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

Hydrocodone (Zohydro ER) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. It stimulates receptors in the brain to reduce pain. Hydrocodone is prescribed for severe pain when other treatments are ineffective, not tolerated, or insufficient.

Hydromorphone hydrochloride (Dilaudid) is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. It is used for acute and chronic pain when opioids are appropriate.

Uses of hydrocodone vs. hydromorphone

Hydrocodone is prescribed for long-term severe pain when other options are inadequate.

Hydromorphone is used for acute and chronic pain when opioids are appropriate.

Side effects of hydrocodone vs. hydromorphone

Hydrocodone side effects

The most frequent adverse reactions include:

• Drowsiness
• Constipation
• Spasm of the ureter, leading to difficulty in urinating.

Other patient warnings include:

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

Hydromorphone HCI BLACK BOX WARNING

• Dilaudid-HP Injection should not be confused with other types of Dilaudid injections or opioids to prevent overdose and death.
• Be cautious to avoid dosing errors with mL and mg measurements that can lead to accidental overdose and death.
• Hydromorphone carries a risk of addiction, abuse, and misuse, which can result in overdose and death.
• Patients should be closely monitored for respiratory depression, which can be life-threatening.
• Prolonged use of hydromorphone during pregnancy can cause neonatal opioid withdrawal syndrome, which requires immediate treatment.
• Pregnant women should be informed about the risk and have access to appropriate treatment.
• Combining opioids with benzodiazepines, alcohol, or other CNS depressants can lead to severe sedation, respiratory depression, coma, and death.

Hydromorphone side effects

Common side effects include:

Other serious side effects:

• Respiratory depression and trouble breathing
• Combining hydromorphone with alcohol or CNS-affecting medications can worsen respiratory depression and may lead to death.

Dosage of hydrocodone vs. hydromorphone

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 OR 3 to 6 mg rectally every 3 to 4 hours, when appropriate.

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

Drug interactions of hydrocodone vs. hydromorphone

Hydrocodone drug interactions

• Combining alcohol and sedatives with hydrocodone can cause increased sedation and confusion.
• Hydrocodone should not be taken with monoamine oxidase inhibitors (MAOIs) or drugs that inhibit monoamine oxidase, to avoid confusion, high blood pressure, tremor, hyperactivity, coma, and death. Hydrocodone should not be used within 14 days of stopping an MAOI.

Hydromorphone drug interactions

• Hydromorphone should be used cautiously with medications that depress the central nervous system, such as hypnotics, anesthetics, tranquilizers, phenothiazines, and alcohol.
• Hydromorphone should be used with caution with mixed agonist/antagonist opioid analgesics because it may reduce the analgesic effect of hydromorphone.

Safe use during pregnancy or breastfeeding

Hydrocodone safety

• There are no adequate studies of hydrocodone in pregnant women.
• Hydrocodone is excreted in breast milk and 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, so it should not be used in nursing mothers.

Summary

Hydrocodone (brand name Zohydro ER) and hydromorphone (brand names Dilaudid and others) are opioid narcotics prescribed for moderate to severe pain when other treatments are insufficient. Both narcotics have a Black Box Warning from the FDA due to serious side effects including coma and death.

• Lightheadedness
• Dizziness
• Sedation
• Nausea
• Vomiting
• Constipation
• Drowsiness
• Spasm of the ureter
• Sweating
• Flushing
• Itching
• Dry mouth
• Taking the drug in larger doses than prescribed
• Having a persistent desire and unsuccessful attempts to cut down or control the use of the drug
• Having a strong desire or craving for the drug
• Spending a lot of time doing various things to get or use the drugs
• Experiencing problems at work, school, or relationships
• Withdrawing from social activities because of the drug

FDA Prescribing Information.

NIH; National Institute on Drug Abuse. "The Science of Drug Abuse and Addiction: The Basics." Updated: Oct 2016.

NIH; National Institute on Drug Abuse. "The Science of Drug Abuse and Addiction: The Basics." Updated: Oct 2016.