Hydromorphone vs. Hydrocodone: What Are the Differences for Pain?

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Many options are available to help millions of Americans manage their pain every day. However, it can be challenging to know which pain reliever is most effective or appropriate for one’s medical condition. 

If your doctor is considering or has prescribed hydromorphone or hydrocodone for your pain treatment needs, you may be wondering what the difference is between the two and if one would perform better than the other for you. While their names are similar, and they are both opioid medications, they are not the same.

First, you must consider how each drug is used to treat pain and if your situation requires this kind of medication.

In short, hydromorphone (Dilaudid) is used to treat moderate-to-severe acute pain, such as pain a patient may feel after surgery. Hydrocodone can be used long-term to treat chronic moderate-to-severe pain because it is not as potent as hydromorphone is. 

According to Verywell Health, a patient could receive Dilaudid while in the hospital and be given a less-potent opioid pain reliever, such as hydrocodone, to treat their pain outside of a hospital setting.

Your primary care physician can help you determine which one you should use to improve your condition. Which medication you are prescribed will depend on multiple factors unique to your situation, including:

  • The condition you are treating
  • Your overall medical condition
  • Your age and other personal medical information
  • The form of the medication you are taking 
  • How much of the medication you are taking as prescribed

Here is an overview of both medications and how they affect pain. You should always consult with your doctor about any medications you are taking and let them know if something is or is not working.

What Is Hydromorphone? 

Hydromorphone is an opioid pain reliever widely recognized under the trade name Dilaudid. The prescription medication is used to treat moderate-to-severe pain. People being treated for cancer or other long-lasting illnesses that bring severe pain may be prescribed Dilaudid to help them manage their symptoms. 

Hydromorphone is available in an oral liquid or an oral tablet. Patients could be given an extended-release version in tablet form. According to Drugs.com, it works by “binding mu-opioid receptors in the brain and stomach and has strong pain-relieving effects.

One important thing to remember about hydromorphone is that it is nearly five times stronger than morphine, according to Drugs.com, making it a much stronger pain reliever than hydrocodone. This is why, as Mayo Clinic explains, it is generally used for the short-term treatment of pain.

The drug can also be administered as an intravenous (IV) or intramuscular injection, or it can be taken as a pill to treat post-surgery pain. 

When abused, hydromorphone can create physical and psychological problems. Prolonged use and misuse can lead to unstable moods, anxiety, depression, and reckless, unpredictable behavior

hydromorphone-vs-hydrocodone

What Is Hydrocodone?

Hydrocodone shares the same drug class as hydromorphone. It, too, is a potent opioid medication prescribed to treat moderate-to-severe pain and cough. Its strength is also similar to that of morphine. 

While it is similar to morphine, it has a shorter half-life, which means there’s a higher risk of sedation, Drugs.com says. The term “half-life” is how long it takes the body to reduce half of the drug from the bloodstream and eliminate it entirely.

Some people who use hydrocodone report feeling euphoric, relaxed, and generally a state of well-being when they use it. These sensations also prompt some people to misuse the drug. Such misuse can lead to substance use and addiction.

As with other opioids, hydrocodone helps patients feel better when it binds to the body’s pain receptors in the central nervous system, specifically the brain and spinal cord, and blocks the nerves from alerting the brain that there is pain. 

This changes how the user perceives their pain and discomfort, but the source of their pain still exists and remains unchanged. 

Hydrocodone Can Be Taken By Itself or in Combination Medication

Pure hydrocodone is available and sold as an extended-release capsule under the trade name Zohydro ER. The extended-release version provides pain relief around the clock and can last for a longer period.

The U.S. Drug Enforcement Administration (DEA) reports that hydrocodone, along with acetaminophen, an over-the-counter pain reliever, and fever reducer, is part of a frequently prescribed powerful drug known as Vicodin. This drug is also sold under the trade names Norco, Lorcet, and Lortab.

Frequent misuse and abuse of hydrocodone can bring on several health problems, such as acetaminophen toxicity and liver damage.

Both Drugs Are Opioids, But One Is Stronger Than the Other

To recap, hydromorphone and hydrocodone are both pain-relieving opioid medications available legally by prescription only. However, their potencies are not the same, which can determine if and how a doctor chooses to prescribe them for pain management. 

Hydromorphone treats acute and chronic pain and is stronger than morphine, while hydrocodone is a weaker opioid whose strength is similar to morphine. 

Generally, opioids medications are generally used to treat moderate-to-severe pain for the short term. They are highly addictive and habit-forming, so everyone needs to be careful when using them, even those who take them to treat health conditions.

So, whether you take hydrocodone or hydromorphone, you could be prescribed these medications for short-term use. But each case is different because it depends on the person being treated.

When taken during a short-term treatment, drugs in this class are considered relatively safe to use, especially when used as directed by a doctor. Still, they are highly addictive and prone to abuse when they get into the wrong hands.

Comparing the Side-Effects of Hydrocodone and Hydromorphone

As with any drug, hydrocodone and hydromorphone both have side effects that users should consider before taking them for pain. Comparing the side effects of both can be helpful in figuring out which one would be better for you to take.

 Hydromorphone Side Effects

The following side effects can occur with hydromorphone use, per Drugs.com:

  • Headache
  • Nausea, vomiting
  • Constipation
  • Dizziness
  • Lightheadedness
  • Low blood pressure
  • Flushing (when the skin feels warm and appears red)
  • Itching
  • Red eyes
  • Dry mouth
  • Sweating

Because hydromorphone is more potent than morphine and causes sedation, you should avoid driving or operating any machinery while using this medication.

Healthline says such side effects can be temporary if they are mild. If they linger, call your doctor.

Other side effects of hydromorphone are more serious and require a call to your doctor right away. They can affect the heart, eyes, stomach, and other parts of the body.

  • Heart rate (fast or slow)
  • Racing pulse
  • Chest pain
  • Headache
  • Blood pressure changes
  • Muscle weakness
  • Tremors (uncontrolled muscle movements)
  • Stomach pain
  • Constipation
  • Nausea and vomiting
  • Bowel blockage
  • Double or blurry vision
  • Mood or behavior changes
  • Agitation
  • Anxiety, depression
  • Hallucinations
  • Confused state (disorientation)

Hydrocodone Side Effects

The following side effects can occur with hydrocodone use, per MedlinePlus:

  • Nausea and vomiting
  • Constipation
  • Dizziness
  • Drowsiness
  • Tiredness or fatigue
  • Cold symptoms (sneezing, stuffy nose, sore throat)
  • Headaches
  • Stomach pain
  • Swollen feet, legs, or ankles
  • Tremors (uncontrollable shaking)
  • Appetite changes
  • Dry mouth
  • Difficult, frequent, or painful urination
  • Ear ringing (tinnitus)
  • Back pain
  • Muscle tension or tightening
  • Trouble falling or staying asleep

More serious side effects can occur with hydrocodone use. See a doctor if you experience:

  • Rapid heart rate
  • Slowed or irregular heartbeat
  • Coordination loss
  • Stiffness
  • Twitching
  • Nausea, vomiting, diarrhea
  • Agitation
  • Hallucinations
  • Sweating 
  • Shivering
  • Having trouble or feeling pain when urinating or making a bowel movement

Drugs.com also advises that if a person stops using hydrocodone and notices changes in their breathing, including noisy breathing, sighing, shallow breathing, or breathing that stops when sleeping, they should call the doctor.

If you have had an allergic reaction to hydrocodone, and have broken out in hives or rashes, stop using the drug immediately. Feeling faint, noticing a slow heart rate or weak pulse are also signs to stop using the medication.

Other signs to stop hydrocodone use include:

  • Confusion 
  • Severe sleepiness
  • Worsening tiredness or weakness

Not everyone will experience the same side effects when taking hydromorphone or hydrocodone. Some users may experience none at all. Still, a look at the side effects can alert you of what to be on the lookout for if you do encounter them.

Always talk with your doctor if you notice any signs or symptoms that you are concerned about. Your doctor can adjust the dosage or move you to another medication altogether. They can also help you figure out the best way to address side effects.

Use Opioid Pain Relievers with Care

Hydromorphone and hydrocodone are habit-forming medications with high addiction potential. Even people with proper prescriptions for them can still develop a physical or psychological dependence. 

Abusing hydrocodone and hydromorphone has consequences. Abuse is any of the following:

  • Taking the medications without having a legitimate prescription
  • Taking more than the quantity prescribed 
  • Taking the medication more times than you should
  • Taking them with other drugs, including other opioids, and alcohol
  • Using them to get high instead of relieving pain, which is their intended purpose (This includes crushing them into a powder in order to smoke it or mixing it with water to inject it.)

If you find your pain medication is not working as well as it once did or that it is not working at all, let your doctor know as soon as possible. Do not stop taking your medication abruptly, as uncomfortable and dangerous withdrawal symptoms could result, and do not take more of your medication as prescribed because you risk dependence and addiction.

If you are abusing pain medications and are having a hard time quitting, visit an accredited facility that treats substance use disorders and enter a drug rehabilitation program that addresses opioid addiction with evidence-based treatment programs.

Sources

Jennifer Whitlock, R. (n.d.). What You Should Know About The Pain Medication Dilaudid. from https://www.verywellhealth.com/dilaudid-what-you-need-to-know-3156907

(April 2019) Hydromorphone. Mayo Clinic. from https://www.mayoclinic.org/drugs-supplements/hydromorphone-oral-route/description/drg-20074171

Dilaudid: 7 Things You Should Know. (n.d.). Drugs.com. from https://www.drugs.com/tips/dilaudid-patient-tips

Hydrocodone [PDF File]. (n.d.). Springfield, VA: Drug Enforcement Administration (DEA). from https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf

(October 2020) Hydromorphone, Oral Tablet. University of Illinois-Chicago, Drug Information Group. Healthline. from https://www.healthline.com/health/hydromorphone-oral-tablet#side-effects

Hydrocodone: MedlinePlus Drug Information. (n.d.). from https://medlineplus.gov/druginfo/meds/a614045.html

Hydrocodone: Uses, Side Effects & Dosage Guide. (n.d.). Drugs.com. from https://www.drugs.com/hydrocodone.html#side-effects

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