Taking Tramadol With Hydrocodone

In our latest question and answer, the pharmacist discusses whether or not there is an interaction between tramadol and hydrocodone.

Mar 21, 2018

Catelyn asked

Can you take tramadol and hydrocodone together?


Hydrocodone and tramadol are pain medications known as opioids. Both are generally prescribed for acute pain and are not typically prescribed together. Taking these together can lead to increased sedation, altered mental status, and respiratory distress. Taking tramadol with opioids can also increase the risk of seizures in some patients.

In order to avoid untoward effects like addiction, constipation, and respiratory depression, the lowest dose for the shortest duration is generally recommended when taking opioids such as hydrocodone and tramadol. If the pain is mild, nonopioids like acetaminophen and ibuprofen may be a good option instead of taking a dose of Norco.

Information About Hydrocodone

Hydrocodone is a controlled substance pain medication that typically comes as a combination tablet with acetaminophen (Norco). Hydrocodone and ibuprofen are also found in a combination tablet known as Vicoprofen, but is used much less frequently than Norco.

Opioids, such as hydrocodone, work by binding to the mu-opiate receptor. This works in the central nervous system to decrease perception of pain and the person’s emotional response to pain.

Norco should start working in about 30 minutes and should reach peak effect in about 90 minutes. Overall, Norco treats pain for about 3-4 hours.

The DEA recently decided to classify hydrocodone as a Schedule II controlled substance. This is the highest risk category that can be prescribed based on abuse potential.

Information About Tramadol

Tramadol (Ultram) is a unique type of pain medication that has multiple modes of action. It is similar to other opioids in that it lessens pain by binding to the mu-opiate receptor, but it is not as potent as other opioids. Tramadol also has effects on the neurotransmitters norepinephrine and serotonin.

Tramadol starts working in about 1 hour and takes about 2 hours to reach peak concentration. The maximum dose recommended is 400 mg for the immediate release formulation.   

The DEA recently decided to classify tramadol as a Schedule IV controlled substance. This means that it is classified as having less risk of abuse than other opioids. Prior to the DEA’s classification, tramadol was not considered to be a controlled substance.


Taking tramadol with hydrocodone is generally not recommended because of the duplication of action on the opiate receptors. Taking both together can lead to an increased risk of sedation, altered mental status, and respiratory depression.

Source: Norco package insert, Ultram package insert

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