Compare Tramadol vs. Acetaminophen with codeine

Head-to-head comparisons of medication uses, side effects, ratings, and more.

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Tylenol #3
(Acetaminophen / Codeine)

Treats moderate to severe pain. Ultram (Tramadol) works well to treat severe pain and mood changes. Although it's a little weaker than other opioids, it can still be addictive.Treats mild to moderate pain. Tylenol #3 (Acetaminophen / Codeine) is a good option to treat pain and cough as needed when over-the-counter medicines can't control the symptoms, but must make sure you don't take too much acetaminophen (Tylenol) to avoid liver problems or death.
How it works
Ultram (Tramadol) is an atypical opioid pain reliever. Researchers don't know exactly how it works, but it alters certain brain chemicals to lower pain perception and improve mood.Tylenol #3 (Acetaminophen / Codeine) is a combination pain medicine. Codeine is an opioid (similar to morphine) that works in the brain to lower pain perception. Acetaminophen is a non-opioid pain reliever and fever reducer.
Type of medication
Pain reliever
Prescription only
Pain reliever
Acetaminophen (APAP)
Prescription only
Available as
  • Pill
  • Extended release
  • Extended release capsule
  • Dissolving tablet
  • Pill
  • Liquid
Used for (click to learn more)
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Reviews & ratings
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Reviews for Ultram (Tramadol)
of people say Ultram (Tramadol) is worth it
say it works well
say it's a big hassle
Reviews for Tylenol #3 (Acetaminophen / Codeine)
+9% vs. Ultram (Tramadol)
+2% vs. Ultram (Tramadol)
+7% vs. Ultram (Tramadol)
Side effects
  • Dizziness (not vertigo) 21%
  • Flushing 12%
  • Itching 11%
  • Dry mouth 10%
  • Dizziness 9%
  • Sleep difficulty 8%
  • Positional low blood pressure 3%
More Tramadol side effects »

The Acetaminophen with codeine FDA package insert doesn’t have numbers about how common side effects are.

More about Acetaminophen with codeine side effects »
Risk factors for serious side effects
  • Higher dose
  • Using other medicines that can cause seizures
  • History of seizures
  • Alcoholism
  • Eating disorders
  • Brain infections
  • Suicidal or at risk
  • Taking other medications that affect serotonin
  • Drug or alcohol abuse
  • Using other medications that affect serotonin
  • History of allergic reactions to codeine or other opioid pain relievers
  • Phenylalanine sensitivity
  • Stopping Ultram (Tramadol) suddenly
  • Taking more than the prescribed dose
  • Taking with alcohol or drugs
  • Taking with alcohol or drugs
    Detailed Ultram (Tramadol) risks & warnings »
    Coming soon.
    Pregnancy category
    • Serious side effects may include drug abuse, dependence, slowed breathing rate (respiratory depression), and death. Don't take more than your doctor prescribes or take with alcohol, illegal drugs, or other opioid pain relievers.
    • Avoid alcohol.
    • Take Ultram (Tramadol) with food to avoid an upset stomach.
    • Generally well tolerated by people, especially if taken with food to lower risk of stomach upset.
    • Take it with food to lower the chance of an upset stomach.
    Kidneys and liver
    • There are different doses for people who are older or who have liver or kidney disease, so work with your doctor to get the right dose.
    No specific kidneys and liver-related info.
    No specific sex-related info.No specific sex-related info.
    No specific sleep-related info.No specific sleep-related info.
    No specific weight-related info.No specific weight-related info.
    Upsides and benefits
    • Relieves moderate to severe pain. It has been shown to work as well as other opioid pain medications.
    • Compared to typical opioids, it provides unique pain relief and effects on your mood when taken regularly.
    • Has a lower chance of causing breathing problems compared to other typical opioids.
    • Doesn't cause as much constipation as other opioid pain medicines. Staying hydrated and taking laxatives can help treat this side effect.
    • Combination pain medicine with an opioid component (codeine) and non-opioid component (acetaminophen or Tylenol) that takes advantage of different modes of pain relieve in a single pill.
    • Provides quick relieve for mild to moderate pain to improve quality of life.
    • Good for as-needed pain and control.
    • Generally well tolerated by people, especially if taken with food to lower risk of stomach upset.
    • Lower rates of misuse compared to pure opioid medicines.
    • Can help you fall asleep easier.
    Downsides and risks
    • Some people think it's weaker than other opioid pain medications. It can also cause more upset stomach.
    • Like other opioid pain relievers, Tramadol has a high risk of addiction, abuse, misuse, overdose, and death. It should only be used for severe pain that requires daily, around-the-clock treatment once alternative treatments haven't worked.
    • It isn't used for short-term, as-needed pain relief.
    • It's a controlled substance regulated by the federal government. This means that your use of Ultram (Tramadol) will be tracked to prevent potential prescription abuse.
    • To get Ultram (Tramadol) in the pharmacy, you'll need to bring in a paper prescription directly from your doctor.
    • Dizziness and drowsiness is common, but your body may adjust.
    • Everyone will get constipation - always stay hydrated and take stool softener or stimulant on days you're taking Acetaminophen with codeine if you need.
    • All opioid containing medicines have the risk of physical dependence and possibility of withdrawal when used long-term.
    • The non-opioid part of Acetaminophen with codeine, acetaminophen (Tylenol), has a high risk of liver failure and death if you take more than the maximum daily dose. Be very careful.
    • Relies on the users to be aware of how much acetaminophen (Tylenol) they are using since it is a very common ingredient in many prescription and non-prescription pain medicines.
    • Avoid alcohol.
    Tips from our pharmacists for people taking the medication
    • Starts working in one hour and works best if you take it regularly.
    • Can make you dizzy or drowsy, so avoid activities that need you to be fully alert until you know how this medicine affects you.
    • Take Ultram (Tramadol) with food to avoid an upset stomach.
    • There are different doses for people who are older or who have liver or kidney disease, so work with your doctor to get the right dose.
    • Swallow the extended-release tablets whole. They're designed to release the drug slowly and breaking, crushing, or chewing them could cause a serious overdose.
    • This is a combination pain medication. It contains both an opioid medicine, and acetaminophen (Tylenol).
    • Starts working in 30 minutes.
    • Works best if you take it as soon as you start feeling pain.
    • Pain relief lasts 4-6 hours.
    • Can make you dizzy or drowsy.
    • Avoid activities need you to be fully alert until you know how it affects you.
    • Take it with food to lower the chance of an upset stomach.
    • Constipation is common and may not go away while you're taking this medicine. Drinking lots of water and using laxatives can help.
    • Don't take more than instructed to prevent liver damage.
    • Use it for the shortest time possible, and at the lowest dose possible, to lower your chance of becoming addicted.
    • Talk to your doctor if it doesn't help enough for your pain, or if the side effects are really bad.
    Learn more
    More about TramadolSide effectsReviews & ratingsAlternativesFDA package insert
    More about Acetaminophen with codeineSide effectsReviews & ratingsAlternativesFDA package insert