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Dilaudid (Hydromorphone): Uses, Side Effects & More

July 1, 2022

Table of Contents

Dilaudid is the brand name of the potent opioid hydromorphone, which is prescribed to relieve moderate to severe pain. 

As an opioid medication, Dilaudid can suppress the central nervous system and lead to a potentially life-threatening overdose, especially when the medication is misused. 

Dilaudid is habit-forming even when taken as directed. Physical and emotional withdrawal symptoms may appear when the medication is stopped. 

Dilaudid is commonly misused, and it is highly addictive. Nearly 2.5 million Americans ages 12 and older had an opioid use disorder (OUD) involving a prescription pain reliever such as Dilaudid in 2020. 

OUD is a treatable disease with several evidence-based care options that support ongoing recovery.

What Is Dilaudid?

This is a prescription narcotic pain reliever. It is made up of the opioid drug hydromorphone, which is between two and eight times more potent than morphine. It also has a greater sedation effect and a shorter duration of action than morphine. 

Dilaudid is available in tablet form, rectal suppositories, oral solutions, injectable formulations, and as an extended-release tablet.

Dilaudid is an opioid drug, which makes it a central nervous system depressant. It slows down heart rate and respiration while lowering blood pressure and body temperature. It binds to opioid receptors in the brain to block pain. 

Uses

Dilaudid is prescribed for moderate to severe pain. The liquid formulation is generally taken every three to six hours as needed, while the tablet is taken every four to six hours. 

The extended-release formulation is designed to be taken by those who are opioid-tolerant and require around-the-clock pain management. It may be used when other treatment methods are not an option.

Dilaudid Side Effects

Side Effects of Dilaudid

Dilaudid suppresses the central nervous system and can therefore cause sedation, drowsiness, problems breathing, a slow heart rate, and reduced blood pressure. 

These are other potential side effects:

  • Headache
  • Dry mouth 
  • Lightheadedness
  • Constipation
  • Stomach pain
  • Itchiness
  • Depression
  • Sleep issues
  • Joint, back, or muscle pain
  • Anxiety
  • Flushing

If you experience more serious side effects, such as agitation, hallucinations, seizures, chest pain, extreme drowsiness, hives, trouble swallowing or breathing, nausea and vomiting, fainting, irregular menstruation, a lack of sexual desire, inability to keep an erection, or swelling, seek immediate medical attention.

Precautions

People with a potential opioid allergy should not take Dilaudid. Those who are pregnant or breastfeeding should talk to their doctor first. 

Dilaudid can cause abdominal issues. If you have had gastrointestinal surgery or a history of abdominal issues, it may not be ideal for you. 

The elderly or people who fall into the special risk category lined out in the FDA labeling should talk to their doctors before starting Dilaudid. They should also potentially begin with a lower dose.

Dilaudid can cause cognitive and mental impairment. You should know how it impacts you before operating heavy machinery or a motor vehicle. 

The medication should be used with particular caution by those with a history of drug or alcohol misuse.

Talk to your doctor about any medications or supplements you are taking as many may interact with Dilaudid.

Interactions

Dilaudid can interact with a variety of both prescription medications and supplements, which can include the following:

  • St. John’s wort
  • Tryptophan
  • Medications for migraines
  • Benzodiazepines
  • Antidepressant medications
  • Medications for glaucoma
  • Buprenorphine products
  • Cough suppressants
  • Medications for urinary problems and ulcers
  • Parkinson’s disease medications
  • Medications for irritable bowel syndrome

Dilaudid can potentially interact with even more medications than those listed. Be sure to talk to your doctor about anything you are taking before beginning Dilaudid.

Overdose

Dilaudid is an opioid medication. Nearly three-quarters of the more than 70,0000 drug overdose deaths in 2019 in the United States involved an opioid drug. Opioid drugs slow down life-sustaining functions and can quickly lead to a potentially fatal overdose. 

An opioid overdose can have the following signs:

  • Pinpoint pupils
  • Trouble breathing
  • Bluish tint to skin, nails, and/or lips
  • Drops in blood pressure and heart rate
  • Lack of coordination and balance
  • Nausea and/or vomiting
  • Dizziness
  • Mental confusion or agitation
  • Sedation and an inability to wake up

Dilaudid overdose is a medical emergency, requiring immediate professional help.

Withdrawal Symptoms

Dilaudid is a habit-forming medication, which means that with regular use, the brain and body can get used to its interaction. A dependence can form. 

When this happens, withdrawal symptoms can occur as soon as the drug wears off. These can be both psychological and physical. They may include the following:

  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain and cramps
  • Headaches
  • Sweatiness
  • Goosebumps
  • Dizziness
  • Muscle aches and back pain
  • Insomnia
  • Anxiety
  • Depression
  • Irritability
  • Restlessness
  • Trouble concentrating and focusing

Dilaudid Misuse 

Dilaudid is one of the most commonly misused painkillers. Its street names include “dust”, “footballs”, “dillies”, “D”, “smack”, and “juice”. 

The medication is often diverted through “doctor shopping,” forged prescriptions, and nursing home and pharmacy robberies. 

Dilaudid can be misused by crushing tablets to snort or inject. Any use of the medication outside of its prescription and dosing directions is considered misuse. 

Of all of the people taking hydromorphone products in 2020, nearly 17% report misuse - over 350,000 people that year alone. 

Regular use of Dilaudid can lead to dependence and opioid use disorder. In 2020, approximately 2.7 million Americans ages 12 and older had opioid use disorder (OUD) with Dilaudid being one of the more common drugs of abuse.

Signs of Dilaudid Misuse

Any use of Dilaudid in a way it was not prescribed is considered misuse. This can include chewing the tablets, crushing and snorting, dissolving and injecting them, or altering them to take them in a way other than intended. It can also mean taking the medication without a prescription.

These are some things to look for that can indicate Dilaudid misuse:

  • Mood swings
  • Changes in appetite and eating patterns
  • Irregular sleep schedules
  • Going to more than one doctor to get prescriptions
  • Continuing to take Dilaudid after the prescription has run out
  • Exaggerating symptoms to get more Dilaudid
  • Keeping Dilaudid close at hand in multiple locations
  • Taking more and higher doses or taking Dilaudid in between doses
  • Social withdrawal and isolation
  • Decreased interest in activities or things that were important before
  • Drop in grades at school or production at work
  • Talking a lot about Dilaudid, where to get it, obtaining it, and using it

Side Effects of Dilaudid Misuse

Two of the most serious side effects of Dilaudid misuse are overdose and opioid use disorder. 

Dilaudid is a powerful narcotic that can lead to fatal overdose, especially if it is misused and/or taken with other substances like sedatives or alcohol. 

It is also highly addictive. Misusing the medication increases the risk for developing opioid use disorder. 

Treatment Options

Treatment for Dilaudid misuse and opioid use disorder can include either inpatient or outpatient options. Both models often include the following:

  • Group and individual therapy sessions involving behavioral therapy interventions, such as cognitive behavioral therapy (CBT)
  • Counseling sessions and life skills training to learn effective coping mechanisms and strategies for managing cravings and emotions, and creating healthy behaviors
  • Pharmacological treatments, which commonly involves MAT (Medications for Addiction Treatment) to minimize opioid withdrawal, reduce cravings, and prevent opioid overdose and a return to dangerous opioid use
  • Dual diagnosis treatment, as addiction often co-occurs with mental health disorders 
  • Peer support group meetings that can promote healthy social interactions and relapse prevention strategies

Treatment programs cater to each individual specifically to promote lasting recovery.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report. October 2021. Accessed March 2022.
  2. Hydromorphone. U.S. National Library of Medicine (NLM). https://medlineplus.gov/druginfo/meds/a682013.html. March 2022. Accessed March 2022.
  3. Dilaudid Oral Liquid and Dilaudid Tablets. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019892s015lbl.pdf. Accessed March 2022.
  4. Drug Overdose Deaths. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/drugoverdose/deaths/index.html. March 2021. Accessed March 2022.
  5. Hydromorphone. Drug Enforcement Administration (DEA). https://www.deadiversion.usdoj.gov/drug_chem_info/hydromorphone.pdf. September 2019. Accessed March 2022.

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