Dilaudid (Hydromorphone) at a glance: schedule, half-life, and class
- Generic name
- Hydromorphone hydrochloride
- Brand names
- Dilaudid, Exalgo (extended release)
- Drug class
- Opioid agonist
- US legal status
- Schedule II, prescription only
- Approved uses
- Severe pain requiring an opioid
- Forms
- Tablets, oral liquid, injection, extended-release tablets
- Onset
- 15 to 30 minutes by mouth; 5 minutes IV
- Half-life
- 2 to 3 hours
- Broken down by
- Glucuronidation in the liver
- Reversal agent
- Naloxone
Dilaudid uses: what hydromorphone is prescribed for
Hydromorphone is approved for pain severe enough to require an opioid when alternatives are inadequate. It is often used in hospitals and in cancer and palliative care, and in people who cannot tolerate morphine. Extended-release tablets are for opioid-tolerant patients only.[1]
Dilaudid dosage: how hydromorphone is usually prescribed
The figures below come from the FDA-approved label and describe how prescribers typically use hydromorphone. They are not personal dosing advice. A prescriber sets the dose for each person and adjusts it over time.[1]
| Product | Typical starting dose (opioid-naive adults) | Notes from the label |
|---|---|---|
| Tablets | 2 to 4 mg every 4 to 6 hours as needed | Start at the low end in older adults |
| Oral liquid 1 mg/mL | 2.5 to 10 mL every 3 to 6 hours | Measure with an oral syringe, never a kitchen spoon |
| High-potency injection (10 mg/mL) | Opioid-tolerant patients only | Confusion with standard strength has caused deaths |
| Extended-release (Exalgo) | Opioid-tolerant patients only | Once daily; swallow whole |
Dilaudid (hydromorphone) side effects and risks
FDA boxed warnings
- Hydromorphone exposes users to risks of addiction, misuse, and abuse, which can lead to overdose and death.
- Life-threatening slowed breathing can occur, especially when starting treatment or after a dose increase.
- Accidental ingestion, especially by children, can cause a fatal overdose.
- Use with benzodiazepines or other central nervous system depressants, including alcohol, can cause profound sedation, slowed breathing, coma, and death.
- Prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated.
- Dosing errors from confusing high-potency and standard-strength products, or mg and mL, have caused fatal overdoses.
Common side effects include constipation, nausea, drowsiness, lightheadedness, itching, and sweating.[1]
Dilaudid interactions: what not to mix with hydromorphone
Choose what it would be combined with:
| Combined with | What happens | Label guidance |
|---|---|---|
| Benzodiazepines (alprazolam, diazepam, clonazepam) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Stronger sedation and slowed breathing | Avoid |
| Gabapentin, pregabalin, sleep medicines, muscle relaxants | Additive sedation and breathing problems | Use caution; lower doses |
| MAOIs | Severe, unpredictable reactions | Avoid within 14 days |
| Anticholinergic drugs | Urinary retention, severe constipation | Use caution |
| Other opioids | Additive breathing suppression | Avoid unless directed by prescriber |
This is not a full list. A pharmacist can check a complete medication list, including supplements and over-the-counter products.[1]
Dilaudid overdose: signs of hydromorphone overdose and what to do
Hydromorphone overdose causes pinpoint pupils, extreme drowsiness, slow or stopped breathing, cold clammy skin, and slow heartbeat.[1][2]
If someone may have overdosed
- Call 911 if the person is unresponsive, cannot be woken, has blue or gray lips, or is breathing slowly or not at all.
- Give naloxone (Narcan or a generic nasal spray, sold without a prescription) into one nostril. If there is no response after 2 to 3 minutes, give another dose.
- If you are trained, give rescue breaths. Otherwise place the person on their side so they do not choke.
- Stay with them. Naloxone can wear off before hydromorphone does, so the overdose can return even after the person wakes up.
- Most states have Good Samaritan laws that protect people who call 911 for an overdose from some drug charges.
Dilaudid withdrawal timeline: how long hydromorphone withdrawal lasts
People who take hydromorphone regularly for more than a few weeks become physically dependent, even when they take it exactly as prescribed. Dependence is not the same as addiction, but it means stopping suddenly causes withdrawal.[1]
- 6 to 12 hoursEarly symptomsAnxiety, restlessness, yawning, sweating, runny nose, watery eyes, and muscle aches.
- Days 1 to 3Peak withdrawalDiarrhea, stomach cramps, nausea and vomiting, goosebumps, dilated pupils, fast heartbeat, and strong cravings. Rarely dangerous in healthy adults, but dehydration can be serious.
- Days 5 to 10, then weeksLingering symptomsPoor sleep, low mood, low energy, and cravings can continue for weeks. Tolerance falls quickly, which raises the risk of overdose if use restarts.
Warning: After a break, the body loses tolerance within days. Returning to a previous dose of hydromorphone can cause a fatal overdose.
The FDA warns against stopping opioids abruptly in people who are physically dependent. A prescriber can taper the dose gradually, often by 10% or less per month for long-term users, and medicines such as clonidine or lofexidine can ease symptoms. For opioid use disorder, buprenorphine and methadone cut the risk of death roughly in half.[3]
How to get prescribed Dilaudid (hydromorphone) legally in the US
In the United States, hydromorphone is a Schedule II controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.[4]
- Refills: Schedule II prescriptions cannot be refilled. A prescriber can write several prescriptions at once, with dates when each may be filled, for up to a 90-day supply in total.[5]
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.[6]
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
- Pharmacies: a legitimate pharmacy always requires a valid prescription, has a licensed pharmacist available, and is licensed in the state it ships to. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm a pharmacy is real.[7][8]
- Cost: generic hydromorphone tablets are widely covered.
Warning: Pills sold as Dilaudid outside a pharmacy are often counterfeit. The DEA reports that fake pills frequently contain fentanyl or methamphetamine, and they cannot be told apart by appearance.[9]
Traveling: keep the medicine in its original pharmacy container and carry a copy of the prescription. Check the rules of the destination country before travel, because many countries restrict controlled medicines or require a permit.
Can you order Dilaudid (hydromorphone) online legally?
Yes, but only with a valid prescription and only from a pharmacy licensed in your state. Many licensed pharmacies, including mail-order pharmacies run by insurers, fill hydromorphone prescriptions online and ship them. Buying hydromorphone from a website that does not require a prescription is illegal, and the product is often fake.[7][9]
- See a licensed clinicianA clinician evaluates you in person or by telemedicine and decides whether hydromorphone is appropriate.
- The prescription goes to a pharmacyPrescriptions for controlled medicines are usually sent electronically, straight from the prescriber to the pharmacy you choose.
- The pharmacy checks and fills itA pharmacist verifies the prescription and your identity, then dispenses the medicine in person or by mail.
Signs that an online seller is illegal:
- It sells hydromorphone with no prescription, or after only a short online questionnaire.
- It takes orders through social media, messaging apps, or email.
- It asks for payment in cryptocurrency, gift cards, or money transfers.
- It has no US street address, no state pharmacy license, and no pharmacist to speak to.
- Its prices are far below those of ordinary pharmacies, or it ships from another country.
The FDA's BeSafeRx tool links to each state's license lookup, and the National Association of Boards of Pharmacy lists verified online pharmacies.[7][8]
Dilaudid price: how much does Dilaudid (hydromorphone) cost without insurance?
Generic hydromorphone tablets are widely covered.
What you pay depends on the strength, the number of doses, your insurance plan, and the pharmacy. Cash prices for the same prescription can differ several times over between pharmacies in the same town, so check current prices before you fill it.
Ways to pay less, legally:
- Ask the prescriber whether a generic hydromorphone is available. FDA-approved generics work the same way as the brand and usually cost much less.
- Compare cash prices between pharmacies before you fill the prescription.
- Use a free prescription discount card, such as GoodRx or SingleCare, when you pay cash. These cards cannot be combined with insurance on the same fill.
- For brand-name medicines, check the manufacturer's savings program or patient assistance program.
- Check your insurer's mail-order pharmacy, which may charge a lower copay.
Warning: A price far below what licensed pharmacies charge, especially with no prescription required, is a strong sign of an illegal seller and counterfeit medicine.[7]
Is Dilaudid legal? Hydromorphone legal status in other countries
| Country | Status |
|---|---|
| United Kingdom | Class A; prescription only |
| Canada | Schedule I of the Controlled Drugs and Substances Act; prescription only |
| Australia | Schedule 8 controlled drug; prescription only |
| International | Schedule I of the 1961 Single Convention on Narcotic Drugs |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border.[10]
Common questions about Dilaudid (hydromorphone)
How strong is Dilaudid (hydromorphone) compared with morphine?
By mouth it is roughly 4 to 5 times as potent as morphine per milligram; by injection the ratio is higher.
What is Dilaudid?
Dilaudid is the brand name for hydromorphone.
How long does Dilaudid (hydromorphone) stay in your system?
Its half-life is 2 to 3 hours. Urine tests usually detect it for 2 to 4 days.
Can you drink alcohol with Dilaudid (hydromorphone)?
No. Alcohol increases sedation and the risk of fatal breathing problems, and it can make extended-release tablets release drug faster.
Can you buy Dilaudid (hydromorphone) without a prescription?
No. Dilaudid (hydromorphone) is a Schedule II controlled substance in the US, so it is illegal to buy or possess it without a valid prescription. Websites and social media sellers that offer it without one are not legal pharmacies, and the DEA warns that pills sold this way are often counterfeit and can contain fentanyl. The legal route is a visit with a licensed clinician, in person or by telehealth, and a prescription filled at a state-licensed pharmacy. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm an online pharmacy is real.
Sources
- Dilaudid (hydromorphone) prescribing information. DailyMed, US National Library of Medicine.
- Information about naloxone and nalmefene. US Food and Drug Administration.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022. Centers for Disease Control and Prevention, MMWR.
- Controlled Substance Schedules. DEA Diversion Control Division.
- 21 CFR 1306.12, Refilling prescriptions; issuance of multiple prescriptions (Schedule II). Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth. US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information. US Food and Drug Administration.
- Safe Pharmacy. National Association of Boards of Pharmacy.
- One Pill Can Kill. US Drug Enforcement Administration.
- International drug control conventions. United Nations Office on Drugs and Crime.
