Hydrocodone vs. Hydromorphone for Pain: Differences between Side Effects and Pain Control

• Hydrocodone (Zohydro ER) and hydromorphone (Dilaudid, Dilaudid-5, Dilaudid-HP Injection, Exalgo) are both opioid narcotic pain relievers.
• Both hydrocodone and hydromorphone are available as generic drugs.
• Side effects of both hydrocodone and hydromorphone are similar and include lightheadedness, dizziness, sedation, nausea, vomiting, and constipation.
• Hydrocodone may also cause drowsiness and difficulty urinating.
• Hydromorphone may cause side effects including sweating, flushing, itching, and dry mouth.
• Serious side effects of both hydrocodone and hydromorphone include slowed breathing and trouble breathing.
• Combining opioids such as hydrocodone and hydromorphone with alcohol or other central nervous system depressants may result in severe sedation, respiratory depression, coma, and death.
• Both hydrocodone and hydromorphone have the potential for abuse and addiction. Withdrawal symptoms for both drugs include restlessness, watery eyes, runny nose, yawning, sweating, chills, muscle pain, and dilated pupils.

Hydrocodone (Zohydro ER) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. Hydrocodone, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain and reduce the perception of pain. Hydrocodone is prescribed for the long-term treatment of severe pain for which other treatment options are not effective, not tolerated, or would most likely not be strong enough to adequately manage the pain. Hydrocodone sometimes is combined with other non-narcotic pain relievers such as ibuprofen (Vicoprofen) or acetaminophen (Vicodin, Norco, Lortab, Lorcet).

Hydromorphone hydrochloride (Dilaudid) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. It is used for management of acute pain and moderate-to-severe chronic pain in patients when the use of an opioid is appropriate. Hydromorphone, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain and reduce the perception of pain.

Hydrocodone is prescribed for the long-term treatment of severe pain for which other treatment options are not effective, not tolerated, or would most likely not be strong enough to adequately manage the pain.

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

Hydrocodone side effects

The most frequent adverse reactions include:

• Lightheadedness
• Dizziness
• Sedation
• Nausea
• Vomiting

Other side effects include:

• Drowsiness
• Constipation
• Spasm of the ureter, which can lead to difficulty in urinating.

Other patient warnings include:

• Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery.
• Hydrocodone can depress breathing and should be used with caution in elderly, debilitated patients, and in patients with serious lung disease.
• Hydrocodone is habit forming. Mental and physical dependence can occur when used long-term.

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.

Hydromorphone side effects

Common side effects

• Lightheadedness
• Dizziness
• Sedation
• Nausea
• Vomiting
• Constipation
• Sweating
• Flushing
• Itching
• Dry mouth

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

Hydrocodone dosage

• The initial dose for adults is 10 mg orally every 12 hours.
• The dose may be increased every 3 to 7 days by 10 mg every 12 hours as needed to control pain.
• Capsules must be swallowed whole and not chewed.

Hydromorphone dosage

• 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.

Hydrocodone drug interactions

• Combining alcohol and other sedatives with hydrocodone can lead to increased sedation and even cause confusion.
• Hydrocodone should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Hydrocodone should not be administered within 14 days of stopping an MAOI.

Hydromorphone 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.

Hydrocodone safety

• There are no adequate studies of hydrocodone in pregnant women.
• Hydrocodone is excreted in breast milk, and, therefore should be used cautiously by nursing mothers.

Hydromorphone 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.