Fentanyl vs Dilaudid: Which Is Better? (2024)

Fentanyl and Dilaudid (hydromorphone) are two potent opioid pain relievers.

Opioids are a family of medicines that produce effects similar to morphine. These medicines are Schedule II controlled substances per the U.S. Food and Drug Administration (FDA). This designation means they are likely to cause dependence or to be abused.

There are some crucial nuances between fentanyl and Dilaudid.

This article delves into how they work, conditions they treat, safety considerations, and alternatives.

What Is Fentanyl?

Fentanyl is a powerful opioid pain medicine that is synthetic (made in a lab). It's 50 times more potent than heroin and 100 times more potent than morphine.

Fentanyl was approved in the U.S. in the late 1960s as an intravenous (IV) pain medicine. Today, it's available as prescription products in the following formulations:

• Injection
• Patch (Duragesic)
• Lozenge (Actiq)
• Dissolving tablet (Fentora)
• Sublingual (under the tongue) tablet (Abstral)
• Sublingual spray (Subsys)
• Nasal spray (Lazanda)

Street use of fentanyl has spiked since 2013 when it began to be made illegally around the world and mixed with other drugs like heroin and cocaine. Fentanyl that's manufactured illegally is either sold as a powder or tablet, often one that's made to look like another medication, such as Percocet (oxycodone with Tylenol).

Fentanyl and drugs related to it are now the main drivers of the opioid epidemic in the United States. In 2022, illegal fentanyl products were responsible for 70% of deaths due to drug overdoses in the U.S. Over 76,000 people died from fentanyl overdoses in the U.S. alone that year.

What It Treats

The FDA has approved prescription fentanyl for the following uses:

• Anesthesia before or during immediate recovery from surgery for people over age 2.
• Long-term, severe pain in people who are used to taking opioid medications ("opioid-tolerant").
• Breakthrough cancer pain in people over age 16 who are taking opioid medications.

How It Works

Fentanyl primarily acts by activating (turning on) the mu-opioid receptor in the brain.

Activation of this receptor helps with pain relief and causes feelings of euphoria.

Side Effects

Common side effects of fentanyl include the following:

• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Insomnia (trouble sleeping)
• Dizziness
• Constipation
• Excessive sweating
• Decreased appetite
• Headache

Serious side effects can include:

• Slow breathing
• Apnea (stopping breathing)
• Stiffness
• Slow heart rate

Using fentanyl can be life-threatening. Symptoms of an overdose (taking too much fentanyl) include:

• Lethargy (exhaustion)
• Changes in the size of the pupils
• Cold, clammy skin
• Cyanosis (turning blue)
• Coma
• Respiratory failure

What Is Dilaudid?

Dilaudid (hydromorphone) is a semi-synthetic opioid pain medication (made in a lab but derived from morphine). It's been used in the U.S. since the 1920s and is two to eight times stronger than morphine.

Dilaudid is available as a prescription medication in the following forms:

• Tablets
• Capsules
• Solution
• Injection
• Suppository
  

What It Treats

Dilaudid is approved by the FDA to treat severe pain that is not controlled by other pain medications.

How It Works

Like fentanyl, Dilaudid relieves pain by activating the mu-opioid receptors.

It works quickly, with maximum levels in the blood occurring 30 minutes to an hour after it's taken by mouth.

Side Effects

Common side effects of Dilaudid include:

• Dizziness
• Sedation
• Nausea
• Vomiting
• Sweating
• Dysphoria (unease)
• Euphoria (a "high")
• Dry mouth
• Itchy skin

Signs of an overdose include the following:

• Drowsiness
• Coma
• Low muscle tone
• Cold, clammy skin
• Constricted pupils
• Low blood pressure
• Slow heart rate
• Respiratory depression

Safety Considerations

There are some important considerations to keep in mind if your healthcare provider prescribes fentanyl or Dilaudid for chronic pain or another condition.

Contraindications

Some populations should not use fentanyl or Dilaudid due to safety risks.

For instance, fentanyl patches should not be used by people who haven't taken opioid medications before.

People who use fentanyl patches should be "opioid-tolerant." This means that a person has been taking opioids like the following for at least one week, around the clock:

• 60 mg morphine per day
• 30 mg oral oxycodone per day
• 8 mg oral hydromorphone per day
• 25 mg oral oxymorphone per day
• 60 mg oral hydrocodone per day

Fentanyl should also not be used by people with the following conditions:

• Pregnancy, because fentanyl may harm the fetus or cause the baby to be born with withdrawal symptoms
• Breastfeeding
• Severe liver or kidney problems
• Circulatory shock, as it may cause very low blood pressure
• Impaired consciousness or coma due to side effects

In the United States, Dilaudid is not approved for children. It also should not be used by people with the following conditions:

• Pregnancy, if another option can be used. Babies born to mothers who take Dilaudid are at risk of withdrawal symptoms.
• Respiratory depression (shallow breathing)
• Severe asthma
• Gastrointestinal obstruction
• Impaired consciousness or coma

Drug Interactions

Both fentanyl and Dilaudid can have dangerous interactions with other medications.

For instance, medications that inhibit the liver enzymes that are responsible for breaking down fentanyl (cytochrome P450 3A4) will increase the level of fentanyl in the body. This can cause breathing problems or death.

Taking a class of medications called monoamine oxidase inhibitors (MAOIs) with Dilaudid will increase drug levels of Dilaudid in the body. This can cause dangerous side effects.

Some medications can interact with both fentanyl and Dilaudid. These include:

• Benzodiazepine sedatives (like Xanax) or alcohol. Taking these medications that slow down the central nervous system (CNS) along with opioids increases the risk of coma and death.
• Medications that increase serotonin levels (such as some antidepressants). These can cause serotonin syndrome if taken with fentanyl or Dilaudid.

Be sure to screen for any drug interactions with your current regimen before starting fentanyl or Dilaudid.

A healthcare provider or pharmacist is the best resource for determining whether one of these medications is a safe option for you.

Dosing and Administration

It is essential to follow your healthcare provider's instructions for dosages of these or any other opioids. Discuss any questions about how to take your medication with your healthcare provider or pharmacist to ensure safety.

Here are a few specifics to keep in mind when taking fentanyl or Dilaudid:

• People with kidney or liver problems should start with a lower dose of fentanyl or Dilaudid to prevent levels of these medicines from getting too high.
• If you take liquid Dilaudid, measure it in a syringe provided by the pharmacy. Kitchen teaspoons are notoriously imprecise. Using these to measure your medicine could result in an overdose.
• If you use a fentanyl patch (Duragesic), be sure it's not exposed to direct heat (things like saunas, hot tubs, or heating pads). Heat will increase levels of fentanyl in the body.

Be aware that even when opioids are taken as prescribed, they can cause drug addiction, overdose, and even death.

Because both fentanyl and Dilaudid pose a danger to people who are not used to opioids, these medications should be kept in a locked cabinet away from children, pets, and visitors.

Follow the manufacturer's guidelines for disposing of any unused medication.

The Research

Much of the current research, particularly involving fentanyl, centers on how to prevent and treat overdoses. For example, because illegal fentanyl acts so quickly, in some cases, naloxone may kick in too late to be effective.

Some interesting studies have compared fentanyl and Dilaudid to other pain medications:

• Researchers have found that fentanyl is an effective choice for pain in people who are addicted to opioids. It is more effective than morphine for this population and causes fewer side effects.
• A clinical trial that compared IV Dilaudid to Tylenol (acetaminophen) found that there wasn't a significant difference in pain control for older people with acute, severe pain.

Alternatives

If you don't feel comfortable taking an opioid, or your healthcare provider doesn't recommend one for you, know that there are many alternative pain management strategies.

Some of these include:

• Pain reprocessing therapy. This psychological approach is based on changing people's beliefs about chronic pain. It helps your mind and body frame pain as a potential false alarm from your brain rather than an actual injury and is effective for lower back pain.
• Acupuncture. This process uses needles to target specific points in the body and is helpful for conditions like back pain and headaches.
• Safer pharmaceuticals such as Neurontin (gabapentin), some antidepressants, or muscle relaxers. Some research shows that gabapentin is more effective than opioids for treating chronic pain in older people. Keep in mind that at high doses, gabapentin can act like opioids and does have the potential to be abused. There's also some evidence to support using antidepressants like Cymbalta (duloxetine) or Elavil (amitriptyline) for fibromyalgia or muscle relaxers like Flexeril (cyclobenzaprine) for back pain.
• OTC medicines like Tylenol (acetaminophen), aspirin, and non-steroidal anti-inflammatories (NSAIDs). These are recommended before opioids for migraines, dental pain, and arthritis.
• Supplements such as capsaicin cream or curcumin.

Potential Challenges and Considerations

Despite a 40% decline in opioid prescriptions in the U.S. since 2010, deaths due to opioid overdoses are still increasing.

The U.S. Center for Disease Control and Prevention (CDC) issued guidelines in 2016 to limit the prescribing of opioids. These guidelines include:

• Trying non-opioid pain medications and therapies first
• Using the lowest opioid dose possible for the shortest duration of time
• Reviewing data from state prescription drug monitoring programs before prescribing or dispensing opioids
• Providing treatment for people with OUD

Public health initiatives have cropped up to address opioid misuse and addiction, mainly focusing on the illicit (illegal) drug use of fentanyl, which is driving the epidemic in the U.S.

Some of these include:

• Early intervention for people at risk of opioid overdose
• Expanding the use of overdose rescue medication Narcan (naloxone)
• Increasing access to substance use disorder treatments

Other initiatives are more controversial and not mainstream in the U.S. An example is safe injection sites, public places where people can use opioids under medical supervision.

Summary

Fentanyl and Dilaudid are two strong opioid medications used to treat some types of pain.

Fentanyl is more potent, and some forms of it should only be used for people who are used to taking opioids.

Illegally-manufactured fentanyl is currently the driver of the opioid epidemic. When mixed with other recreational drugs, it's hazardous.

Keep in mind that while they're both very effective pain relievers, fentanyl and Dilaudid carry risks of dependence, addiction, and overdose. Some populations shouldn't take them due to safety concerns. These medicines also have some significant drug interactions to be aware of, including alcohol, some antidepressants, and medications for anxiety.

If you are prescribed fentanyl or Dilaudid, be sure to take it exactly as directed for optimal safety. Never share it with others, and plan to keep Narcan on hand in case of an overdose.