Dilaudid vs. Oxycodone: Which Is the Right Painkiller for You?

Dilaudid and oxycodone are two opioid painkillers with many similarities but also some notable differences. The most significant is that Dilaudid (a brand name for the generic hydromorphone) is more potent than oxycodone.[1,2] 

Both medications have a place in modern medicine, and both also have a significant risk of misuse and opioid use disorder (OUD). Opioids should only be taken as prescribed by a doctor. Talk to a doctor as soon as you suspect your use of opioids may be unnecessary, or you think you’re struggling to take them only as prescribed.

Dilaudid vs. Oxycodone

Here is a breakdown of how Dilaudid and oxycodone compare:[1,3]

What Is Dilaudid?

Dilaudid is a brand name for the drug hydromorphone. Another common brand name the drug is sold under is Exalgo.[1] 

Hydromorphone is an opioid painkiller. This prescription drug is generally only used to treat severe pain when less potent pain relievers cannot provide sufficient relief to a patient. Hydromorphone should only be used exactly as prescribed.[1] 

Dosing

Dilaudid specifically comes in the form of a liquid and tablet. Hydromorphone can also come in the form of an extended-release tablet. The liquid is taken every three to six hours while the tablets are taken every four to six hours. Extended-release tablets are taken less frequently, generally at a rate of one per day.[1] 

While dosing should only be decided by the prescribing doctor, the dosing for oral liquid is usually 2.5 mg to 10 mg per dose. For tablets, typical starting dosing is 2 mg to 4 mg.[2] 

Dosing may need to be modified by your doctor if pain relief isn’t effective at your current dose or if you have certain medical conditions that affect your ability to metabolize drugs. Opioids are typically taken “as needed” so long as a patient doesn’t exceed their prescribed dosing. Some doses may be skipped, although taking the drug on a long-term basis and then stopping can lead to withdrawal. 

Misuse Risk

As an opioid, hydromorphone has high risk for misuse and dependence. Dependence is when the body adjusts to the presence of a drug and essentially starts to treat having the drug in your system as its “default” state.[4] 

In the absence of the drug, the body experiences temporary withdrawal symptoms, as it readjusts to drug abstinence. Withdrawal from opioids is often described as involving flu-like symptoms. It can be extremely uncomfortable. It is not typically life-threatening, but it can be in rare cases.[3,5,6] 

What Is Oxycodone?

Oxycodone is a drug with many similarities to hydromorphone. It is also an opioid painkiller that can only be obtained through prescription.[7] 

Unlike Dilaudid, oxycodone is the drug’s generic name. It is sold under many different brand names, including OxyContin. When combined with acetaminophen, it is sold under the popular brand name Percocet.[7]

Dosing

Oxycodone comes in many different forms, including a solution, concentrated solution, tablet, capsule, extended-release tablet and extended-release capsule. Most of these forms are typically taken every four to six hours, although the extended-release options should instead be taken every 12 hours. 

As is always the case, this should be taken as the general dosing instructions. If your doctor has instructed you to take your medication at a different rate, follow their instructions.[7] 

For acute pain, the initial recommendation is that an adult take oxycodone at a dose of 5 mg to 15 mg every four to six hours. For chronic pain, the goal is usually to start at a low dose, from 2.5 mg to 10 mg every four to six hours, until the lowest dose that provides the proper relief can be found.[8] 

As with hydromorphone, these drugs should only be taken as needed. A patient should take the medication less often if pain is manageable. 

Misuse Risk

Because oxycodone is also an opioid, it has a similar dependence and misuse risk when compared to hydromorphone.[7] The list of withdrawal symptoms one might experience stopping their use of the drug are likewise similar (with withdrawal discussed more later).

What Is the Difference Between Dilaudid & Oxycodone?

The main difference between hydromorphone and oxycodone is potency.[1,7] Hydromorphone is more potent than oxycodone, which means it has a more intense effect at an equal dose. 

Hydromorphone also typically spends a longer amount of time in a user’s system. This means that, broadly speaking, hydromorphone is used to treat more severe pain than oxycodone. 

Still, these medications have overlapping use cases and share many similarities.

Which Is Better for Pain Relief & Management?

As is usually the case for prescription painkillers, neither oxycodone or hydromorphone should be viewed as “better” for pain relief and management. Instead, the goal is to find the least potent solution to a person’s pain that still provides adequate relief. 

Some people just react better or worse to certain pain medications. If one medication seems to be less effective, a doctor may recommend a patient instead start taking a different option. 

What Are Withdrawal Symptoms for Dilaudid & Oxycodone?

Both Dilaudid (hydromorphone) and oxycodone share a similar list of potential withdrawal symptoms. Common early symptoms of withdrawal from these opioids include the following:[3]

• Sweating
• Insomnia
• Increased tearing
• Agitation
• Muscle aches
• Yawning
• Runny nose
• Anxiety

Later symptoms of opioid withdrawal include the following:[3]

• Nausea
• Goosebumps
• Abdominal cramping
• Diarrhea
• Vomiting
• Dilated pupils

After the acute phase of withdrawal, which can last a week or more, a longer period of less severe withdrawal begins. During this phase, a person can often function in their day-to-day life but may feel generally unwell and will still feel cravings to misuse opioids. This phase can generally last up to six months.[3]

How to Safely Stop Misusing Dilaudid & Oxycodone 

Because these drugs are addictive and can cause physical dependence, it isn’t recommended that a patient suddenly stop taking them without medical supervision. 

If you’ve been taking either drug for valid medical reasons within the parameters of a prescription for a while, talk to your doctor before stopping use. They may have you gradually reduce your dose to ease your body off the medication.[9]

If you’ve been misusing either Dilaudid or oxycodone, you also shouldn’t suddenly stop taking them without support. It’s likely that you’ll experience severe withdrawal symptoms. Relapse is common during withdrawal, as people simply want to make the discomfort go away. 

Instead, you can safely stop misuse of opioids and avoid strong withdrawal symptoms with Medication for Addiction Treatment (MAT).[10,11] Suboxone is considered the gold standard form of MAT for OUD.[12] 

At Bicycle Health, we offer MAT via our telehealth services. You can meet with a doctor from the comfort of your own home and often get a same-day prescription for Suboxone that you can fill at a local pharmacy. Contact us to learn more and get started on the path to a better future without opioid misuse.