Author: Nancy Swezey, RN

Dilaudid is a brand name for the medication hydromorphone. It is used to manage moderate to severe pain that is untreatable by alternative methods. Dilaudid is one of the most frequently prescribed opioids. Prescriptions of it have gone down in recent years as a response to the opioid crisis from 3.5 million prescriptions in 2016 to 2.7 million in 2018.¹

Dilaudid is a controlled substance, meaning that its manufacturing, possession, and distribution are overseen and regulated by the government for safety. The U.S. Drug Enforcement Administration (DEA) lists Dilaudid as a Schedule II drug due to its high potential for dependence and misuse.¹ For this reason, prescribers are encouraged to use the lowest dose of medication over the shortest possible period of time to manage your pain and minimize your risks.

Dilaudid Side Effects

Dilaudid has several common side effects including:¹

• Constipation
• “Pinprick” pupils
• Slow shallow breathing
• Cough suppression
• Sleepiness
• Low blood pressure

In addition to treating pain, taking Dilaudid has the following effects, which contribute to its risk for misuse and dependence:¹

• Euphoria
• Feelings of relaxation
• Improvement in feelings of anxiety

Dilaudid Dosage

Dilaudid comes in oral tablets, oral liquid solutions, rectal suppositories, and injection forms.⁴ A common initial dose range is 2-4 mg every 4-5 hours as needed for the tablet form, and 2.5-10 mg of oral solution every 3-6 hours as needed.⁴

Doses of intravenous (IV) Dilaudid are much lower than the oral doses. This is related to how much of the medication is metabolized in your intestines and liver before reaching your bloodstream in the oral form. Because IV medications bypass this metabolism, lower doses are needed to achieve the same effect. You will feel the effects of Dilaudid 15 minutes after injection, or 30 minutes after oral intake. The effect usually lasts for more than 5 hours.¹

The dose of Dilaudid you receive depends on the extent of your pain and your tolerance of the medication. If you have a history of opioid use, you may require higher initial doses than someone who has never taken them.

Dosing of Dilaudid also depends on:⁴

• Your age
• Your kidney health
• Your liver’s health

Dosing for children is often dependent on their weight. Normal pediatric doses are generally much lower than adult doses. Older adults are also prescribed lower doses because often their kidneys are less efficient at clearing medications than younger people. This puts them at risk for accumulation of the medication in their bloodstream. They are also more sensitive to medications that affect your central nervous system than younger people.⁴

Dilaudid is metabolized in your liver and cleared by your kidneys. For this reason, if you have compromised liver or kidney health, you will likely be prescribed lower doses of Dilaudid. If you have severe liver disease, you may have to be given an alternative to Dilaudid.

Dilaudid Precautions

Strict adherence to prescribed dosing is essential for the safe use of Dilaudid. An error in dosing can lead to overdose and death. For example, one common error if you are prescribed the oral liquid solution is to confuse milligram (mg) with milliliters (ml). Milligrams refers to the strength of Dilaudid while milliliters refer to the amount of liquid. The manufacturer warns against confusing these two terms, which can lead to an accidental overdose.² Your prescriber should write both the milligram and milliliter amount on your prescription to avoid this dangerous error.

Though taking even prescribed doses can prevent the more serious side effects and overdose, it cannot protect you from the risk of misuse, dependence, or withdrawal. These can happen even if you take Dilaudid as prescribed.²

Non-Prescription Dilaudid

One major concern for Dilaudid is diversion, the sharing or selling of prescribed Dilaudid to those without a prescription. It also encompasses healthcare professionals who take it from their workplace to use themselves, share, or sell.¹ Other forms of diversion include:¹

• Forging a prescription
• Doctor shopping, or going to multiple doctors to get excessive medication
• Pharmacists, doctors, and other providers diverting from work
• Robbery of pharmacies and nursing homes

Diversion is the means by which prescription medications with the potential for misuse like Dilaudid can become street drugs. Street names for Dilaudid include:¹

• Dust
• Juice
• Dillies
• Smack
• D
• Footballs

Dilaudid Overdose

Dilaudid overdose is a potentially fatal medical emergency. Symptoms of Dilaudid overdose include:¹

• Stupor
• Coma
• Muscle weakness and loss of tone
• Cold and clammy skin
• Slow heart rate
• Low blood pressure
• Death

Dilaudid overdose can be reversed by naloxone, better known by its brand name, Narcan. Narcan rapidly reverses the effects of opioids and puts the person into immediate withdrawal. It is considered a rescue medication. If you are prescribed opioids like Dilaudid for medical needs and you have a history of overdose, withdrawal, or opioid use disorder, your prescriber may prescribe you naloxone in addition to Dilaudid as a precaution.

Dilaudid vs. Morphine

Historically morphine has been the first-line hospital treatment for pain, but in recent years production and use of Dilaudid have surpassed morphine in that setting.⁵ Both medications have the same interactions and precautions with other medications, as well as the same misuse and dependence potential. Like Dilaudid, morphine has the potential for overdose, which can be reversed by Narcan.¹

Dilaudid is significantly more potent than morphine, meaning that at any given dose, Dilaudid is 5-10 times stronger than morphine. You’d have to take 30 mg of morphine to get the same result as 7.5 mg of Dilaudid, or 7.5 mg of morphine to get the same effect as 1.3 mg of Dilaudid.¹ Those who use Dilaudid are considered more at risk for addiction since Dilaudid acts faster to produce euphoria and pain relief than morphine. In one study, more patients taking hydromorphone than morphine required Narcan, as a life-saving rescue measure for opioid overdose.⁵

Dilaudid and Reproduction

Ongoing, especially heavy, use of opioids can jeopardize your reproductive function. If you are already pregnant, the benefits of using Dilaudid must be weighed against the risks of affecting your infant and compromising your pregnancy. Dilaudid both crosses the placenta and enters into breast milk, affecting both the fetus and the newborn. Infants can be dependent on Dilaudid, and if not recognized, untreated infant opioid withdrawal can be a fatal event.³

Dilaudid Misuse

Opioid use disorder begins with misuse. Misuse is taking medication for non-medical purposes. Misusing Dilaudid includes taking more than prescribed, or taking it when it is not prescribed to you. Some people develop a dependence on opioids even while taking it as prescribed to them, and then graduate to smoking or injecting street analogs of Dilaudid, such as heroin.

Opioid use disorder puts you at high risk for overdose and subsequent death. If you have a history of substance use disorder or overdose, it is important to discuss this with your prescriber. They can help you access the resources you may need to be safe while taking Dilaudid. They can also help you find alternatives to treat your pain.

Opioid Use Disorder

As Dilaudid is an opioid, it is implicated in opioid use disorder. This involves ongoing hazardous use of opioids that causes significant damage and duress to your quality of life. Opioid use disorder is diagnosed if you have experienced at least two of the following in a 1-year period:

• Taking more medication than intended
• Desire to stop or slow down and inability to do so
• Excessive time spent finding, using, or recovering from opioid use
• Cravings for opioid
• Failure to meet school, home, or work responsibilities related to your use
• Continuous use despite social and interpersonal problems related to your use
• Giving up social, professional, or recreational activities because of your use
• Patterns of finding yourself in physically precarious situations related to your use
• Continuing use despite physical or mental problems caused by overuse
• Experiencing opioid tolerance: needing higher doses to achieve the same effect
• Experiencing withdrawal or avoiding withdrawal by continuous use

Dilaudid and the Opioid Crisis

Thanks to increased awareness since the onset of the opioid crisis, there has been a considerable decrease in Dilaudid and other opioid prescriptions and overdoses in recent years, as well as increased resources for treatment. The Center for Disease Control and Prevention (CDC) for example dedicates an entire page to educating and offering access to resources for treatment for opioid misuses including medications, treatment centers, and counseling.⁶ You can also contact 800-934-1582(Who Answers?) to speak to a treatment specialist.

References

1. DEA Hydromorphone. (2019). Drug Enforcement Administration Diversion Control Division Drug & Chemical Evaluation Section.
2. Purdue Pharma L.P. (2016). Dilaudid (hydromorphone hydrochloride). Stamford, CT.
3. Abbot Laboratories, Inc. (n.d.). Dilaudid Oral Liquid & Dilaudid Tablets. North Chicago, Il.
4. Lexicomp. (n.d.). Hydromorphone: Drug Information. Retrieved March 10, 2021.
5. Gulur, P., Koury, K., Arnstein, P., Lee, H., McCarthy, P., Coley, C., & Mort, E. (2015). Morphine versus hydromorphone: does choice of opioid influence outcomes? Pain research and treatment, 2015.
6. Center for Disease Control and Prevention. (2020, August 12). Recovery is possible. Retrieved March 14, 2021.