How does this medication work? What will it do for me?

Hydromorphone belongs to the family of medications known as opioid analgesics (narcotic pain relievers). It is used to treat moderate to severe pain, including pain after surgery. High concentration injectable forms of this medication are only used to treat severe pain for people who need higher than usual doses of hydromorphone.

Hydromorphone works on the brain to increase the ability to tolerate pain. Hydromorphone begins to work within 30 minutes for oral (by mouth) forms, or within 5 minutes for injectable forms.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?


Each mL of sterile solution contains hydromorphone HCl 2 mg. Nonmedicinal ingredients: citric acid and sodium citrate. Preservative-free.

Oral Liquid

Each mL of clear, unflavoured, syrupy liquid contains hydromorphone HCl 1 mg. Nonmedicinal ingredients: glycerin, methylparaben, propylparaben, and sucrose. Sucrose: 0.5 g/mL.


Each tablet contains hydromorphone HCl 1 mg (green), 2 mg (orange), 4 mg (yellow), or 8 mg (white, scored). Nonmedicinal ingredients: lactose anhydrous, magnesium stearate, D&C Yellow No. 10 Lake and FD&C Blue No. 1 Lake (for 1 mg), D&C Red No. 30 Lake, and D&C Yellow No. 10 Lake (for 2 mg), D&C Yellow No. 10 Lake (for 4 mg). Tartrazine-free.


Each mL of sterile solution contains hydromorphone HCl 10 mg, citric acid 2 mg, and sodium citrate 2 mg, in water for injection. No added preservatives.

How should I use this medication?

The usual adult dose of hydromorphone taken by mouth is 2 mg to 4 mg every 4 to 6 hours as required. The oral liquid may be diluted in fruit juice or other beverage if desired. Rectal suppositories are often used at night, with the usual dose of 1 suppository every 6 to 8 hours.

The usual adult dose of hydromorphone when given by injection is 2 mg given under the skin or into a muscle every 4 to 6 hours if necessary. When given by injection in the hospital, your doctor may inject the medication slowly into a vein.

For high-concentration hydromorphone injection, the dose will depend on the dose of other opioid medications that you are currently using. Your doctor will determine the dose that is appropriate for you.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, take or use it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take or use a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children. Protect the ampulees and vials from light.

This medication is available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms listed here. The forms available for the specific brand you have searched are listed under "What form(s) does this medication come in?"

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Hydromorphone should not be taken or used by anyone who:

  • is allergic to hydromorphone, other opioid (narcotic) pain medications (e.g., morphine, codeine, oxycodone), or to any of the ingredients of the medication
  • has acute asthma or other obstructive airway disease
  • has acute respiratory depression (slowed breathing)
  • has increased intracranial pressure (increased pressure inside the head)
  • has pulmonary edema (fluid buildup in the lungs)
  • has severe central nervous system (CNS) depression (e.g., slowed nervous system)

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • dizziness, lightheadedness, or feeling faint
  • drowsiness
  • dry mouth
  • headache
  • loss of appetite
  • nausea or vomiting
  • nervousness or restlessness
  • nightmares or unusual dreams
  • trouble sleeping
  • weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred or double-vision or other changes in vision
  • decrease in amount of urine
  • depression or other mood or mental changes
  • difficult or painful urination
  • fast, slow, or pounding heartbeat
  • frequent urge to urinate
  • increased sweating
  • irregular breathing
  • itching
  • shortness of breath, wheezing, or troubled breathing
  • skin rash
  • stomach cramps or pain
  • swelling of face
  • trembling or uncontrolled muscle movements
  • unusual excitement or restlessness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • cold, clammy skin
  • confusion
  • fainting
  • hallucinations (seeing, hearing or feeling things that are not there)
  • "pinpoint" pupils of eyes
  • seizures
  • severe drowsiness
  • signs of a severe allergic reaction (hives; difficulty breathing; swelling of the face, throat, or tongue)
  • slow heartbeat
  • slow or troubled breathing

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Dependence: As with other opioid medications (narcotics), this medication may become habit-forming if taken for long periods of time. Misuse of hydromorphone usually is not a problem when it is used appropriately for pain relief. Withdrawal symptoms (e.g., body aches, diarrhea, nausea, nervousness, restlessness, runny nose, sneezing, goose bumps, shaking, shivering, nausea, stomach cramps, fast heart rate, fever, sweating) may occur if hydromorphone is stopped suddenly. People who are taking this medication for a long time and no longer require it for pain control should stop the medication gradually, as directed by their doctor.

Difficulty breathing: Hydromorphone can cause serious breathing problems. If you experience slowed breathing or difficulty breathing, seek immediate medical attention. People with lung problems, head injury, and those who are taking other medications that can slow breathing are more at risk for experiencing this. Make sure you follow the instructions on how to properly use this medication. If you have any questions, contact your doctor or pharmacist. People with chronic lung conditions (e.g., bronchitis, emphysema, asthma) should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Hydromorphone may reduce the mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Do not drive or operate dangerous machinery while using this medication unless you have determined that the medication does not affect your ability to do so.

Kidney function: People with reduced kidney function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with reduced liver function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Hydromorphone can cause low blood pressure, which may be severe. If you experience severe dizziness, especially when standing from a lying or sitting position, contact your doctor.

Medical conditions: People with abnormal heart rhythms, reduced adrenal function (e.g., Addison's disease), low thyroid, inflammation of the pancreas, enlarged prostate, gallbladder disease, alcoholism, or urethral strictures should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping the medication: Do not suddenly stop using his medication since withdrawal symptoms may occur. These symptoms include body aches, diarrhea, nausea, nervousness, restlessness, runny nose, sneezing, goose bumps, shaking, shivering, nausea, stomach cramps, fast heart rate, fever, and sweating. Your doctor will advise you on how to safely stop taking this medication if you no longer require it for pain control.

Tolerance: Hydromorphone may lead to tolerance when used for long periods of time. Tolerance means that your body gets used to the medication so that more medication may be needed to produce the same pain relief. Your doctor will recommend the dose of hydromorphone that is most appropriate for you. Do not change your dose or the way you are using this medication on your own. Speak to your doctor if you have any questions.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Infants born to mothers who have been taking hydromorphone for long periods of time or who are physically dependent on hydromorphone will also be physically dependent on the medication and may experience breathing difficulties as well as withdrawal symptoms.

Breast-feeding: Hydromorphone passes into breast milk. If you are a breast-feeding mother and are using hydromorphone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding

Children: The safety and effectiveness of using hydromorphone have not been established for children.

Seniors: Seniors may be more sensitive to the effects of hydromorphone.

What other drugs could interact with this medication?

There may be an interaction between hydromorphone and any of the following:

  • alcohol
  • amphetamines (e.g., dextroamphetamine)
  • anesthetics
  • anticholinergic medications (e.g., benztropine, hyoscyamine)
  • antihistamines that cause drowsiness (e.g., diphenhydramine)
  • barbiturates (e.g., phenobarbital, butalbital, thiopental)
  • benzodiazepines (e.g., lorazepam, diazepam, clonazepam)
  • beta-blockers (e.g., atenolol, metoprolol)
  • MAO inhibitors (e.g., phenelzine, tranylcypromine) taken within the past 14 days
  • methocarbamol
  • naltrexone
  • other opioid medications (e.g., morphine, codeine, oxycodone, butorphanol)
  • phenothiazines (e.g., chlorpromazine, promethazine, perphenazine)
  • tricyclic antidepressants (e.g., amitriptyline, desipramine)
  • warfarin

If you are taking any medications that have a sedating effect, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.