Dihydrocodeine vs Tramadol — Which Should You Use?
Both are step-up painkillers when paracetamol and ibuprofen aren’t enough, but they work very differently.
Mechanism
- Dihydrocodeine is a pure opioid agonist — it binds opioid receptors and blocks pain signals
- Tramadol is an atypical opioid — partly opioid, partly affecting serotonin and noradrenaline pathways
Strength
- 50mg tramadol ≈ 30mg codeine — much weaker than dihydrocodeine 30mg
- 100mg tramadol ≈ 30mg dihydrocodeine — roughly equivalent
- 200mg tramadol SR ≈ 60mg dihydrocodeine SR
Best for
- Dihydrocodeine: acute musculoskeletal pain, post-op pain, fracture pain
- Tramadol: mixed nociceptive + neuropathic pain (sciatica, diabetic nerve pain), pain with low mood
Side-effect differences
- Tramadol is less constipating than dihydrocodeine
- Tramadol can cause more nausea
- Tramadol can interact with antidepressants (serotonin syndrome risk)
- Tramadol is more associated with seizures, especially at high doses
Which to choose
UK GPs typically reach for dihydrocodeine first for body pain and tramadol first for nerve pain. See the vs codeine guide for context on the opioid ladder.
Order dihydrocodeine
Buy dihydrocodeine online — UK next-day delivery, bank transfer or Bitcoin.