Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 19, 2026
Fact checked
Quick Summary
  • Dilaudid (hydromorphone hydrochloride) is an opioid medication for pain that works analogously to morphine, oxycodone, fentanyl, methadone, and other opioids.
  • Dilaudid, like all other opioids, acts on pain receptors on nerves in the brain, raising the threshold for pain and decreasing pain perception.
  • It's an opioid pain medication that's similar to oxycodone, hydrocodone, and other opioids.
Reading time: 12 min

Dilaudid (hydromorphone hydrochloride) is an opioid medication for pain that works analogously to morphine, oxycodone, fentanyl, methadone, and other opioids. Dilaudid, like all other opioids, acts on pain receptors on nerves in the brain, raising the threshold for pain and decreasing pain perception.

The opium plant contains the chemical morphine. It’s an opioid pain medication that’s similar to oxycodone, hydrocodone, and other opioids. Morphine also stimulates pain nerve endings on nerves in the brain, raising the pain threshold (the level of input required to feel pain) and decreasing pain perception (the perceived intensity of pain).

Generic forms of Dilaudid and morphine are available. Hydromorphone is sold under the brand name Dilaudid. Morphine is sold under the brand names Astramorph, Infumorph, Avinza, and Duramorph.

Nausea, constipation, vomiting, itching, dizziness, and sleepiness are all common side effects of morphine and Dilaudid. Lightheadedness, flushing, and sweating are all possible side effects of Dilaudid.

Other adverse effects of morphine include difficulties urinating, slowing heart rate, low blood pressure, confusion, fever, weakness, headache, and reduced oxygen distribution to the body.

When opioids like Dilaudid and morphine are used with alcohol or other CNS depressants, severe drowsiness, coma, respiratory depression, and death can occur.

Abuse and addiction are possible with both Dilaudid and morphine. Agitation, watery eyes, nasal congestion, yawning, chills, sweating, muscle discomfort, and dilated pupils are all symptoms of withdrawal from both substances.

It is difficult to answer this question quantitatively. However, efforts have been made in the past by competent authorities to find out morphine vs. Dilaudid strength and also in comparison with other opioids.

The Centers for Disease Control and Prevention published revised statistics on prescription opioid analgesic use in individuals aged 20 and above in February 2015. The study concluded that the percentage of people who had used only a ‘weaker-than-morphine-opioid’ in the past month decreased from 42.4 percent in 1999-2002 to 20 percent in 2011-2012, while the percentage of people who used a ‘stronger-than-morphine-opioid’ substantially increased from 17.0 percent in 1999-2002 to 37.0 percent in 2011-2012.” (source: MedlinePlus, 2024)

Codeine, meperidine, dihydrocodeine, propoxyphene, pentazocine, and tramadol were weaker-than-morphine opioids; morphine, hydrocodone, and tapentadol were morphine-equivalent opioid analgesics; and fentanyl, methadone, hydromorphone, oxymorphone, and oxycodone were stronger-than-morphine opioids.

This study had its limitations as well. The FDA gave a warning in 2013 regarding codeine safety risks, particularly when it was used by children. Tramadol has a different method of action than morphine, therefore the amount of pain relief it may provide is limited. Putting it in the same categorization as the other medications makes no sense.

The authors’ inclusion of morphine, hydrocodone, and tapentadol in the “morphine-equivalent” group is perplexing.

Although hydrocodone is a “morphine comparable” analgesic, it has only recently been sold without a non-opioid like an acetaminophen. The dose that can be given with such a non-opioid is limited. Furthermore, intravenous injection of hydrocodone is not possible.

Tapentadol works differently from morphine because it has a dosage ceiling, while morphine does not. As a result, classifying it as a morphine-equivalent analgesic makes no sense.

Fentanyl, methadone, hydromorphone, oxymorphone, and oxycodone according to the authors, are “stronger” than morphine.

While it is evident that a lower dose of these medications is necessary to provide the same analgesic activity as morphine, this does not imply that they are more effective.

Morphine is a powerful analgesic that can be used in very large dosages to relieve intense pain in terminally ill patients. To get the same level of pain relief as 30 milligrams of oral morphine, you will need about 20 milligrams of oral oxycodone and 7.5 milligrams of oral hydromorphone. Are they the criteria the authors used to designate these medications as being more powerful than morphine? (source: MedlinePlus, 2024 (Morphine))

There is a lot of debate and misunderstanding about opioid analgesics and what role they can play in the treatment of chronic pain. If there is to be a productive discussion on the role of opioids in pain treatment, there must be a clear understanding of the meanings of terminology and opioid pharmacology.

Morphine is the most well-known pain reliever. Hydromorphone, often known as hydromorph, is a morphine-like substance. Hydromorphone is more potent than morphine (5 times stronger according to some resources), which essentially means that a lesser amount of hydromorphone relieves the same amount of pain as a bigger amount of morphine. It’s critical to understand this if someone is moved from morphine to hydromorphone.

Someone using 10 mg of morphine, for instance, might be shifted to 1 or 2 milligrams of hydromorphone. The level of pain alleviation is identical.

When using opioids to manage pain, it’s common practice to start with a low dose, assess how it’s working, then slowly progressively increase the dose until the dose is adequate and the person is comfortable. To check for adverse effects, monitoring is required. The drug is occasionally switched.

People are frequently prescribed additional medicine known as breakthrough drugs. This is an additional dose for any pain flare-ups, or periods when pain is stronger than normal and “breaks through” the ordinary level of pain control.

Moderate to severe pain is treated with both morphine and hydromorphone. Morphine is frequently the first drug utilized. Hydromorphone, on the other hand, maybe a preferable initial choice for some patients. Older individuals may have fewer difficulties with hydromorphone side effects like tiredness or confusion. People with impaired kidney function may benefit from hydromorphone since it is excreted from the body by the liver rather than the kidneys. When determining which drug to utilize, a doctor considers these variables.

People are normally changed to the slow-release type after becoming accustomed to a short-acting medicine. Both types usually take action in about half an hour. The fast-acting version lasts four hours, while the slow-release version lasts eight. As a result, the slow-release version does not require as frequent administration. Individuals with stable pain may be shifted to a fentanyl patch, which has a longer duration. For acute and breakthrough pain, people who have a fentanyl patch continue to take oral pain medicine.

Side Effects Of Morphine Injectables   (source: NIDA, 2024)

The following are the most common morphine side effects:

  • Mouth dryness
  • Constipation
  • Nausea
  • Vomiting
  • Drowsiness
  • Dizziness
  • Urination problems

Other negative consequences include:

  • Low blood pressure
  • Reduced heart rate
  • Fever
  • Itching
  • Weakness
  • Confusion
  • Headache
  • Reduced supply of oxygen to the body

With intrathecal administration, individuals may develop anemia as well as pain at the site of injection. The aged may be more vulnerable to negative consequences. Morphine has the ability to become addictive. Prolonged use can lead to tolerance and psychological and physical dependence. High dosages can lead to seizures. Overdosing might result in respiratory collapse, coma, or death.

Dilaudid Warnings

Overdose and death can occur if Dilaudid – HP Injection is mixed up with other forms of Dilaudid injectable solutions or other opioids.

When distributing, prescribing, or delivering the oral solution, avoid dosage errors caused by confusion between milligrams and milliliters Dosing mistakes can lead to an overdose and death.

Hydromorphone puts patients at risk for addiction, misuse, and abuse, which can result in death from overdose.

Individuals should be continuously watched since respiratory depression can be acute, life-threatening, or deadly. (source: NHS, 2023)

Long-term hydromorphone use through pregnancy can cause newborn opioid withdrawal effects, which can be fatal if not diagnosed and treated. Pregnant women should be informed about the danger of newborn opioid withdrawal syndrome and should have access to appropriate therapy.

When opioids are combined with benzodiazepines, CNS depressants, or alcohol, severe sedation, respiratory failure, coma, and death can occur.

Side Effects Of Dilaudid

  • Dizziness
  • Loss of coordination
  • Sedation
  • Vomiting
  • Nausea
  • Sweating
  • Constipation
  • Itching
  • Flushing
  • Mouth feeling dry

Other dangerous side effects include:

Respiratory failure and difficulty breathing are two other major and critical side effects of hydromorphone.

Because hydromorphone is a restricted drug, it comes with a boxed warning that it can cause respiratory distress and abuse. When combined with alcohol or other central nervous system drugs, it might aggravate respiratory failure and perhaps cause death.

The following are some of the parameters of differences between Dilaudid and morphine:

Drug Characteristics

Both pharmaceutical drugs are opioid analgesics, commonly known as narcotics, which are a type of pain reliever. They affect your nervous system’s opioid receptors. This activity alters your perception of pain, allowing you to feel less pain. (source: SAMHSA, 2023)

Hydromorphone and morphine are available in a variety of strengths and forms. Oral versions (those taken by mouth) are the most common. Although all forms can be utilized at home, injectable forms are more commonly used in hospitals.

Both medicines have serious negative effects and can be addictive, so follow the directions carefully.

If you’re taking many pain medications, pay attention to the dosage directions for each one to avoid mixing them up. Ask your healthcare practitioner or pharmacist if you have any questions about how to take your drugs.

Insurance, Cost, And Availability

Most pharmacies have all types of morphine and hydromorphone on hand. However, it’s essential to contact ahead to be sure your pharmacy has your prescription on hand.

Generic medications are usually less expensive than brand-name drugs. Hydromorphone and morphine are both generic medicines.

Hydromorphone and morphine had similar pricing at the time this article was written.

Dilaudid, the brand-name medication, was more expensive than generic morphine. Your out-of-pocket cost will be determined by your health insurance coverage, drugstore, and dosage. (source: WHO, 2023)

Adverse effects

The effects of hydromorphone and morphine are comparable in the body. They also have the same side effects as the ones listed above.

Each medication has the potential to cause respiratory depression (shallow and slow breathing). They can all lead to dependence if taken on a regular basis (where your body gets acclimated to the drug and in order to feel normal, you should take a drug).

Interactions With Other Drugs

The following are some medication interactions and associated consequences.

Because morphine and hydromorphone are both opioids, their drug interactions are likewise comparable.

Both medicines have the following drug interactions:

  1. Anticholinergics

When you combine morphine or hydromorphone with one of these medications, you run the risk of severe constipation and the inability to urinate. (source: NCBI Bookshelf, 2024)

  1. Monoamine Oxidase Inhibitors

Within 2 weeks of taking a monoamine oxidase inhibitor (MAOI), you should not take hydromorphone or morphine.

Taking either medicine with an MAOI or within 2 weeks of taking an MAOI can result in the following side effects: 

  • Breathing Problems
  • Hypotension
  • Extreme exhaustion
  • Coma and death
  1. Other Pain Relievers, Antipsychotics, Anxiety Meds, And Sleeping Pills

If you mix hydromorphone or morphine with any of these medications, you could get:

  • Breathing difficulties
  • Severely low blood pressure 
  • Extreme exhaustion
  • Coma

Before taking morphine or hydromorphone with any of these medications, see your doctor.

Other drugs may interact with each other, increasing your chance of significant adverse effects. Make sure your healthcare provider is aware of all prescription and over-the-counter medications you’re using.

Use In Conjunction With Other Health Conditions

Certain health problems may alter the way morphine and hydromorphone act in your body. It’s possible that taking these drugs isn’t safe for you, or that your healthcare practitioner will need to watch you more carefully during your treatment.

If you have respiratory problems such as chronic obstructive pulmonary disease (COPD) or asthma, consult a doctor before taking morphine or hydromorphone. These medications have been associated with life-threatening respiratory issues. (source: NEJM, 2016)

If you have a history of substance abuse or addiction, you should also discuss your safety. These medicines are highly addictive and can lead to overdose and death.

Other medical issues that you should address with your doctor before using morphine or hydromorphone include:

  • Bile tract problems
  • Renal problems
  • Liver problems
  • A history of concussion
  • Low blood pressure (hypotension)
  • Seizures
  • Occlusion in the gastrointestinal tract, particularly if you have paralytic or spastic ileus

Also, see your doctor before using morphine if you have an irregular cardiac rhythm. It could aggravate your issue.

Consult Your Healthcare Practitioner

Both morphine and hydromorphone are extremely powerful pain relievers.

They have a great deal in common and function in similar ways, however, there are some minor differences:

  • Forms
  • Dosage
  • Negative consequences

Consult your healthcare professional if you have any queries regarding these medications.

They can address your concerns and recommend the appropriate medicine for you based on the following criteria:

  • Your well-being
  • Current prescriptions
  • Additional parameters

FAQs

Dilaudid Vs Fentanyl: How Strong Is Fentanyl Compared To Dilaudid?
Dilaudid is a brand-name drug that contains hydromorphone, a semi-synthetic opioid produced from morphine. Dilaudid is a pain reliever used to relieve moderate to severe pain. Dilaudid is mainly restricted for short-term medicinal use due to its significant risk for addiction. Dilaudid is only around one-tenth as strong as fentanyl, despite being roughly 5 times more potent than morphine.
It can take up to half an hour for Dilaudid to start acting before it will last for several hours. Fentanyl acts quickly, sometimes in under a minute. Fentanyl, on the other hand, has a limited duration of action and usually wears off in just 90 minutes. Dilaudid is, therefore, more commonly used for long-term pain treatment, whereas fentanyl is utilized for quick relief.
Can I Use Morphine Or Dilaudid While Breastfeeding Or Pregnant?
Hydromorphone has not been adequately studied in pregnant women to determine whether it is effective and safe. Because low quantities of opioid medicines can pass into breast milk, they should not be taken by nursing mothers.
Morphine injections must only be given in pregnancy when no other options for pain relief are available and the fetus can be monitored. Chronic dosing may cause unwanted side effects or symptoms of withdrawal in newborns. Although morphine is secreted in breast milk, an American Academy of Pediatrics committee has determined that using it during nursing is safe.

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