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Hydromorphone (brand name Dilaudid) is a strong prescription opioid used for moderate to severe pain, a semi-synthetic derivative of morphine that is several times more potent. It is a full mu-opioid agonist, producing pain relief, euphoria, sedation and respiratory depression. Like all strong opioids it carries a real overdose and dependence risk, and naloxone reverses it.
- Strong pain relief
- Euphoria
- Sedation
- Respiratory depression
- Constipation and nausea
- Dependence and withdrawal
- Dangerous with alcohol or benzodiazepines
Mechanism
Hydromorphone is a semi-synthetic morphine derivative and a full at the mu-opioid receptor, the target responsible for analgesia, euphoria, sedation and respiratory depression. It is several times more potent than morphine, so it is active at smaller doses. As a mu-opioid drug it is reversible by the naloxone.
receptor fingerprint
Mu-opioid receptorFull agonist
Safetyrisks and cautions, not medical advice
Hydromorphone is a strong opioid, so the key danger is respiratory depression, breathing that slows or stops, particularly with higher doses or in people without tolerance. It is deadly combined with other depressants such as benzodiazepines and alcohol. Regular use leads to tolerance, physical dependence and withdrawal on stopping. Naloxone can reverse an overdose. Not medical advice.
Interactionsdocumented pairs only, not exhaustive
Hydromorphone combined with CYP3A4-inhibiting macrolide antibiotics (clarithromycin or erythromycin) markedly increases opioid toxicity risk; a population-based study found that macrolide exposure in the preceding 14 days was associated with 3.38-fold increased risk of opioid toxicity (hospitalization or death) compared to no macrolide [3]. This is a pharmacokinetic interaction; the macrolides inhibit the CYP3A4 enzyme responsible for hydromorphone metabolism, raising plasma concentrations. Azithromycin, which does not inhibit CYP3A4, showed no increased risk, confirming the mechanism. Similar risk elevation was observed with fentanyl and oxycodone. Interactions with other CYP3A4 inhibitors (certain antiretrovirals, azole antifungals) likely carry comparable risk but have not been formally quantified in clinical cohorts.
Checking a whole stack? Run it through interactions + stacks.
Subjective profileweighing the evidence above
A strong opioid that does its job well for severe pain under prescription, with the matching risks: respiratory depression, dependence and overdose, all multiplied by alcohol or benzodiazepines. Not a compound for casual use, and worth keeping naloxone on hand wherever it is in the house.
Resources
No suppliers are provided for compounds like this. This entry is here for reference.
Research
- 2010first citedOral hydromorphone extended-release.
- 2026most recentOpioid Toxicity Following Concomitant Use of Macrolide Antibiotics with Fentanyl, Hydromorphone…
- 1.Research Progress of Hydromorphone in Clinical Application.
- 2.Oral hydromorphone extended-release.
- 3.Opioid Toxicity Following Concomitant Use of Macrolide Antibiotics with Fentanyl, Hydromorphone, or Oxycodone: A Population-Based Study.
3 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
FAQ
How strong is hydromorphone compared to morphine?
It is several times more potent than morphine, so it produces its effects at smaller doses.
What is it used for?
It is a prescription opioid for moderate to severe pain, available in both immediate- and extended-release forms.
Does naloxone reverse it?
Yes. It is a mu-opioid agonist, so the antagonist naloxone can reverse an overdose.
Adverse effects
- Respiratory depression
- Constipation and nausea
- Dependence and withdrawal
- Dangerous with alcohol or benzodiazepines