Dilaudid vs Morphine

  • Medical Editor: 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 vs. morphine

What are Dilaudid and morphine?

Dilaudid (hydromorphone hydrochloride) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. Hydromorphone, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain and reduce the perception of pain.

Morphine is a chemical found in the opium plant. It is a narcotic (opioid) pain reliever similar to hydrocodone, oxycodone, methadone, fentanyl, and other opioids. Morphine, 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).

What are the side effects of Dilaudid and morphine?

Dilaudid 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 woman 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

Other serious 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 central nervous system can worsen respiratory depression and may lead to death.

Morphine injection

The most frequent adverse reactions of morphine include:

Other side effects include:Patients may also develop anemia with intrathecal injection, and pain at the injection site. The elderly may be more sensitive to adverse effects. Morphine has the potential to be habit forming. Tolerance and physical and psychological dependence may occur with prolonged use. Seizures may result from high doses. Overdoses may cause respiratory depression, coma, and death.

What is the dosage of Dilaudid vs. morphine?

Dilaudid

  • 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.

Morphine injection

Dosing is specific to the route of administration. In adults (at least 18 years of age) the initial intravenous dose should be 2 to 10 mg per 70 kg of body weight over 24 hours. For epidural administration, 5 mg may be administered initially, with a maximum dose of 10 mg over 24 hours. Initial dosing for intrathecal administration should be 0.2 to 1 mg over 24 hours.

What drugs interact with Dilaudid and morphine?

Dilaudid

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.

Morphine injection

Combining alcohol and other sedatives with morphine can lead to increased sedation and even cause confusion.

Fluoxetine (Prozac) may increase blood levels and the effect of morphine leading to increased side effects.

Morphine should also be avoided in patients treated with monoamine oxidase inhibitors (MAOI) due to enhance toxicity of morphine including confusion, high blood pressure, tremor, hyperactivity, coma, and death.

Drugs in this class include isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane), and linezolid (Zyvox). Morphine should not be administered within 14 days of stopping an MAOI.

Is it safe to take Dilaudid or morphine if I'm pregnant or breastfeeding?

  • 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.
  • Morphine injection should only be given to pregnant women when no other method of controlling pain is available and there are methods to monitor the fetus. Newborns may exhibit withdrawal symptoms if chronic dosing is used.
  • Morphine is excreted in breast milk, however, the American Academy of Pediatrics committee states that it is safe to use while nursing

Summary

Dilaudid (hydromorphone hydrochloride) and morphine are both opioid narcotic pain relievers. Dilaudid is a brand name. Brand names of morphine include Astramorph, Duramorph, Infumorph, and Avinza. Side effects of both Dilaudid and morphine are similar and include:

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Medically Reviewed on 9/13/2017
References
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