone, Tylenol 3, Vicodin, Fentanyl, etc.
Though Tramadol is similar to codeine, Tramadol’s demethylated metabolite is believed to be a much stronger mu-opioid receptor agonist than the parent molecule, with less action at other receptor sites. Tramadol’s effects vary depending on the patient, dosage, time of day, other drugs, foods, and so on because it works on multiple receptor sites simultaneously.
Tramadol is thought to have several different mechanisms of action. The various effects are mutually beneficial. It has an antidepressant-like effect, influencing serotonin and norepinephrine, in addition to acting on some opiate receptors.
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Tramadol must also be transformed by enzymes into a more active form. The activity of these enzymes varies depending on the patient’s genetic composition. This could explain why certain people are more likely to develop a tramadol addiction. It could also explain why some people don’t get as much benefit from tramadol as others. Read more about Tramadol Therapy and CYP2D6 Genotype.
Codeine is similar in that it must be converted to morphine via enzymes. Around 10% of people (European Caucasians) are unable to convert codeine to morphine, hence codeine has no analgesic effect on them.
Codeine, just like morphine, heroin, and opium, is derived from the poppy plant. Tramadol is chemically identical to codeine, however, it is made in a laboratory from precursor molecules. It’s popular among doctors because it is better tolerated and has a lower risk of addiction than other opioids, though that doesn’t imply it’s completely safe.
Other opiates like morphine, heroin, and its synthetic cousin Fentanyl are significantly more potent than tramadol and codeine. As a result, using tramadol for moderate pain symptoms or codeine for cough for a short period of time carries a low risk of addiction or withdrawal.
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Understanding How Tramadol And Codeine Works
Opiates work because the central nervous system has three main opioid receptors in the nerve cells that regulate pain sensation, reward, aspects of gastrointestinal function, aspects of respiratory function, and aspects of urogenital function when combined with natural opioids produced by your body. The receptors are Mu receptors, Delta receptors, and Kappa receptors. They are found on the surfaces of nerve cell membranes and are activated when an opioid, whether naturally existing in the body or introduced as a medicine, fits into the molecule like a key in a lock.
Opiate medicines are synthetic versions of the body’s natural opioids. Their chemicals bind to and activate the same receptors. Codeine, tramadol, morphine, and all other poppy derivatives are “Mu receptor agonists,” meaning they target and activate the Mu receptors.
The body’s own efforts to deaden pain are mediated by these receptors and the naturally produced (endogenous) opioids they partner with. As a result, flooding the Mu receptors with pharmaceutical opioids like codeine, tramadol, and others can enhance the analgesic (painkilling) characteristics of that region of the central nervous system.
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Pharmaceutical opioids are especially addictive because the endogenous opioid system also controls reward pathways. The main endogenous opioids secreted by your neurological system in response to sex, a wonderful meal, and other sources of pleasure are endorphins. Euphoria and a great sense of well-being are potential side effects of all opiate medicines on the market since opiates activate the same Mu receptors as endorphins do. Patients can become physically and mentally addicted as their bodies and minds want that blissful condition.

The endogenous opioid system aids in the regulation of the muscular reflex that expands and contracts your ribcage to breathe in and out in response to blood carbon dioxide levels. Small doses of opiate medications, such as codeine, can help suppress coughing and relieve the pain of a sore throat in a variety of diseases and disorders where coughing and throat pain are symptoms.
Researchers haven’t found out the exact mechanism by which codeine suppresses coughs, even though they know the cough reflex is linked to the endogenous opioid system. They don’t know why it doesn’t work for some persistent coughs, for example.
Is Tylenol With Codeine Stronger Than Tramadol?
Tylenol with codeine combinations is stronger than tramadol alone. Tylenol, also known as Paracetamol or Acetaminophen, is a pain reliever that is used to treat mild to moderate pain and fever. Paracetamol only marginally lowers body temperature at a typical dose; it is inferior to ibuprofen in this regard, and the benefits of its use for fever are uncertain.
Tylenol is widely combined with codeine or tramadol to increase their efficacy. So, it makes sense that a combination of Tylenol with codeine will be stronger or more effective than tramadol alone.
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However, the efficacy of a Tylenol with codeine and Tylenol with tramadol is equal according to research. The results of this study suggest that tramadol/APAP tablets (37.5mg/325mg) are as effective as codeine/APAP capsules (30mg/300mg) in the treatment of chronic non-malignant low back pain and OA pain and are better tolerated. However, the individual drugs’ quantity varies (Tramadol/Tylenol is higher in quantity than Codeine/Tylenol) but are equal in the same effect they produce. This also shows that Tylenol with Codeine is stronger than Tylenol with Tramadol if the individual drugs are combined in the same quantity. For instance, 30mg of Codeine with 300mg of Tylenol against 30mg of Tramadol with 300mg of Tylenol.
Does Ultram Contain Codeine?
Ultram does not contain codeine. Ultram is a brand of tramadol with 50mg tramadol hydrochloride contained in each hard capsule.
Many opioids are mixed with other medications to boost their effectiveness, but not with another opioid. Codeine and tramadol, for example, should not be used together since they may raise the dangers and side effects, including the likelihood of an overdose.
Is Tylenol 3 Stronger Than tramadol?
Tylenol 3 is stronger than tramadol alone. Tylenol 3 is a combination of Codeine (30mg) and Acetaminophen (300mg). This mixture of medications is used to treat mild to moderate pain. Codeine alters the way your body perceives and responds to pain by acting on the brain. Acetaminophen helps to bring down a high temperature.
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Conclusion
Tramadol is considered to be stronger than codeine due to its stronger mu-opioid receptor agonist activity, several different synergistic mechanisms of action, and ability to be converted easily into morphine compared to codeine.
Tramadol is popular among doctors because it is better tolerated and has a lower risk of addiction than other opioids, though that doesn’t imply it’s completely safe. It is always safer to consult your doctor before taking any strong pain relief. Self-medication is detrimental to your life!