1. Hydromorphone oral tablet is available as both a generic and brand-name drug. Brand names: Dilaudid and Exalgo.
  2. Hydromorphone is also available in a liquid oral solution and a solution that a healthcare provider gives you in an injection.
  3. Hydromorphone oral tablet is an opioid that’s used to treat severe pain that isn’t controlled by other treatments.

Hydromorphone oral tablet is a prescription drug that’s available as the brand-name drugs Dilaudid (immediate release) and Exalgo (extended release). Both the immediate-release and extended-release tablets are also available as generic drugs. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name versions.

Hydromorphone also comes in the following forms:

  • oral liquid solution
  • injectable solution
  • high-potency injectable solution

The injectable solutions are only given by a healthcare provider.

Hydromorphone oral tablet is a controlled substance. Your use of this drug will be closely monitored by your doctor.

Why it’s used

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

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

How it works

Hydromorphone oral tablet 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.

Hydromorphone oral tablet can cause drowsiness and dizziness. These effects may be more likely in the first few hours after you take it. This drug can also cause other side effects.

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
  • Adrenal insufficiency. Symptoms can include:
    • long-lasting tiredness
    • muscle weakness
    • pain in your abdomen
  • Androgen deficiency. Symptoms can include:
    • tiredness
    • trouble sleeping
    • decreased energy
  • Extreme drowsiness
  • Trouble breathing or shortness of breath

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.

Hydromorphone oral tablet 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.

Examples of drugs that can cause interactions with hydromorphone are listed below.

Interactions that increase your risk of side effects

Increased side effects of hydromorphone: Taking hydromorphone with certain medications raises your risk of side effects. Examples of these drugs include:

  • Benzodiazepines such as lorazepam, clonazepam, and diazepam: Taking these drugs with hydromorphone may cause breathing problems, a drop in blood pressure, and extreme drowsiness. It can also cause coma or death.
  • 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 hydromorphone toxicity (having dangerous levels of the drug in your body). The use of hydromorphone is not recommended if you take MAOIs or within 14 days of stopping treatment with an MAOI.
  • 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.

Increased side effects from other drugs: Taking hydromorphone with certain medications raises your risk of side effects from those drugs. Examples of these drugs include:

  • Serotonergic drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs): Taking these drugs with hydromorphone may cause serotonin syndrome, which can be fatal. Symptoms can include agitation, sweating, muscle twitches, and confusion.

Interactions that can make your drugs 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.

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

Forms and strengths

Generic: Hydromorphone

  • Form: oral tablet
  • Strengths: 2 mg, 4 mg, 8 mg
  • Form: extended-release oral tablet
  • Strengths: 8 mg, 12 mg, 16 mg, 32 mg

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

Dosage for severe pain

Adult dosage (ages 18–64 years)

  • Oral tablet: Typical starting dosage is 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.

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 percent to 50 percent lower than the typical starting dose.

People with liver disease: Your doctor may start you at a dose that is 25 percent to 50 percent lower than the typical starting dose. 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 speak with your doctor or pharmacist about dosages that are right for you.

FDA warnings:

  • This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about 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).
  • Misuse, abuse, and diversion warning: This drug is a Schedule II 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.
  • Risk Evaluation and Mitigation Strategy (REMS): ): Because of this drug’s risk of abuse and addiction, the FDA requires that the drug’s manufacturer provide a REMS program. Under the requirements of this REMS program, the drug manufacturer must develop educational programs regarding the safe and effective use of opioids for your doctor.
  • 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. Symptoms of withdrawal may include: irritability, hyperactivity and unusual sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, and failure to gain weight.

Other warnings

This drug comes with several other warnings.

Low blood pressure warning

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.

Allergy warning

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).

Alcohol interaction warning

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.

Warnings for people with certain health conditions

For 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.

For 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.

For 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.

Warnings for other groups

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

For women who are breastfeeding: 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.

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.

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).

Hydromorphone oral tablet is generally used for short-term treatment. 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 seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 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.

Keep these considerations in mind if your doctor prescribes hydromorphone oral tablet for you.

General

  • Take this drug with food. This may help to reduce upset stomach.
  • Take this drug at the times recommended by your doctor. Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead.
  • You can cut, crush, or split the immediate-release tablet. Do not cut or crush the extended-release tablet.

Storage

  • 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.

Refills

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

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 container 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.

Prior authorization

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.

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.

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.