Hydromorphone | Side Effects, Dosage, Uses & More
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Generic Name:

hydromorphone, Oral tablet

All Brands

  • Dilaudid
SECTION 1 of 5

Highlights for hydromorphone

Oral tablet
1

Hydromorphone is used to treat severe pain that isn’t controlled by other opioid drugs.

2

This drug is available as an oral tablet. It also comes as a liquid solution and extended-release tablet you take by mouth. You can also receive this drug as an intravenous (IV) injection of a solution or high-potency solution from a healthcare provider.

3

Hydromorphone is available as the brand-name drugs Dilaudid and Exalgo. It’s also available as a generic drug.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning indicates drug effects that may be dangerous.

Serious breathing problems warning. This drug can increase your risk of life-threatening breathing problems. Seniors, people with lung problems, and people with other health problems may have a higher risk.

Alcohol, opioid, and other sedative-hypnotics warning. Taking this drug with alcohol, opioid drugs, and other sedative-hypnotic drugs can cause serious breathing problems. These can be fatal (cause death).

Medication error warning. This drug is available in a high-potency injection form, which is only given by a healthcare provider. This means that it’s more concentrated. This form is only given to people who haven’t had pain relief after taking other opioid drugs for a week or longer. These include at least 60 mg oral morphine per day, 25 mcg/hour fentanyl patch, 30 mg oral oxycodone per day, 8 mg hydromorphone per day, 25 mg oral oxymorphone per day, or another opioid of similar dosage. The high-potency form of this drug should not be confused with the regular form. Using the high-potency form can greatly increase your risk of overdose side effects that may be fatal.

Misuse, abuse, and diversion warning. This drug is a Schedule 2 opioid agent. It has a chance of causing dependence and addiction. The risk of abuse and addiction is especially high in people with a history of these problems.

Overdose in children warning. If a child accidentally swallows this drug, it can lead to overdose. This can be fatal.

Opioid withdrawal in newborn babies warning. If a woman takes this drug for a long time during pregnancy, it can lead to opioid withdrawal syndrome in a newborn. This can be life-threatening for the baby.

Low blood pressure

This drug may cause a sudden drop in blood pressure. This may cause lightheadedness, dizziness, and even fainting. Your risk may be higher if you have a low blood volume and have trouble keeping a normal blood pressure. Your risk may also be higher if you take certain medications. These include drugs called phenothiazines or general anesthetics.

What is hydromorphone?

This drug is a Schedule 2 prescription drug. It comes in the following forms:

  • oral tablet
  • oral liquid solution
  • extended-release oral tablet
  • injectable solution
  • high-potency injectable solution

The injectable solutions are only given by a healthcare provider.

Hydromorphone is available as the brand-name drugs Dilaudid and Exalgo. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name versions.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Hydromorphone is used to treat severe pain that isn’t controlled by other opioid drugs. The extended-release tablet is used for people who need daily, around-the-clock pain treatment.

How it works

This drug belongs to a class of drugs called opioid analgesics. A class of drugs is a group of medications that work in a similar way.

See Details

How it works

This drug belongs to a class of drugs called opioid analgesics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how this drug works to ease pain. It may reduce pain by acting on certain opioid-receptors in the brain and spinal cord, which make up your central nervous system.

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SECTION 2 of 5

hydromorphone Side Effects

Oral tablet

More common side effects

The more common side effects of this drug can include:

  • lightheadedness

  • dizziness

  • drowsiness

  • nausea

  • vomiting

  • sweating

  • flushing (reddening and warming of your skin)

  • euphoria (a feel-good effect)

  • dry mouth

  • itching

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Heart problems. Symptoms can include:

    • very fast or slow heart rate
    • faster pulse
    • chest pain
  • Eye or vision changes. Symptoms can include:

    • trouble seeing or blurry vision
    • double vision
    • small pupils that look like pinpoints
  • Stomach problems. Symptoms can include:

    • constipation
    • stomach pain
    • bowel blockage, which can cause:
      • nausea
      • vomiting
      • inability to pass gas or stool
  • Nervous system and muscle problems. Symptoms can include:

    • headache
    • tremors (involuntary muscle movements)
    • unusual or involuntary movement of your eyes
    • strange or prickling sensation on your skin 
  • Mood or behavior changes. Symptoms can include:

    • agitation
    • nervousness
    • anxiety
    • depression
    • hallucinations (seeing or hearing something that isn’t there)
    • disorientation
    • trouble sleeping
    • strange dreams
  • Blood pressure changes. Symptoms can include:

    • flushing
    • high or low blood pressure
  • Low blood pressure. Symptoms can include:

    • lightheadedness or feeling faint when getting up
  • Extreme drowsiness

  • Trouble breathing or shortness of breath

  • Redness and itching at the injection site (injectable forms only)

Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug can cause drowsiness and dizziness. These effects may be more likely in the first few hours after you take it.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

hydromorphone May Interact with Other Medications

Oral tablet

This drug can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

Drinking alcohol can increase your risk of side effects from this drug. These can include breathing problems, low blood pressure, extreme drowsiness, and coma. If you drink alcohol, talk to your doctor.

Medications that might interact with this drug

Interactions that increase your risk of side effects

Increased side effects of hydromorphone: Taking hydromorphone with certain medications raises your risk of side effects from hydromorphone. This is because the amount of hydromorphone in your body is increased. Examples of these drugs include:

  • Sedatives, hypnotics, or tranquilizers such as zolpidem, eszopiclone, lorazepam, clonazepam, diazepam, and haloperidol
    • Taking these drugs with hydromorphone may cause breathing problems, a drop in blood pressure, and extreme drowsiness. It can also cause a coma.
  • General anesthetics such as propofol, midazolam, and etomidate
    • Taking these drugs with hydromorphone may cause breathing problems, a drop in blood pressure, and extreme drowsiness. It may also cause a coma.
  • Prochlorperazine, promethazine, and chlorpromazine
    • Taking these drugs with hydromorphone may cause breathing problems, a drop in blood pressure, and extreme drowsiness. It may also cause a coma.
  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine, isocarboxazid, and selegiline
    • MAOIs can greatly increase your risk of side effects from hydromorphone.
  • Anticholinergic drugs such as diphenhydramine, solifenacin, tolterodine, and benztropine
    • Taking these drugs with hydromorphone can cause urinary retention (trouble passing urine), severe constipation, and bowel blockage.

Interactions that can make your drugs less effective

When hydromorphone is less effective: When you take hydromorphone with certain drugs, it may not work as well to treat your condition. This is because the amount of hydromorphone in your body may be decreased. Examples of these drugs include:

  • Pentazocine, nalbuphine, butorphanol, and buprenorphine
    • Taking these drugs with hydromorphone can also cause symptoms of opioid withdrawal if you’ve been taking hydromorphone for a long time.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
head injury warning
People with head injury and increased head pressure

This drug can increase intracranial pressure (blood pressure in your brain). This can make your condition worse. Ask your doctor if this drug is safe for you.

liver problem warning
People with liver problems

If you have liver problems or a history of liver disease, you may not be able to process this drug well. This may increase the levels of the drug in your body and cause more side effects. If you have severe liver problems, your doctor may give you a lower dosage.

kidney problem warning
People with kidney problems

If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of it in your body and cause more side effects.

pregnancy warning
Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the pregnancy. If a woman takes this drug for a long time during pregnancy, it can lead to opioid withdrawal syndrome in a newborn. This can be life-threatening for the baby.

breast feeding warning
Women who are breast-feeding

This drug may pass into breast milk and cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

senior warning
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

childrens warning
For children

This medication has not been studied in children. It should not be used in people younger than 18 years. If a child accidentally swallows this drug, it can lead to overdose. This can be fatal (cause death).

call the doctor
When to call the doctor

Call your doctor right away if you become pregnant while taking this drug.

allergy warning
Allergies

This drug can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • rash

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take hydromorphone (Dosage)

Oral tablet

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

The dosage information below is for the conditions that this drug is most often prescribed to treat. This list may not contain all conditions that your doctor can prescribe the drug for. If you have questions about your prescription, talk with your doctor.

What are you taking this medication for?

Severe pain

Generic: hydromorphone

Form: oral liquid solution
Strengths: 5 mg/5 mL
Form: oral tablet
Strengths: 2 mg, 4 mg, 8 mg
Form: extended-release oral tablet
Strengths: 8 mg, 12 mg, 16 mg, 32 mg
Form: injectable solution
Strengths: 1 mg/mL, 2 mg/mL, 4 mg/mL
Form: high-potency injectable solution
Strengths: 10 mg/mL

Brand: Exalgo

Form: extended-release oral tablet
Strengths: 8 mg, 12 mg, 16 mg, 32 mg

Brand: Dilaudid

Form: oral tablet
Strengths: 2 mg, 4 mg, 8 mg
Form: oral liquid solution
Strengths: 5 mg/5 mL
Form: injectable solution
Strengths: 1 mg/mL, 2 mg/mL, 4 mg/mL
Form: high-potency injectable solution
Strengths: 10 mg/mL
Adult dosage (ages 18–64 years)

Typical starting dosage:

  • oral solution: 2.5–10 mL (or 1/2 to 2 tsp.) once every 3–6 hours
  • oral tablet: 2–4 mg once every 4–6 hours
  • extended-release oral tablet: This form of the drug is only used in people who are taking at least 60 mg of morphine, 30 mg of oral oxycodone, or 8 mg of oral hydromorphone per day. Your doctor will tell you what dosage of hydromorphone you should take. They may increase your dosage by 4–8 mg every 3–4 days if needed./li>
  • injectable solutions: Your doctor will determine a dosage that’s right for you based on your individual needs. Your general health may affect your dosage. Tell your doctor about all health conditions you have before your healthcare provider administers the drug to you.

Dosage increases: Your doctor will adjust your dosage as needed.

Child dosage (ages 0–17 years)

This medication has not been studied in children. It should not be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dosage or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

People with kidney disease: Your doctor may start you at a dose that is 25 to 50% lower than the typical starting dose. The difference depends on how well your kidneys work.

People with liver disease: Your doctor may start you at a dose that is 25 to 50% lower than the typical starting dose. The difference depends on how well your liver works. If you have severe liver problems, your doctor may use another drug for pain relief instead of the extended-release tablet, or they may give you a lower dosage of another form of this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your pain likely won’t get better.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • severe breathing problems
  • extreme drowsiness
  • loss of consciousness
  • slow heart rate
  • low blood pressure

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

Your pain may be better controlled.

This drug is used for short-term treatment.

Important considerations for taking this drug
take with food
Take this drug with food. This may help to reduce upset stomach
timing considerations
Take this drug at the times recommended by your doctor
ok to crush
You can cut, crush, or split the oral tablet
storage considerations
Store this drug carefully
See Details
medication is not refillable
A prescription for this medication is not refillable
See Details
travel considerations
Travel considerations
See Details
clinical monitoring considerations
Clinical monitoring
See Details
not usually stocked
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead
prior authorization needed
Insurance
See Details

Store this drug carefully

  • Store this drug at room temperature between 59°F and 86°F (15°C and 30°C).
  • Store this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is not refillable

You or your pharmacy will have to contact your doctor for a new prescription if you need to refill this medication.

Travel considerations

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor may monitor certain health issues during your treatment. This can help make sure you stay safe while you take this drug. These issues include:

  • Kidney function. Your doctor may do blood tests to check how well your kidneys work. If your kidneys aren’t working well, your doctor may lower your dosage of this drug.
  • Liver function. Your doctor may do blood tests to check how well your liver works. If your liver isn’t working well, your doctor may lower your dosage or stop your use of this drug.
  • Blood pressure and heart rate. Your doctor will monitor your blood pressure and heart rate. If your blood pressure gets too low, your doctor may lower your dosage or stop your treatment with this drug.
  • Breathing rate. Your doctor will monitor your breathing. If this drug affects your breathing, your doctor may lower the dosage or stop your treatment with it.

Insurance

Many insurance companies require a prior authorization for this drug. That means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does hydromorphone Cost?

Oral tablet

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Lowest price for hydromorphone

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Kroger Pharmacy $9.99
These prices represent the lowest priced national pharmacies for hydromorphone on GoodRx. They may be lower than your insurance.

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These prices represent the lowest priced national pharmacies for hydromorphone on GoodRx. They may be lower than your insurance.

Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 19, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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