Dilaudid vs. Oxycodone: Similarities & Differences
Medically reviewed by Mary Choy, PharmD
Dilaudid (hydromorphone) and oxycodone are opioid pain medications used to relieve mild to severe pain in people expected to need pain alleviation around the clock (ATC) and who cannot be treated with other medications.
While these medications are used for similar purposes, they carry notable differences, such as in dosing requirements, forms of administration, and potential side effects.
This article will provide an in-depth analysis of Dilaudid and oxycodone.
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What Is Dilaudid?
Brand-name, prescription-based Dilaudid is classified by the Drug Enforcement Administration (DEA) as a Schedule II controlled substance due to its potential for misuse, abuse, and dependence.
Dilaudid contains the active ingredient hydromorphone, which is chemically related to morphine, is Food and Drug Administration (FDA)–approved to manage moderate to severe ATC pain in adults.
How It Works
Dilaudid is classified as an opiate analgesic, a medication that works by changing the way the brain and nervous system respond to pain.
More specifically, opiate analgesics act on opioid receptors to produce morphine-like effects.
Because of the risks of misuse, abuse, and addiction, even at usual doses, Dilaudid should only be used when other options are not adequate—for example when other, less potent medications have not provided sufficient pain relief.
Administration
Dilaudid is administered in a variety of ways, including as an orally administered extended-release (ER) tablet, an immediate-release (IR) tablet, a liquid solution, and as an intravenous (IV, within a vein) injection.
The active ingredient in Dilaudid, hydromorphone, is also available as a generic product and administered in multiple forms, such as an IV injection or suppository.
Off-Label Uses
Sometimes, healthcare professionals may prescribe a drug for non-FDA-approved uses. This is called off-label prescribing.
An example of off-label prescribing with Dilaudid would be its use in children and teenagers for the management of severe pain.
What Is Oxycodone?
Oxycodone is an FDA-approved generic opioid to alleviate moderate to severe ATC pain in adults 18 and older whose pain cannot be treated with other medications.
Like Dilaudid, oxycodone should only be used when other options are not adequate or cannot be tolerated.
How It Works
Like Dilaudid, oxycodone as an opiate analgesic works by changing the way the brain and nervous system respond to pain.
More specifically, oxycodone blocks pain signals that stem from the central nervous system (CNS). It also reduces the anxiety and stress that accompanies ATC pain.
Administration
Oxycodone dosing depends on the needs of the person, as well as the dosage form the drug is in. Oxycodone is administered as an IR tablet, ER tablet, ER capsule, or liquid solution.
Brand-name versions of oxycodone exist, such as Xtampza ER.
Off-Label Uses
As an off-label use, healthcare providers sometimes prescribe oxycodone for children and adolescents.
Safe Guidance Overview
Both Dilaudid and oxycodone, as well as all other prescription opioids, carry a black box warning.
A black box warning is the most severe warning assigned by the FDA.
Black Box Warning
For opioids like Dilaudid and oxycodone, the warnings state:
Opioid pain medications have a risk of misuse, abuse, and addiction, which can cause overdose and death. Before prescribing an opioid, the healthcare provider will consider the associated risks and regularly monitor the individual during treatment.
Because respiratory depression (slowed, ineffective breathing) may occur, which can cause death, individuals who take opioid medications will be closely monitored.
Accidentally ingesting an opioid medicine, especially by a child, can cause death by overdose.
Taking an opioid medicine for some time during pregnancy can cause a withdrawal syndrome in the baby when the baby is born. This can be life-threatening if not treated.
Opioids can cause CNS depression, which is a slowing down of the nervous system. Combining an opioid with alcohol or other CNS depressants can lead to extreme sedation, slowed breathing, coma, and death. If the combination cannot be avoided, healthcare providers will prescribe the lowest doses for the shortest time and monitor them closely.
Other safety information about Dilaudid and oxycodone includes:
Certain people should be closely monitored, including those with chronic lung disease, older adults, or cachexia.
Opioids can cause severe hypotension (low blood pressure). Opioid pain medicines should not be used in individuals who are in circulatory shock (insufficient blood flow due to circulation problems).
There is a higher risk of breathing problems in individuals with brain tumors, increased pressure in the skull, head injury, or impaired consciousness (not awake, aware, or oriented). Opioids should not be used in people with impaired consciousness or who are in a coma.
Dilaudid-Specific Warning
Dilaudid's black box warning notes that careful attention should be given when prescribing, dispensing, and taking Dilaudid oral solution.
This is because dosing mistakes could occur, which can lead to accidental overdose and death.
Oxycodone-Specific Warning
Oxycodone carries another aspect of its black box warning that states that combining certain medications (enzyme inhibitors) with oxycodone can lead to an overdose and death.
Side Effects
The following sections will compare and contrast potential side effects associated with Dilaudid and oxycodone.
Common Side Effects: Dilaudid
Common side effects of Dilaudid include:
Common Side Effects: Oxycodone
Common side effects of oxycodone include:
Drowsiness
Headache
Dry mouth
Stomach pain
Constipation
Severe Side Effects: Dilaudid & Oxycodone
Serious side effects and their symptoms can include some of the following:
Anaphylaxis (severe allergic reaction): Seek emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Hallucinations (seeing or hearing things that do not exist)
Stiff or twitching muscles
Severe drowsiness
Feeling light-headed or fainting
Call your healthcare provider right away if you have serious side effects.
Dial 911 if your symptoms feel life-threatening or if you think you or a loved one is experiencing a medical emergency.
Dosage Guidelines
With any opioid, healthcare providers aim to prescribe the lowest effective dose for the shortest period.
Dosing is individualized based on factors such as the person's severity of pain, risk factors for abuse, and response to treatment.
People with kidney or liver problems generally require lower doses and close monitoring. When an opioid is discontinued after some time, the healthcare professional will provide instructions on how you can taper off the medication safely and slowly.
Also, anyone who takes an opioid pain medicine should have naloxone on hand in case of overdose. Narcan, a commonly dispensed form of naloxone, is a nasal spray that can be used to reverse an opioid overdose and save lives.
It is now available over the counter (OTC).
Learn how to use it, and teach your family, caregivers, and close friends where it is and how to use it on you in case of an overdose.
Dilaudid
Brand-name Dilaudid is administered as oral tablets, most commonly as IR tablets.
Additionally, generic hydromorphone ER tablets are also available.
Brand-name Dilaudid is administered as an oral liquid solution and intravenously. As mentioned above, Dilaudid is only approved for adults, not children or adolescents.
Examples of commonly administered doses include:
Dilaudid IR tablets: 2 to 4 milligrams (mg) orally every four to six hours as needed for pain
Dilaudid oral solution: Using a calibrated measuring cup or syringe, one-half teaspoonful (2.5 milliliters, or mL) to 2 teaspoonsful (10 mL) orally every three to six hours as needed for pain
Oxycodone
Oxycodone is administered as an IR tablet, ER tablet, ER capsule, or liquid solution.
Xtampza ER, Roxicodone, and Oxycontin are brand-name versions of oxycodone.
Oxycodone is also available as an active ingredient in combination products, such as Percocet, which contains oxycodone and acetaminophen.
Examples of commonly administered doses include:
Oxycodone IR tablets are dosed between 5 and 15 mg orally every four to six hours as needed.
Oxycodone ER tablets are sometimes prescribed in individuals with chronic pain who require ATC pain management. The dosage is calculated based on the dose of other oxycodone formulations.
Potential for Interaction
Tell your healthcare provider about all of the medicines you take, including:
Prescription medications
OTC medicines
Vitamins
Dietary supplements
While taking Dilaudid or Oxycodone, do not start any new medications without approval from your healthcare provider.
Interactions: Dilaudid & Oxycodone
Some drug interactions that apply to both Dilaudid and oxycodone are:
Drugs that increase serotonin levels can result in a life-threatening condition called serotonin syndrome (SS). Examples of these medications include certain antidepressants, medications for migraine, muscle relaxers, herbal medications, such as Saint-John's-wort, and cough suppressants, such as dextromethorphan.
Drugs or substances that cause CNS depression, including alcohol, other opioids, benzodiazepines (a category of anxiety medications), or medications that help you sleep. This combination could result in extreme sedation, slowed breathing, coma, or death. The combination should be avoided if possible, but if it cannot be, the healthcare provider will prescribe the lowest doses of each medication and closely monitor the patient.
Monoamine oxidase inhibitors (MAOIs), such as Nardil (phenelzine), should not be used within 14 days of an opioid pain medication.
Drugs classified as mixed agonists/antagonists (such as buprenorphine) should not be combined with opioids because they can reduce the pain-relieving effect of the pain medication and/or cause withdrawal symptoms.
Anticholinergic drugs (medications that block a neurotransmitter called acetylcholine), such as Benadryl (diphenhydramine) may increase the risk of urinary problems and/or severe constipation.
Note that this is not a complete list of drug interactions. Other drug interactions may occur with Dilaudid or oxycodone.
Oxycodone-Specific Interactions
Oxycodone has some additional interactions, such as:
Drugs that cause an increase in oxycodone levels, which could lead to overdose, including antibiotics, such as topical erythromycin.
Drugs that cause a decrease in oxycodone levels, which could lead to lower efficacy, including anti-seizure medications, such as Tegretol (carbamazepine) or Dilantin (phenytoin).
Consult your healthcare provider for more information about drug interactions and how they may affect you.
Which One Is Right for Me?
More data is needed to effectively compare Dilaudid and oxycodone directly.
In treating pain, however, many healthcare providers look to the World Health Organization (WHO) analgesic guidelines, which outline treatment for pain as follows:
Mild pain is treated with non-opioid medication in combination with other measures such as physical therapy.
For people with mild to moderate pain who need additional pain relief, healthcare providers will add a "weak" opioid pain medication to the non-opioid medication (along with other nondrug methods). For example, oxycodone combined with another drug (such as Percocet) is considered a weak opioid, while Dilaudid and oxycodone alone are considered potent opioids.
For people with moderate to severe pain who need additional pain relief, a "strong" opioid will be substituted for the weaker opioid, and nonopioid medication, as well as other nondrug measures, will still be used. Dilaudid and oxycodone are both considered potent opioids.
One consideration may be how fast the medicine works and how long the pain relief lasts.
For example, Dilaudid reaches its highest levels in the body within 30 minutes to one hour, and one dose lasts up to four to five hours.
In comparison, IR oxycodone reaches its highest levels within the body at just over one hour, and one dose lasts between three to four hours.
Another consideration may be which drug is more potent or more robust. When comparing strength, Dilaudid is more potent, or stronger, than oxycodone.
In choosing the best pain medication for you, your healthcare provider will take many individual factors into account, such as:
Allergies to medications
Medical history
Family history
Symptoms/medical conditions
Potential drug interactions
Risk of abuse/history of substance use disorder
Summary
Dilaudid (hydromorphone) and oxycodone are prescription opioid pain medications.
They are prescribed for pain when other non-opioid medications are not effective or cannot be tolerated. As Schedule II controlled substances, however, they have the potential for abuse, addiction, and dependence.
While these medications are used for similar purposes, they carry notable differences, such as differences in dosing requirements, forms of administration, and potential side effects, among others.
Consult your healthcare provider for more information and medical advice to see if one of these medications is appropriate.
Frequently Asked Questions
What alternatives to opioids are available for pain relief?
Nonopioid analgesic medications such as Tylenol (acetaminophen) may help with pain while nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin or Advil (ibuprofen), may help with pain and inflammation.
Other measures, like physical therapy, may also help with pain relief.
How should I store Dilaudid or oxycodone?
Because of the potential for abuse, misuse, and addiction, these medications should be stored where no one can get to them, especially children.
Keep track of your medication so you know if any medicine is missing. Keep the bottle tightly closed when not in use.
Store at room temperature (68-77 degrees F), away from direct light, heat, and moisture. Ask your pharmacist about the best way to dispose of your medication when you no longer need it.
Read the original article on Verywell Health.
