Dilaudid vs. Fentanyl

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Dilaudid (hydromorphone) vs. fentanyl quick comparison of differences

  • Dilaudid (hydromorphone hydrochloride) and fentanyl are opioid narcotic pain-relievers used to manage pain in individuals whose pain its severe enough that it requires 24/7, long-term opioid treatment.
  • Side effects of Dilaudid and fentanyl that are similar include:
  • A serious side effect of fentanyl and Dilaudid is respiratory depression (decreased rate or depth of breathing).
  • Side effects of fentanyl that are different from Dilaudid include:
  • Side effects of Dilaudid that are different from fentanyl include sweating and flushing.
  • Both Dilaudid and fentanyl are controlled substances and are habit-forming. Mental and physical dependence can occur, even at doses prescribed. Abruptly stopping fentanyl or Dilaudid in patients who have been taking the drug for a long time can precipitate a withdrawal reaction. Symptoms of withdrawal include:
  • Brand names for fentanyl include Duragesic, Subsys, and Abstral.

What is Dilaudid? What is fentanyl? How do they work?

Dilaudid (hydromorphone hydrochloride) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain (increasing the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain).

Fentanyl is a strong, synthetic narcotic that is similar to morphine. A 0.1 mg dose of fentanyl is approximately equal to 10 mg of morphine administered by intramuscular injection. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain (the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). Fentanyl is available in transdermal (for application to the skin), transmucosal (for application to mucous membranes) and parenteral (injectable) forms.

What are the uses of Dilaudid vs. fentanyl?

Dilaudid uses

Dilaudid (hydromorphone) is used for the management of acute pain and moderate-to-severe chronic pain in patients when the use of an opioid is appropriate.

Fentanyl patch uses

The fentanyl transdermal system is used for patients with severe chronic pain, for example, cancer pain.

What are the side effects of Dilaudid vs. fentanyl?

Dilaudid (hydromorphone) HCI BLACK BOX WARNING

  • Dilaudid-HP Injection should not be confused with other types of Dilaudid injections or other opioids, as overdose and death could result.
  • Avoid dosing errors from confusion between mg and mL when dispensing, prescribing, or administering the oral solution. Dosing errors can result in accidental overdose and death.
  • Hydromorphone exposes patients to risks of addictions, abuse, and misuse, which can lead to overdose and death.
  • Patients should be monitored closely because serious, life-threatening, or fatal respiratory depression may occur.
  • Prolonged use of hydromorphone during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Pregnant women should be advised of the risk of neonatal opioid withdrawal syndrome and appropriate treatment should be available.
  • Combining opioids with benzodiazepines, alcohol, or other central nervous system (CNS) depressants may result in severe sedation, respiratory depression, coma, and death.

Dilaudid side effects

Common side effects

Other serious and important side effects of hydromorphone are respiratory depression and trouble breathing.

Since hydromorphone is a controlled narcotic, it carries a box warning of respiratory depression and abuse potential. Use with alcohol or other medications affecting the central nervous system can worsen respiratory depression and may lead to death.

Fentanyl side effects

Fentanyl side effects include:

Transdermal fentanyl can cause a variety of skin reactions. Commonly, redness occurs at the site of application and can last for 6 hours following removal of the patch.

Possible serious side effects include:

Fentanyl can cause respiratory depression (decreased rate or depth of breathing), muscle rigidity, and slow heart rate.

The FDA is investigating reports of deaths and other serious side effects from the use of the fentanyl transdermal system as well as overdoses.

Exposing the patch to heat can increase the amount of fentanyl released and may lead to an overdose. Some patches may cause burns of the skin if worn during an MRI (magnetic resonance imaging) scan. Patients should tell their health-care professional that they are using a medication patch prior to receiving an MRI scan.

Are Dilaudid and fentanyl addictive?

Physical dependence occurs commonly during therapy with opiate agonists such as Dilaudid and fentanyl. Abruptly stopping these drugs in patients can precipitate a withdrawal reaction.

Symptoms of withdrawal include:

  • Nausea
  • Diarrhea
  • Coughing
  • Tearing
  • Nasal discharge
  • Profuse sweating
  • Twitching muscles
  • Yawning

What is the dosage of Dilaudid vs. fentanyl?

Dilaudid dosage administration

  • Immediate-release tablets: Take 2 to 4 mg tablets by mouth every 4 to 6 hours as needed. Increase to 8 mg after careful observation and if needed to control pain.
  • Extended-release tablets: Start after discontinuation of all other opioid extended-release tablets. Dosed once-daily, individualized based on prior opioid therapy.
  • Injections: Give 1 to 2 mg intramuscularly or subcutaneously every 2 to 3 hours as needed. Give 0.2 to 1 mg intravenously over 2 to 3 minutes every 2 to 3 hours as needed.
  • Oral solution: Give 2.5 to 10 mg every 3 to 6 hours as needed.
  • Rectal suppository: Insert one 3 mg suppository rectally every 6 to 8 hours OR3 to 6 mg rectally every 3 to 4 hours, when appropriate.

Safe and effective use of hydromorphone in children has not been established.

Fentanyl transdermal patch dosage administration

  • Patches should be applied to a flat, non-irritated area on the upper torso.
  • The area of application should be clean and washed with water only prior to application.
  • The patch should be applied immediately after removing it from the package and pressed firmly against the skin for 10 to 20 seconds especially around the edges.
  • Patches should never be cut or otherwise damaged.
  • Doses required to control pain vary widely among patients.
  • The recommended dose is 25 to 100 mcg/hour patch applied every 72 hours.

Fentanyl injection dosage administration

  • Fentanyl injection can be injected into the muscle (intramuscular) or into veins (intravenous).
  • The usual dose for surgical premedication in adults is 0.05 mg to 0.1 mg per dose given by intramuscular injection or by intravenous injection.
  • For anesthesia, the dose is 0.5 to 20 mcg/kg per dose given intravenously. A maintenance intravenous infusion of 1-2 mcg/kg/hour also may be used.
  • There are several recommended regimens for treating pain.
  • Fentanyl also is used for patient-controlled anesthesia (PCA).
  • The manufacturer considers a fentanyl transdermal dose of 100 µg/hour approximately equivalent to 360 mg/day of oral morphine.

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What are the drug interactions of Dilaudid vs. fentanyl?

Dilaudid drug interactions

Hydromorphone should be used very cautiously with medications that depress the central nervous system (for example, hypnotics, anesthetics, tranquilizers, phenothiazines, and alcohol).

Hydromorphone should be used with caution with mixed agonist/antagonist opioid analgesics (for example, pentazocine, nalbuphine, butorphanol, and buprenorphine) because it may take away the analgesic effect of hydromorphone.

Fentanyl drug interactions

The use of fentanyl with other central nervous system depressants can intensify the depressant effect of fentanyl on breathing, depress the brain, sedate, and lower blood pressure. Other drugs that should be used cautiously with fentanyl include antipsychotics, for example, thorazine, stelazine, and haloperidol (Haldol), anxiolytics, for example, diazepam (Valium), lorazepam (Ativan), and zolpidem (Ambien), certain antihistamines, for example, diphenhydramine (Benadryl) and hydroxyzine (Vistaril), barbiturates, for example, phenobarbital (Donnatal), tricyclic antidepressants, for example, amitriptyline (Elavil, Endep) and doxepin (Sinequan), alcohol, and skeletal muscle relaxants, for example, carisoprodol (Soma), cyclobenzaprine (Flexeril) and baclofen (Lioresal). The use of fentanyl with amiodarone (Cordarone) may result in a slow heart rate.

Cimetidine (Tagamet), when used with fentanyl, can cause confusion, disorientation, or seizures due to impairment in breathing and brain function.

The monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) significantly increase the action of fentanyl resulting in more side effects. Fentanyl should not be used in patients taking MAOIs or within 14 days of stopping MAOIs.

Combining fentanyl with drugs that reduce activity of liver enzymes that breakdown fentanyl, for example, ritonavir (Norvir), ketoconazole (Nizoral, Extina, Xolegel, Kuric), itraconazole (Sporanox), troleandomycin, clarithromycin (Biaxin, Biaxin XL), nelfinavir (Viracept), nefazadone, amiodarone, amprenavir (Agenerase), aprepitant, diltiazem (Cardizem, Dilacor, Tiazac), erythromycin, fluconazole (Diflucan), fosamprenavir, and verapamil (Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS), may result in an increase in fentanyl blood levels, increasing or prolonging side effects of fentanyl.

Is Dilaudid or fentanyl safe to take if I am pregnant or breastfeeding?

Dilaudid safety

  • There are no adequate studies of hydromorphone to determine safe and effective use in pregnant women.
  • Low levels of opioid medications may be excreted in breast milk; therefore, it should not be used in nursing mothers.

Fentanyl safety

  • Fentanyl can cross the placenta and enter the fetus. Effects on the developing fetus are not known; however, fentanyl can slow breathing in newborn infants whose mothers were exposed to fentanyl. Routine use of fentanyl by pregnant women can lead to withdrawal reactions in the newborn. Thus, caution should be used if fentanyl is administered near the time of delivery.
  • The effects of fentanyl on the infants of breastfeeding mothers is unknown. Since most drugs are concentrated in breast milk, it is advisable that women requiring fentanyl bottle-feed their infants.

Summary

Dilaudid (hydromorphone) and fentanyl are narcotic pain relievers prescribed to patients for the treatment and management of severe chronic pain, for example, pain related to cancer. Dilaudid and fentanyl have the same mechanism of action (they work the same way in relieving and stopping pain).

Since Dilaudid and fentanyl work the same way in the body, they have many similar side effects, for example, headache, dry mouth, nausea, vomiting, diarrhea, abdominal pain, rash, itching, and anxiety.

Dilaudid can cause additional side effects of sweating and flushing. Fentanyl also may cause muscle rigidity, confusion, and reduced heart rate.

Opioid (narcotic) pain relievers like Dilaudid and fentanyl can be habit forming even if you take them at the doses your doctor has prescribed. These drugs also can be addictive and abused. Withdrawal symptoms may occur if Dilaudid or fentanyl are discontinued abruptly. Symptoms of withdrawal include yawning, nasal discharge, profuse sweating, tearing, coughing, twitching muscles, diarrhea, and nausea.

Both drugs interact with many other medications. Read the drug interactions for Dilaudid and fentanyl.

REFERENCE: FDA Prescribing Information.

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Medically Reviewed on 11/8/2017
References
Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine

REFERENCE:

FDA Prescribing Information.
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