Dilaudid (hydromorphone) is a potent opioid analgesic, prescribed to treat chronic or acute severe pain. It is also a widely misused drug and can lead to serious adverse effects, overdose, abuse, and addiction. Understanding Dilaudid side effects and risks can help people use the drug safely and know when to seek professional advice and support.
- Dilaudid (hydromorphone) is an opioid pain relief medication, classified as a Schedule II controlled substance.
- Dilaudid can cause mild to severe side effects and has a risk of abuse and addiction.
- Professional advice and treatment can help people reduce or stop Dilaudid misuse and manage addiction.
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How Dilaudid (hydromorphone) works in the body
Dilaudid (hydromorphone) is an opioid medication that is a derivative of morphine. It is highly potent, over five times more potent than morphine, and produces similar side effects to morphine. [1]
Hydromorphone binds to different opioid receptors, particularly the mu-opioid receptor, which is the likely cause of its strong analgesic effects. Dilaudid is an immediate-release form of hydromorphone that begins working within 15-20 minutes, and the effects last for 3-4 hours. Extended-release hydromorphone is also available, with effects emerging in 6 hours and lasting for 13 hours. [1][2]
Common side effects of Dilaudid
Serious and life-threatening side effects
In some cases, serious and life-threatening effects can occur when taking Dilaudid. If any of the following side effects occur, EMS should be contacted immediately: [3][4]
- Significant change in heart rate and blood pressure
- Seizure
- Trouble breathing
- Slowed or stopped breathing
- Impaired vision
- Vomiting or diarrhea that does not go away
- Urinary retention
- Fainting
- Shaking and tremor
- Hallucinations
- Extreme changes in mood
Long-term health risks
Using Dilaudid long-term can increase the risk of: [3]
- Dependence and addiction: Hydromorphone is highly addictive and can cause physical dependence within several weeks of use.
- Neonatal drug withdrawal syndrome: People who are pregnant and using Dilaudid may see signs of neonatal drug withdrawal syndrome in their newborn.
- Decreased fertility: Dilaudid can decrease fertility in men and women.
- Respiratory issues: Long-term use of Dilaudid can contribute to impaired respiratory function and may increase the risk of respiratory depression or arrest.
High-risk populations & precautions
People with the following conditions or circumstances may be at higher risk of experiencing adverse effects when taking Dilaudid: [3][4]
- People who are pregnant or breastfeeding
- People with a history of substance use issues
- People with liver or kidney problems
- Older adults
- People who have experienced issues with stomach or intestinal function
- People with a history of seizures, diabetes, enlarged prostate, low blood pressure, adrenal insufficiency, or gallbladder, pancreas, or thyroid disease
Interactions
Dilaudid can interact with other medications and substances, causing an increased risk of adverse effects or changes in the effects of the medication.
Central nervous system (CNS) depressants, including other opioids, alcohol, and benzodiazepines, can increase the risk of respiratory depression, coma, and death when used alongside Dilaudid. [3]
Other possible interactions with Dilaudid include some antibiotics and some antidepressants. [4] Examples of antidepressants that may interact with Dilaudid are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and paroxetine (Paxil), serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor), and tricyclic antidepressants (TCAs) such as amitriptyline. These interactions may increase the risk of serotonin syndrome or alter the effects of Dilaudid.
Always discuss medication and substance use with the prescribing doctor before commencing a new treatment.
Signs of Dilaudid overdose
Dilaudid use can cause overdose, which may be serious or life-threatening. Signs of Dilaudid overdose can include: [2][4]
- Difficulty breathing
- Slow or shallow breathing
- Extreme sedation
- Unresponsiveness
- Cold, clammy skin
- Significantly slowed heart rate
- Dizziness and fainting
- Weakness
- Loss of consciousness
If a Dilaudid overdose is suspected, call 911 immediately, as life-saving care may be required. Naloxone can be administered in the case of Dilaudid overdose, as it is an opioid antagonist that reverses the effects of hydromorphone. [3]
Managing side effects & staying safe
People taking Dilaudid can report any side effects to the prescribing doctor, who can help manage unpleasant symptoms. Any serious side effects may require a change in dosage or medication, which can also be discussed with the prescribing physician.
Typically, a new Dilaudid treatment will be commenced slowly, with gradual dose increases. This can help reduce the severity of side effects when starting a new medication. [3] Side effects that emerge with a new treatment will typically reduce on their own within a few weeks. Effects such as drowsiness and dizziness often occur at the start of a new treatment, so it is advised not to drive or operate heavy machinery until these effects are known and to rise from lying or seated positions slowly, to help prevent falls. [4]
It is important to take Dilaudid exactly as prescribed.
Signs of dependence & what to do
Using Dilaudid, whether as prescribed or illicitly, can result in the development of tolerance and dependence, particularly with prolonged use. As tolerance develops, the impact of the medication reduces, resulting in a need for increased doses to achieve the same effects. This can contribute to the misuse or abuse of Dilaudid. [3]
Physical dependence develops as the body becomes reliant on the substance, which leads to withdrawal symptoms when use is reduced or stopped, or antagonists are administered. [2]
Common withdrawal symptoms of Dilaudid include sweating, chills, irritability, pain, weakness, cramping, insomnia, nausea, and changes in heart rate and blood pressure. These symptoms can range from mild to severe. As such, Dilaudid use should not be stopped abruptly, and doses should be reduced slowly. [3]
Addiction, misuse, and withdrawal
Dilaudid is a commonly misused substance and has a high potential for addiction. Misuse can occur in people who have been prescribed the medication or those who have used it illicitly. This can include administering the substance in an unintended manner, such as crushing and snorting or injecting, and the development of addictive behaviors. [5]
Withdrawal from Dilaudid following the development of addiction may require professional support to manage withdrawal symptoms and addictive or drug-seeking behaviors, and can help reduce the risk of relapse. [2]
Comparing Dilaudid to other opioids
Dilaudid is between 5-7 times more potent than morphine and 2-3 times more potent than hydrocodone and oxycodone. Fentanyl is around 20 times more potent than hydromorphone. [1][6]
In terms of analgesic effects and side effects, evidence suggests that hydromorphone and other opioids are very similar. [7]
All opioid analgesics carry a risk of addiction, abuse, and harm. As such, these medications, including oxycodone, hydrocodone, codeine, and legally produced fentanyl, are all Schedule II controlled substances. [8]
When to seek emergency help
People taking hydromorphone may require professional help if:
- They experience severe side effects or symptoms that worsen and persist
- They no longer feel the analgesic benefit of the dosage they have been prescribed
- It is suspected that an intentional or unintentional overdose of hydromorphone has occurred
- They are showing signs of addiction, such as using increasing amounts, social, professional, or personal impairments, and/or physical or mental harm
The prescribing physician can make any necessary adjustments to the medication. A doctor or specialist can refer to or provide appropriate services to help reduce and stop harmful hydromorphone use.
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