Content reviewed by the PillRelax Healthcare Team | Last reviewed: September 2026
Both Tramadol and Co-codamol are opioid-containing prescription painkillers used in the UK for moderate to severe pain.
Quick Comparison
| Factor | Tramadol | Co-codamol 30/500mg |
|---|---|---|
| Active ingredients | Tramadol HCl | Codeine 30mg + Paracetamol 500mg |
| Standard UK dose | 50-100mg every 4-6 hours | 1-2 tablets every 4-6 hours |
| Max daily dose | 400mg | 8 tablets |
| Controlled status | Schedule 3 | Schedule 5 |
| Best for | Moderate-severe pain, neuropathic component | Moderate pain, combined analgesia |
Which Is Stronger?
Tramadol 100mg is generally considered stronger than Co-codamol 30/500mg. Tramadol acts on mu-opioid receptors AND inhibits noradrenaline and serotonin reuptake, giving it additional analgesic properties for neuropathic pain.
Important Safety Differences
Tramadol lowers the seizure threshold and can cause serotonin syndrome when combined with antidepressants. Never combine Tramadol with other serotonergic medicines without medical guidance.
Frequently Asked Questions
Can I take Tramadol and Co-codamol together?
No. Combining two opioid-containing medicines significantly increases the risk of respiratory depression, sedation, and overdose.
Which is better for back pain?
For lower back pain without a neuropathic component, Co-codamol is often tried first. For back pain with a nerve component (sciatica), Tramadol may be more effective.
