Hydromorphone, Hydromorphone ER

Introduction

Written by Ashley Wong, PharmD
Medically reviewed by Christina Bookwalter PharmD, MS MEd, BCPS, BCACP 
Updated on October 25, 2023

Hydromorphone (hye droe MOR fone) is a generic medication prescribed for severe pain that isn’t managed by other treatments. It’s prescribed for adults. Hydromorphone belongs to a group of drugs called opioids.

This article doesn’t provide coupons for all forms of hydromorphone. To find coupons for some forms of hydromorphone, see these articles:

• Hydromorphone ER, Hydromorphone Hydrochlorideer, Hydromorphone
• Hydromorphone Hydrochlorideer, Hydromorphone ER, Hydromorphone

Note: The Food and Drug Administration (FDA) has not approved hydromorphone rectal suppository. This is because the drug was available before the FDA began its drug approval process. If you have questions about this, talk with your doctor or pharmacist.

Boxed warnings

Hydromorphone has boxed warnings about certain risks. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). These warnings are:

• risk of medication errors with hydromorphone injection and oral solution
• risk of addiction and misuse* with hydromorphone oral tablet, extended-release (ER) oral tablet,† injection, oral solution, and rectal suppository
• risk of serious respiratory depression with hydromorphone oral tablet, ER oral tablet,† injection, oral solution, and rectal suppository
• risk of accidental ingestion or exposure with hydromorphone oral tablet, ER oral tablet,† oral solution, and rectal suppository
• risk of neonatal withdrawal syndrome with hydromorphone oral tablet, ER oral tablet,† injection, oral solution, and rectal suppository
• risk of serious harm if certain other drugs are used along with hydromorphone oral tablet, ER oral tablet,† injection, oral solution, and rectal suppository

For details, see the “Interactions and warnings for hydromorphone” section.

* Addiction means a drug is used even if it’s causing harm. Misuse means a drug is taken in a way other than how it’s prescribed. You may hear doctors refer to addiction and misuse as substance use disorder.
† “Extended release” means the drug is released into your body slowly over a long period of time.

Uses of hydromorphone

The Food and Drug Administration (FDA) approves prescription drugs such as hydromorphone for certain conditions. The approved use for hydromorphone is described below. 

Use for pain

Doctors may prescribe hydromorphone for treating severe pain that isn’t managed by other treatments. It’s approved for this purpose in adults. Doctors may prescribe these forms of hydromorphone: oral tablet, extended-release oral tablet,* injection,† oral solution, and rectal suppository.

Some doctors prescribe hydromorphone off-label for children. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved to treat or help prevent. Doctors might prescribe it for children for moderate to severe short-term pain. They may prescribe these forms for children: oral tablet, oral solution, injection, and rectal suppository.

Pain is different for everybody. It can feel sharp or dull, or it can be described as throbbing or burning. Pain can be consistent, or it might come and go. Some people have sudden pain that lasts only a short time. Others have long-term (chronic) pain that lasts for months or years. 

Because of hydromorphone’s risk of addiction and misuse, doctors may prescribe hydromorphone only in certain situations. (Addiction means a drug is used even if it’s causing harm. Misuse means a drug is taken in a way other than how it’s prescribed. You may hear doctors refer to addiction and misuse as substance use disorder.) These include:

• when alternative pain medications, such as non-opioids, haven’t provided adequate pain relief
• when other pain medications, such as non-opioids, cannot be used

* “Extended release” means the drug is released slowly into your body over a long period of time.
† A healthcare professional may give hydromorphone injection in one of three ways. They may give it by intravenous (IV) infusion, which is an injection given into your vein over time. They may give it by intramuscular injection, which is given into your muscle. Or they may give it by subcutaneous injection, which is given under your skin.

Side effects of hydromorphone

Hydromorphone may cause mild or serious side effects. The lists below include more common mild side effects of hydromorphone and its serious side effects. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about hydromorphone’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for hydromorphone listed in the “Resources” section.

Mild side effects

The lists below include more common mild side effects reported with some forms of hydromorphone. These side effects may differ based on the form of hydromorphone you take. 

This article doesn’t include all possible mild side effects of the drug. To learn more about hydromorphone’s side effects based on the form, refer to the prescribing information for hydromorphone listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Hydromorphone extended-release oral tablet’s mild side effects include:

• constipation
• nausea
• sleepiness
• headache
• mild allergic reaction*

Hydromorphone injection’s† mild side effects include:

• lightheadedness
• dizziness
• extreme sleepiness
• nausea
• mild allergic reaction*

* For details about these side effects, see the “Interactions and warnings for hydromorphone” section.
† A healthcare professional may give hydromorphone injection in one of three ways. They may give it by intravenous (IV) infusion, which is an injection given into your vein over time. They may give it by intramuscular injection, which is given into your muscle. Or they may give it by subcutaneous injection, which is given under your skin.

Serious side effects

The list below includes serious side effects of hydromorphone. These side effects may differ based on the form of hydromorphone you take. 

This article doesn’t include all possible serious side effects of the drug. To learn more about hydromorphone’s side effects based on the form, refer to the prescribing information for hydromorphone listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number. 

In general, hydromorphone’s serious side effects include:

• heart problems
• eye or vision changes
• stomach problems
• nervous system problems
• mood or behavior changes
• kidney problems
• urination problems
• adrenal insufficiency (when your adrenal glands don’t make enough hormones)
• blood pressure changes
• boxed warnings:*
  • risk of medication errors
  • risk of addiction and misuse†
  • risk of serious respiratory depression
  • risk of accidental ingestion or exposure
  • risk of neonatal withdrawal syndrome
  • risk of serious harm if certain other drugs are used along with it
• severe allergic reaction*

For hydromorphone extended-release oral tablet, the following serious side effects also may occur:

• vertigo
• ringing in your ears
• hypogonadism (when your body doesn’t make enough sex hormones)
• stomach flu
• diverticulitis (a digestive condition caused by inflammation)
• water retention
• erectile or sexual dysfunction
• breathing problems

* For details about these side effects, see the “Interactions and warnings for hydromorphone” section.
† Addiction means a drug is used even if it’s causing harm. Misuse means a drug is taken in a way other than how it’s prescribed. You may hear doctors refer to addiction and misuse as substance use disorder.

Interactions and warnings for hydromorphone

Below, you’ll find information about hydromorphone’s possible interactions and warnings. 

Interactions of hydromorphone

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction. 

Before you take hydromorphone, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for hydromorphone” section below.

Warnings for hydromorphone

Some people should not take hydromorphone, and others should take it cautiously.

Boxed warnings

Hydromorphone has boxed warnings about certain risks. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). 

To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Risk of medication errors with hydromorphone injection and oral solution. It’s extremely important to take hydromorphone exactly as prescribed. Taking a dosage of hydromorphone higher than prescribed can cause serious, life threatening side effects. Examples include accidental overdose and death. 

Risk of medication errors is highest with hydromorphone injection and oral solution.

For hydromorphone oral solution, use only the measuring device that comes with your prescription to measure your dose. Avoid using household teaspoons, tablespoons, and similar measuring devices because they aren’t accurate. If you have questions about how to measure your dose of hydromorphone, talk with your doctor or pharmacist. 

Risk of addiction and misuse with hydromorphone oral tablet, extended-release (ER) oral tablet, injection, oral solution, and rectal suppository. Hydromorphone has a risk of addiction and misuse. (Addiction means a drug is used even if it’s causing harm. Misuse means a drug is taken in a way other than how it’s prescribed. You may hear doctors refer to addiction and misuse as substance use disorder.) Addiction can occur even when taking hydromorphone at the recommended dosage. If you have a personal or family history of substance misuse or mental health conditions, your risk may be higher.

Because of this risk, hydromorphone is prescribed only through the opioid analgesic risk evaluation and mitigation strategy (REMS) program. This program helps ensure hydromorphone is prescribed safely.

Risk of serious respiratory depression with hydromorphone oral tablet, ER oral tablet, injection, oral solution, and rectal suppository. Hydromorphone can cause serious respiratory depression, which causes life threatening breathing problems. This can occur even when taking it at the recommended dosage and at any time during treatment. But the risk is highest when you first start taking it or when your dosage is increased. Your breathing can become very slow and shallow. If this isn’t recognized and treated, it can lead to death. 

If you have problems breathing during hydromorphone treatment, call 911 or a local emergency number right away. Your doctor may prescribe naloxone (Narcan, Kloxxado, Zimhi) along with hydromorphone. Naloxone is a medication that can treat serious breathing problems caused by opioids. It can be used while you’re waiting for emergency services to arrive. Naloxone is also available without a prescription at some pharmacies. If you have questions about this, talk with your doctor or pharmacist.

Risk of accidental ingestion or exposure with hydromorphone oral tablet, ER oral tablet, oral solution, and rectal suppository. If someone accidentally takes even one dose of hydromorphone, it can cause overdose, especially in children. This can lead to serious and life threatening breathing problems. 

Due to this risk, store hydromorphone in a secure place. Be sure it cannot be accessed by others, especially children. 

Risk of neonatal withdrawal syndrome with hydromorphone oral tablet, ER oral tablet, injection, oral solution, and rectal suppository. For more information about this risk, see the “Hydromorphone and pregnancy” section below.

Risk of serious harm if alcohol or certain other drugs are used along with hydromorphone oral tablet, ER oral tablet, injection, oral solution, and rectal suppository. Hydromorphone is a medication that slows down your central nervous system (CNS). Taking it with other medications that slow down your CNS can cause serious side effects. Examples of these medications include muscle relaxants, benzodiazepines, and sedatives. Taking these drugs together can cause life threatening symptoms such as slowed breathing, extreme sleepiness, and coma. This can also occur if you take hydromorphone with alcohol.

Due to this risk, doctors will prescribe this combination of medications only if it’s the best option or if there is no other option. If your doctor does prescribe them together, they’ll prescribe the lowest dose of each medication. They’ll also prescribe them for the shortest amount of time needed. 

If you’re taking hydromorphone with any of these substances, watch for the following symptoms. If you experience any, you or a friend or family member should get emergency medical help right away:

• difficulty breathing
• slow or shallow breathing
• extreme sleepiness
• inability to wake up

Other warnings

Hydromorphone could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether hydromorphone is a safe option for you. These warnings may differ based on the form of hydromorphone you take.

Ask your doctor about specific warnings for hydromorphone, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Hydromorphone can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to hydromorphone or any of its ingredients, your doctor will likely not prescribe hydromorphone. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems 

If you have an allergic reaction to hydromorphone, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of hydromorphone

You should not take more hydromorphone than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much hydromorphone, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have symptoms that concern you, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and hydromorphone

Information about hydromorphone and pregnancy and breastfeeding is described below.

Hydromorphone and pregnancy

Taking hydromorphone during pregnancy has risks, including the risk of neonatal opioid withdrawal syndrome (NOWS) in a newborn. But having unmanaged pain while pregnant also has risks. (Keep in mind that hydromorphone is taken for managing severe pain.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about treatment options for pain during pregnancy. You can discuss the risks and benefits of treatment options. Then together you can decide whether you should take hydromorphone during pregnancy.

Risk of neonatal withdrawal syndrome (NOWS) 

Hydromorphone has a boxed warning about the risk of NOWS. Boxed warnings are the most serious warnings from the FDA.

Taking hydromorphone for a long period of time during pregnancy can cause NOWS. (Withdrawal symptoms are side effects that can occur when you stop taking a drug on which your body is dependent. Dependence means your body needs the drug to feel like it usually does.) In this situation, the withdrawal symptoms affect the newborn. Symptoms of NOWS include irritability, high-pitched crying, tremor, unusual sleep pattern, and inability to gain weight. If the condition is not recognized and treated, it can be life threatening for the newborn. 

Because of this risk, doctors may not prescribe hydromorphone during pregnancy unless the benefits clearly outweigh the risks. If the drug is prescribed, your newborn will be closely monitored, and symptoms of NOWS will be treated as needed.

Hydromorphone and breastfeeding

Taking hydromorphone while breastfeeding has risks. But having unmanaged pain during this time also has risks. (Keep in mind that hydromorphone is taken for managing severe pain.)

For instance, hydromorphone may cause increased sleepiness and trouble breathing in a breastfed child. 

If you’re planning to breastfeed, talk with your doctor about treatment options for pain. Discuss the risks and benefits of your treatment options. Then decide whether or not you should take hydromorphone during this time. Your doctor may recommend other healthy ways to feed your child.

Common questions about hydromorphone

Below you’ll find answers to a few commonly asked questions about hydromorphone.

What brand names are available for hydromorphone?

Hydromorphone oral tablet, oral solution, and injection are available under the brand-name drug Dilaudid. Brand-name versions of hydromorphone rectal suppository and extended-release oral tablet do not exist. 

A generic medication is an identical copy of the active drug in a brand-name medication. (An active drug is the ingredient that makes a medication work.) Generic drugs are believed to be as effective and safe as brand-name drugs. And generic drugs typically cost less compared to brand-name drugs.

If you’d like to know more about this, talk with your doctor or pharmacist.

Is hydromorphone similar to morphine?

Yes, it’s similar in some ways. Hydromorphone and morphine both are approved to treat severe pain that isn’t relieved by non-opioid medications. Both also belong to the same class of drugs called opioids. (A class of drugs is a group of medications that work in a similar way.)

But morphine is available in more forms than hydromorphone. Hydromorphone is available as an oral solution, oral tablet, extended-release (ER) oral tablet, injection, and rectal suppository. Morphine is available in the same forms plus an ER oral capsule.

If you have questions about what’s the best treatment for your pain, talk with your doctor.

How does hydromorphone work? And how long does it take to start working?

Hydromorphone works to treat pain by binding to certain receptors in your brain and spinal cord. This helps reduce the pain that you feel. 

The time it takes for hydromorphone to work depends on the form your doctor prescribes. Hydromorphone oral tablet and oral solution start to work within 15–30 minutes. Hydromorphone extended-release (ER) oral tablet starts to work within 6 hours. A healthcare professional gives you hydromorphone injection. The form of the injection* determines how long it takes to start working in your body.

* A healthcare professional may give hydromorphone injection in one of three ways. They may give it by intravenous (IV) infusion, which is an injection given into your vein over time. They may give it by intramuscular injection, which is given into your muscle. Or they may give it by subcutaneous injection, which is given under your skin. 

Talk with your doctor or pharmacist if you’d like to know more about how hydromorphone works to treat pain. 

What to ask your doctor

Let your doctor know if you have questions about hydromorphone or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• How can I lower my risk of addiction and misuse* with hydromorphone?
• Are there drug interactions I should avoid when taking hydromorphone?
• What alternative treatments can you prescribe for pain?
• Which form of hydromorphone is best for my pain?

* Addiction means a drug is used even if it’s causing harm. Misuse means a drug is taken in a way other than how it’s prescribed. You may hear doctors refer to addiction and misuse as substance use disorder.

Resources

• Abi-Aad KR et al. (2023). Hydromorphone. https://www.ncbi.nlm.nih.gov/books/NBK470393/
• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Hydromorphone hydrochloride extended-release tablets, for oral use, CII. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/8bb81796-6990-40e9-bee4-1f292f91ae99/spl-doc
• Hydromorphone hydrochloride injection, USP [high potency formulation (HPF)], for intravenous, intramuscular, or subcutaneous use. (2020). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/4d33b072-0755-4b8c-9558-2551306756a3/spl-doc
• Hydromorphone hydrochloride oral solution; hydromorphone hydrochloride tablets, for oral use, CII. (2021). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/fab97112-e276-40e0-bc82-0a29d7fa75fa/spl-doc
• Hydromorphone hydrochloride suppositories, for rectal use, CII. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/bec32a94-4b79-4bd4-b000-45e9030d3106/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.