Hydromorphone
Hydromorphone is a potent opioid analgesic used to manage moderate to severe pain when other treatments are insufficient. As a full mu-opioid receptor agonist, it provides powerful pain relief without a ceiling effect, meaning dose increases can continue to provide additional analgesia. It is available in various formulations including immediate and extended-release versions for different pain management needs.
Hydromorphone is a strong opioid pain medication used for moderate to severe pain relief.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N02AA03
- RxNorm
- 3423
- Generic
- Hydromorphone
- Class
- atc-n02
- Brands
- Dilaudid, Dilaudid Cough
- Availability
- rx
- Lactation
- unknown
- Routes
- oral, rectal
- Forms
- prefilled syringe, injection, capsule, tablet, solution
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
13 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks; opioid analgesics should not be used in early pregnancy
regular fetal monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteravoid if possible
avoid use unless benefits outweigh risks
regular fetal monitoring and growth assessments
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
third trimesteravoid if possible
avoid use especially near delivery; may cause neonatal respiratory depression and withdrawal
close fetal monitoring; neonatal assessment for withdrawal symptoms
Use of this medication in this population requires careful consideration of risks and benefits.
lactation
breastfeedingdiscontinue breastfeeding
hydromorphone passes into breast milk; do not breastfeed during treatment
monitor infant for signs of sedation or respiratory depression
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
elderlystart with 25-50% of adult dose
use lowest effective dose; increased sensitivity to opioid effects; monitor for falls and constipation
close monitoring of respiratory status, cognitive function, and bowel function
Use with caution and monitor for adverse effects.
pediatric_age
children under 12not recommended
hydromorphone is not recommended for use in children, especially for cough
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
pediatric_age
adolescents 12 17use with extreme caution and reduced dosing
use only for severe pain; not recommended for cough; monitor closely for respiratory depression
close monitoring of respiratory status
Use with caution and monitor for adverse effects.
renal_impairment
mildreduce dose by 25%
use with caution; monitor for accumulation
monitor renal function and drug levels
Use with caution and monitor for adverse effects.
renal_impairment
moderatereduce dose by 50%
use with caution; extended intervals between doses
frequent monitoring of renal function and drug levels
Use with caution and monitor for adverse effects.
renal_impairment
severeavoid or use with great caution
avoid if possible; if used, significantly reduce dose and extend dosing interval
very close monitoring of renal function, drug levels, and respiratory status
Use of this medication in this population requires careful consideration of risks and benefits.
hepatic_impairment
mildreduce initial dose by 25%
use with caution; metabolism may be reduced
monitor liver function and drug response
Use with caution and monitor for adverse effects.
hepatic_impairment
moderatereduce dose by 50%
use with extreme caution; significant metabolism impairment
close monitoring of liver function and respiratory status
Use of this medication in this population requires careful consideration of risks and benefits.
hepatic_impairment
severeavoid use
do not use in severe hepatic impairment
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
Statistics and clinical data
Commonly prescribed since
General prescribing information for hydromorphone
Drug class
Drug class as opioid receptor agonist
Common uses
Primary therapeutic indication
Controlled substance schedule
Federal controlled substance classification
Treatment of moderate to severe pain requiring opioid analgesia, including postoperative pain, cancer pain, and other acute or chronic pain conditions when non-opioid analgesics are inadequate.
Hydromorphone acts as a full agonist at mu-opioid receptors in the central nervous system, reducing pain perception and altering the emotional response to pain. It has no ceiling effect, allowing for dose escalation to achieve adequate pain control.
High risk of dependence, tolerance, and addiction with prolonged use. Can cause respiratory depression, especially at high doses or when combined with CNS depressants. Schedule II controlled substance with strict prescribing regulations. Dosage must be individualized and carefully titrated to balance pain relief with safety.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy