Two medicines, side by side
Meperidine vs tramadol
Meperidine and tramadol are both labeled for pain. Drugs@FDA records approvals of meperidine since 1942 and of tramadol since 1995. Pharmacies paid $0.157 per mL (Meperidine 50 mg/5 mL solution) and $0.0248 per tramadol HCl 50 mg tablet (NADAC, October 7, 2026). How each works, in its label's words: Meperidine, “Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle.”; Tramadol, “Tramadol hydrochloride extended-release tablet contains tramadol, an opioid agonist and an inhibitor of reuptake of norepinephrine and serotonin.”
Check it at the source: the meperidine FDA label on DailyMed (effective November 29, 2025); the tramadol FDA label on DailyMed (effective March 5, 2026).
Highlights of the meperidine record
Meperidine (Demerol) · label of November 29, 2025
SERIOUS AND LIFE-THREATENING RISKS FROM USE OF MEPERIDINE HYDROCHLORIDE TABLETS Addiction, Abuse, and Misuse Because the use of Meperidine hydrochloride tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions [see Warnings and Precautions (5.2) ].
Used for
From the label: indicationsMeperidine hydrochloride tablets are indicated for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. […]
On the market
- Earliest approval on file
- November 10, 1942
- Generic labelers
- 3 labelers
- Pharmacy cost
- $0.157 per mL
Supply and safety
- Shortage
- Listed; available
- Recalls
- 0
Highlights of the tramadol record
Tramadol (Ultram) · label of March 5, 2026
SERIOUS AND LIFE-THREATENING RISKS FROM USE OF TRAMADOL HYDROCHLORIDE EXTENDED-RELEASE TABLETS Addiction, Abuse, and Misuse Because the use of Tramadol hydrochloride extended-release tablet exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient's risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions [see Warnings and Precautions ( 5.1 )].
Used for
From the label: indicationsTramadol hydrochloride extended-release tablet is indicated for the management of severe and persistent pain that requires an opioid analgesic and that cannot be adequately treated with alternative options, including immediate-release opioids. […]
On the market
- Earliest approval on file
- March 3, 1995
- Generic labelers
- 39 labelers
- Pharmacy cost
- $0.0248 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 8
Source: FDA drug labels via openFDA (Meperidine label of November 29, 2025, Tramadol label of March 5, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do meperidine and tramadol differ on the record?
How each works, in its label's words: Meperidine, “Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle.”; Tramadol, “Tramadol hydrochloride extended-release tablet contains tramadol, an opioid agonist and an inhibitor of reuptake of norepinephrine and serotonin.”
Both are in FDA's class opioid agonists.
Both labels carry a boxed warning; the records quote them.
Generics: meperidine since 1972; tramadol since 2002 (Drugs@FDA).
DEA schedule: meperidine CII; tramadol CIV.
| Meperidine | Tramadol | |
|---|---|---|
| Labeled for | Pain | Pain |
| Pharmacologic class | Opioid Agonist | Opioid Agonist |
| How it works (label) | Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle. | Tramadol hydrochloride extended-release tablet contains tramadol, an opioid agonist and an inhibitor of reuptake of norepinephrine and serotonin. |
| Half-life (label) | Elimination The elimination half-life is 3 to 8 hours in healthy volunteers. | n/a |
| Earliest approval on file (Drugs@FDA) | November 10, 1942 | March 3, 1995 |
| First generic approved | April 26, 1972 | June 19, 2002 |
| Generic labelers (NDC) | 3 labelers | 39 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.157 per mL (Meperidine 50 mg/5 mL solution) | $0.0248 per tablet (Tramadol HCl 50 mg tablet) |
| 12-month price change | -2% | -1% |
| Boxed warning | Yes | Yes |
| Shortage now | Listed; available | No current entry |
| Recalls recorded | 0 | 8 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 9,161 | 37,421 |
| DEA schedule | CII | CIV |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What do the labels say about using others of their kind?
Meperidine label, warnings and precautionsRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant use of meperidine hydrochloride tablets with benzodiazepines and/or other CNS depressants, including alcohol (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids …
Tramadol label, warnings and precautionsRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant use of tramadol hydrochloride extended-release tablets with benzodiazepines and/or other CNS depressants, including alcohol (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics …
Source: FDA drug labels via openFDA
What next?
- Alternatives to meperidine
- every medicine labeled for the same conditions