Hydromorphone vs. Morphine: How Are They Different?

Medically reviewed by Alan Carter, PharmD on October 24, 2017Written by University of Illinois-Chicago, Drug Information Group

Introduction

If you have severe pain and haven’t found relief with certain medications, you may have other options. For example, Dilaudid and morphine are two prescription drugs used to treat pain after other medications haven’t worked.

Dilaudid is the brand-name version of the generic drug hydromorphone. Morphine is a generic drug. They work in similar ways, but they also have a few notable differences. Compare the two drugs here to learn if one may be a good option for you.

Drug features

Both medications belong to a class of drugs called opioid analgesics, also known as narcotics. They work on the opioid receptors in your nervous system. This action changes the way you perceive pain to help you to feel less pain.

Hydromorphone and morphine each come in several forms and strengths. The oral forms (taken by mouth) are most commonly used. All forms can be used at home, but injectable forms are more often used in the hospital.

Both drugs can cause severe side effects and can be addictive, so you should take them exactly as prescribed. If you’re taking more than one pain medication, be sure to follow the dosage instructions for each drug carefully so you don’t mix them up. If you have questions about how to take your medications, ask your doctor or pharmacist.

The chart below further describes the features of both medications.

Hydromorphone Morphine
What are brand names for this drug?Dilaudid, ExalgoKadian, Duramorph PF, DepoDur, Infumorph, Morphabond, MS Contin
Is a generic version available?yesyes
What does this drug treat?painpain
What is the typical length of treatment?decided by your doctordecided by your doctor
How do I store this drug?at room temperature* at room temperature*
Is this a controlled substance?**yesyes
Is there a risk of withdrawal with this drug?yes†yes†
Does this drug have potential for misuse?yes¥yes¥

* Check the package instructions or your doctor’s prescription for exact temperature ranges.

** A controlled substance is a drug that is regulated by the government. If you take a controlled substance, your doctor must closely supervise your use of the drug. Never give a controlled substance to anyone else.

† If you’ve been taking this drug for longer than a few weeks, don’t stop taking it without talking to your doctor. You’ll need to taper off the drug slowly to avoid withdrawal symptoms such as anxiety, sweating, nausea, and trouble sleeping.

¥ This drug has a high misuse potential. This means you can get addicted to it. Be sure to take this drug exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.

A key difference between these drugs is the forms they come in. The table below lists the forms of each drug.

FormHydromorphoneMorphine
subcutaneous injection X
intravenous injectionXX
intramuscular injectionnot recommendedX
immediate-release oral tabletXX
extended-release oral tabletXX
extended-release oral capsule X
oral solutionXX
oral solution concentrate X
rectal suppositoryXX

Cost, availability, and insurance

All forms of hydromorphone and morphine are available at most pharmacies. However, it’s best to call your pharmacy ahead of time to make sure they have your prescription in stock.

In most cases, generic forms of drugs cost less than brand-name products. Morphine and hydromorphone are generic drugs. At the time this article was written, hydromorphone and of morphine had similar prices, according to GoodRx.com. The brand-name drugs Dilaudid and Exalgo were more expensive than the generic forms of morphine. In any case, your out-of-pocket cost will depend on your health insurance coverage.

Side effects

Hydromorphone and morphine work similarly in your body. They also share similar side effects.

The chart below lists examples of side effects of hydromorphone and morphine.

Both drugsHydromorphoneMorphine
dizzinesstrouble falling asleep or staying asleepdiarrhea
drowsinesslightheadednessweight loss
nauseamuscle, back, or joint painweakness
vomitinganxietyagitation
stomach pain and crampsdepressionnervousness
headacheitchinessmood changes
loss of appetiteflushing (reddening and warming of your skin)confusion
dry mouthlightheadedness when changing positionssmall pupils
sweating difficulty or pain when urinating
swelling of your eyes, face, mouth, lips or throat itching
rash blue or purple skin
hives heart rate changes
extreme drowsiness fever
fainting
chest pain
seizures
trouble breathing or swallowing
hoarseness

Drug interactions

Interactions with either drug

Hydromorphone and morphine are narcotics that work in the same way, so their drug interactions are also similar. Interactions for both drugs include the following:

Anticholinergics

Using hydromorphone or morphine with one of these drugs raises your risk of severe constipation and not being able to urinate.

Monoamine oxidase inhibitors

You shouldn’t take hydromorphone or morphine within 14 days of taking a monoamine oxidase inhibitor (MAOI). Taking either drug with an MAOI or within 14 days of using an MAOI can cause:

  • breathing problems
  • low blood pressure
  • extreme tiredness
  • coma

Other pain medications, phenothiazines (mental health drugs), tranquilizers, and sleeping pills

Mixing hydromorphone or morphine with any of these drugs may cause breathing problems, low blood pressure, extreme tiredness, or coma. You should talk to your doctor before using hydromorphone or morphine with any of these drugs.

Interactions with morphine only

Morphine also interacts with other drugs. For example, taking morphine with a diuretic may decrease how well your diuretic works. Morphine can also increase your risk of bleeding when used with blood thinners such as warfarin. Skeletal muscle relaxants, cimetidine (a heartburn drug), and drugs that block the enzyme P-Glycoprotein, such as atorvastatin, erythromycin, and ketoconazole, can all cause trouble breathing if you take any of them with morphine.

Use with other medical conditions

If you have certain health issues, they may change how hydromorphone and morphine work in your body. It may not be safe for you to take these drugs, or your doctor may need to monitor you more closely during your treatment.

You should talk to your doctor before taking hydromorphone or morphine if you have breathing problems such as chronic pulmonary disease (COPD) or cor pulmonale. These drugs have been linked with serious breathing problems that can cause death.

You should also talk about your safety if you have a history of drug abuse or addiction. These drugs can be addictive and increase your risk of overdose and death.

Examples of other medical conditions you should discuss with your doctor before taking hydromorphone or morphine include:

  • biliary tract problems
  • kidney issues
  • liver disease
  • a history of head injury
  • low blood pressure
  • seizures
  • gastrointestinal obstruction, especially if you have paralytic ileus

Also, if you have an abnormal heart rhythm, talk to your doctor before using morphine. It may make your condition worse.

Talk with your doctor

Both hydromorphone and morphine are very strong pain medications. They work in similar ways and have a lot in common, but they do have slight differences in forms, dosage, and side effects. Morphine also interacts with more drugs than hydromorphone does.

If you have questions about these drugs, talk with your doctor. They can answer your questions and select the drug that’s best for you based on your health, current medications, and other factors.

CMS Id: 109454