Hydromorphone is used to treat severe pain when other medicines are not enough. Common side effects include constipation, itching, dizziness, and drowsiness. Talk to your health care provider if you get confused or feel like your pain is getting worse instead of better. Hydromorphone comes in several forms, including a tablet, liquid, and suppository. Hydromorphone is also available in injectable forms.

Uses

What is hydromorphone used for?

Hydromorphone is commonly used to treat severe pain. 

Hydromorphone may also be used for other conditions as determined by your health care provider.

How does hydromorphone work (mechanism of action)?

Hydromorphone binds to and activates specific receptors in the body to help keep you from feeling pain. 

How is hydromorphone supplied (dosage forms)?

Brands and other names

  • Dilaudid
  • Exalgo

Dosage forms and strengths

  • 2 mg, 4 mg, 8 mg oral tablets
  • 8 mg, 12 mg, 16 mg, 32 mg extended-release oral tablets
  • 1 mg/mL oral solution 
  • 3 mg rectal suppository

Hydromorphone is also available in injectable forms.

How should I store hydromorphone?

Oral Tablet and Oral Liquid. Hydromorphone tablets and liquid should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Protect from light.

Rectal Suppository. Hydromorphone suppositories should be stored in a refrigerator between 36 F to 46 F (2 C to 8 C). Protect from light.

Injection Liquid. Hydromorphone injection is usually given by a health care provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of hydromorphone?

The most common side effects of hydromorphone are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Constipation (see below)
  • Stomach pain
  • Headache
  • Dizziness or lightheadedness
  • Drowsiness or sleepiness
  • Nausea or vomiting
  • Sweating or flushing
  • Feeling of unhappiness/uneasiness
  • Feeling of excitement or happiness
  • Dry mouth
  • Itching

There may be other side effects of hydromorphone that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of hydromorphone?

While less common, the most serious side effects of hydromorphone are described below, along with what to do if they happen.

Severe Allergic Reactions. Hydromorphone may cause allergic reactions, which can be serious. Stop taking hydromorphone and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Risk of Misuse and Addiction. Misusing hydromorphone can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Take hydromorphone exactly as prescribed. Tell your health care provider if you feel that hydromorphone is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures
  • Trouble breathing

Breathing Problems. Hydromorphone may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your health care provider if you develop severe sleepiness or trouble breathing, especially when you start hydromorphone or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake

Reduced Adrenal Function. Long-term use of hydromorphone can cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your health care provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure
  • Loss of appetite
  • Dizziness

Low Blood Pressure (Hypotension). Hydromorphone may cause low blood pressure. If you feel faint or dizzy, lie down. Tell your health care provider right away if you have any of the following symptoms of low blood pressure.

  • Dizziness, feeling lightheaded, or fainting
  • Confusion
  • Feeling weak or tired

Constipation. Some people taking hydromorphone have had severe constipation. Some needed to go to the hospital. Stop taking hydromorphone and get help right away if you have severe constipation.

Sphincter of Oddi Spasm. The sphincter of Oddi is a muscular valve in your body that controls the flow of bile and digestive juices from the pancreas into the small intestine. When this valve spasms, it may feel like getting a tight muscle cramp, causing pain and blocking the flow of these juices, which can lead to discomfort and digestive problems. This is more likely to happen if you do not have a gallbladder. Stop taking hydromorphone and get emergency help if you have new or worse stomach pain or pain in the upper right side of your stomach-area that travels to your back or shoulder, with or without nausea and vomiting. 

Increase in Pain Sensitivity. Hydromorphone tablets can cause increased pain sensitivity (hyperalgesia). It can cause things that normally cause pain to feel more painful than usual. It can also cause allodynia. This happens when things that normally do not cause pain, such as wearing glasses or brushing your hair, become painful. If your pain increases, do not use extra doses of hydromorphone. This could cause you to overdose or develop other serious side effects. Call your health care provider if your pain increases, you feel more sensitive to pain, or if you develop pain in other areas of your body. 

Dizziness and Sleepiness. Hydromporphone may make you dizzy or sleepy. Do not drive or do other activities that require alertness or coordination until you know how hydromorphone affects you.

Warnings & Precautions

Who should not use hydromorphone?

Allergies to Ingredients. People who are allergic to any of the following should not take hydromorphone.

  • Dilaudid
  • Exalgo
  • Hydromorphone
  • Sulfites
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific hydromorphone products they stock.

Previous Opioid Use. Hydromorphone extended-release tablets should not be used if you have not been using or taking another opioid. Examples of opioids include codeine, fentanyl, morphine, or oxycodone. Hydromorphone extended-release tablets can cause breathing problems that can lead to death if your body is not used to another opioid medicine.

Breathing Problems. Hydromorphone should not be used if you have respiratory depression (breathing problems), severe asthma, or lung problems. Taking hydromorphone can make breathing problems worse or lead to death.

Gut Blockage or Slowed Gut Movement. Hydromorphone should not be used if you have a blockage in your gut (bowel obstruction) or have narrowing in your stomach or your intestines. Hydromorphone should not be used if you have a condition called paralytic ileus, where your intestines are unable to move food through them. Hydromorphone can make these conditions worse. 

What should I know about hydromorphone before using it?

Read and follow the instructions for the product you have. Taking this medicine the wrong way can cause serious side effects.

Do not take hydromorphone unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share hydromorphone with other people, even if they have the same condition as you. It may harm them.

Keep hydromorphone out of the reach of children. Since hydromorphone suppositories should be kept in a refrigerator, take special precautions to keep them away from children who also use the refrigerator. Hydromorphone is a controlled substance because it can be misused or lead to dependence. Store hydromorphone in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

Use an accurate measuring device to measure your dose of hydromorphone liquid. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

Do not chew, cut, or crush hydromorphone extended-release tablets. This can lead to overdose or death. 

Taking hydromorphone for a long period of time can affect your ability to get pregnant or get your partner pregnant. Talk to your health care provider to learn more. 

People who are 65 and older can be at greater risk for some side effects from hydromorphone. Talk to your health care provider about your risks if you are in this age group.

When taking hydromorphone extended-release tablets, you may see the tablet shell in your stool. This is normal and there is no need to be concerned.

Talk to your health care provider about a medicine called naloxone. Naloxone is a medicine that can be used as an emergency treatment for an opioid overdose, including accidental overdoses.

If you have been taking hydromorphone regularly, do not stop taking it without talking to your health care provider. Stopping too quickly may cause serious side effects. Call your health care provider right away if you have any of the following symptoms. 

  • Irritability
  • High or low energy or low mood
  • Feeling restless 
  • Changes in sleep habits
  • Headache
  • Nausea
  • Dizziness
  • Electric-shock like feelings
  • Confusion

Throw away any unused or expired hydromorphone by either taking the medicine to a U.S. Drug Enforcement Administration (DEA) collection site or medicine take-back program. You can also flush hydromorphone down the toilet. Do not throw it in the trash. You can find out more on how to properly dispose of your medicines at www.fda.gov/drugdisposal.

What should I tell my health care provider before using hydromorphone?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if hydromorphone is right for you.

In particular, make sure that you discuss any of the following.

Substance Use Disorder or Alcohol Use Disorder. Talk to your health care provider if you have ever misused alcohol, prescription medicines, or street drugs or live with someone who has this problem. Hydromorphone has a risk of being misused.

Other Medicines and Supplements. Hydromorphone may interact with other medicines and supplements. Before taking hydromorphone, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Head injuries, increased pressure in your skull, or a brain tumor
  • Asthma
  • Seizures
  • Problems peeing
  • Liver or kidney problems
  • Thyroid problems
  • Pancreas or gallbladder problems
  • Mental health problems, such as depression
  • Chronic obstructive pulmonary disease (COPD)
  • History of an opioid overdose

Pregnancy. Hydromorphone may cause harm to an unborn baby. Tell your health care provider if you are, think you are, or plan to become pregnant. Your health care provider will advise you if you should use hydromorphone while you are pregnant or trying to get pregnant. Using hydromorphone for a long time while you are pregnant can cause withdrawal symptoms in your newborn baby that can be life-threatening. Tell your health care provider if you took hydromorphone during your pregnancy, especially near the end of your pregnancy.

Breastfeeding. Hydromorphone passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will advise you if you should take hydromorphone while breastfeeding. If you breastfeed while using hydromorphone, watch your baby for increased sleepiness, slowed breathing, or limpness if you are breastfeeding. Get help right away if you notice these things. Do not stop hydromorphone or breastfeeding without talking to your health care provider.

 

Interactions

Does hydromorphone interact with foods or drinks?

There are no known interactions between hydromorphone and foods or nonalcoholic drinks.

Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol while taking hydromorphone. Drinking alcohol while taking hydromorphone can increase your risk of overdose and death.

Does hydromorphone interact with other medicines (drug interactions)?

Hydromorphone interacts with many other medicines. Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking hydromorphone.

  • An antipsychotic, which is a medicine for certain mental health conditions
  • Any medicine that affects serotonin, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), some other medicines used for depression, some migraine medicines, and some medicines for nausea and vomiting
  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • A mixed agonist/antagonist or partial agonist opioid analgesic, such as buprenorphine (Butrans, Sublocade), butorphanol, nalbuphine, pentazocine, and others, which is a medicine used to treat certain types of pain or opioid use disorder
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines (including opioids), sleep medicines, muscle relaxers, or medicines for anxiety (including benzodiazepines)

This may not be a complete list of medicines that can interact with hydromorphone. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much hydromorphone?

If you or someone else has used too much hydromorphone, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of hydromorphone?

Oral Tablets (Extended-Release). If you miss a hydromorphone extended-release tablet dose, skip the missed dose. Take the next scheduled dose at your usual time. Do not take double or extra doses. Do not take more than your prescribed dose.

Oral Tablets, Oral Liquid, or Rectal Suppository. Hydromorphone tablets, liquid, and suppositories are meant to be used only when needed. Use them as your health care provider recommends. Do not take double or extra doses. 

Injection Liquid. Hydromorphone injection is usually given by a health care provider in a hospital. Your health care provider will make sure you are receiving hydromorphone injection as scheduled.