Dilaudid vs. Oxycodone: Which Is Better for Pain?

Dilaudid vs. Oxycodone: Which Is Better for Pain?


Dilaudid and oxycodone are both prescription opioids. Opioids are a group of strong pain relieving drugs, which includes morphine. These drugs lessen the strength of pain signals that reach the brain and affect your emotional response to pain. Dilaudid is the brand name for the generic drug hydromorphone hydrochloride. Oxycodone is the main ingredient in the brand name drugs OxyContin and Percocet.

Similarities and Differences

Hydromorphone hydrochloride and oxycodone are somewhat similar. Both can be given in tablet form, and are available in liquids. Both drugs also have extended-release forms, which are given to those who have taken opioids for a long time and need a higher, controlled dose of the drug to be comfortable.

Dilaudid and other versions of hydromorphone are stronger drugs than oxycodone. These drugs are often used for serious pain caused by surgery, broken bones, or cancer. The World Health Organization's (WHO) three-step ladder for treating cancer pain, explains that the first step in treating cancer pain would be non-opioid analgesic medications. These drugs are available without a prescription and include aspirin, ibuprofen, and acetaminophen (Tylenol). When patients don’t get enough relief from over-the-counter medications, the second step would be mild opioids (like codeine). The third step would be potent opioids such as oxycodone and hydromorphone. WHO also recommends scheduled dosing, instead of giving the drugs only as needed, for serious pain.


Oxycodone dosing depends on the needs of the patient, as well as whether the drug is in liquid form or as a tablet designed for immediate or extended-release. The dose of hydromorphone also depends on its form, too. The immediate release forms are usually dosed every 4–6 hours, and the strength of oxycodone or hydromorphone can be gradually increased if a patient develops a tolerance for the drugs or if the severity of pain increases.

The dose will depend on the cause of your pain and will be determined by your doctor. If you take one of these drugs for a long time and your dose goes up, your doctor may change your prescription to the extended-release form.

Side Effects of Each

The most common side effects of oxycodone and hydromorphone are similar. Hydromorphone is very potent, so its side effects can be more intense. Side effects for these drugs can include:

  • shallow or light breathing
  • constipation, which can be severe, especially with extended-release forms
  • drowsiness
  • dizziness or lowered blood pressure, when standing up
  • nausea
  • headache
  • mood changes
  • vomiting
  • lethargy
  • insomnia
  • dry mouth
  • itching
  • skin rash
  • motor skill impairment

Severe, though less common side effects include:

  • respiratory depression (the risk is higher in older adults, those with serious illnesses, and those who have respiratory disease)
  • seizures
  • hallucinations
  • feeling like you might pass out or have lowered blood pressure (this risk is greater in those who have reduced blood volume or who are in shock)
  • hypersensitivity reaction (could include itching, hives, trouble breathing, or swelling of the tongue or throat)
  • nervousness
  • uncontrolled muscle movements
  • rapid heartbeat (leading to possible heart failure)
  • painful urination
  • confusion
  • depression

Get immediate help or call 911 if you experience any of these symptoms.

Less common side effects of hydromorphone include:

  • heart palpitations
  • respiratory complications
  • skin rashes

As mentioned, the extended-release forms of these drugs can cause severe constipation, which can be dangerous. This is especially true for hydromorphone. This is one reason why extended-release forms are reserved for those who have taken the drug long term, and who need an increased dose.

Do not drive if you are taking oxycodone or hydromorphone. Both drugs affect your ability to drive or use machinery, as well as your judgement and physical skills.

If you take either drug for several weeks or months, there is a major risk of becoming dependent. Long-term use means your body can adjust to the drug and if you suddenly stop taking it, you may experience withdrawal symptoms. Talk to your doctor before you stop taking either medication. Your doctor can help you taper off the medication slowly, which reduces the risk of withdrawal.

Both of these drugs can also lead to overdose and are very dangerous for children. Keep your medication locked and away from any children in your household. Because hydromorphone is so potent, if a child takes just one extended-release tablet, it could be fatal. 

Warnings and Interactions

Hydromorphone comes with a black box warning on its label, which means research has found the drug may have serious and even life-threatening side effects. One of the main concerns with hydromorphone is a condition known as respiratory depression, which means a person isn’t getting enough oxygen into their system. Hydromorphone may also cause a drop in blood pressure, and should be used carefully, if at all, in individuals who already suffer from low blood pressure or who take medications to lower their blood pressure.

Oxycodone also carries serious warnings. Like hydromorphone, oxycodone can enhance the depressant effects of alcohol. Oxycodone can also cause gastrointestinal complications, too.

Both drugs are also commonly misused and abused by people who don’t need the medications for pain relief. They can become habit-forming if taken consistently for weeks or months. You could find yourself taking more than the prescribed dose, or taking the drug more frequently than prescribed, which means you may be becoming dependent on the drug. You may need to taper off the drug gradually because if you stop taking it suddenly, you could experience withdrawal. Talk to your doctor to get help tapering off either medication.

Choosing the Right Drug

Whether oxycodone or hydromorphone is the right pain reliever for you depends primarily on the type of pain you’re experiencing. As noted earlier, hydromorphone is the more powerful medication. Your doctor will decide what kind of pain relief you need and will probably start you on a short-acting drug first. If your pain is not well controlled, you may need an extended-release version or may need to take a more potent drug like hydromorphone. Severe pain can have a debilitating effect on your quality of life. When these drugs are used as prescribed and for short periods of time, they can provide much needed relief.

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