Fentanyl vs. Dilaudid | Potency & Side Effects

Fentanyl is extremely potent, up to 100 times stronger than morphine, while Dilaudid is very strong but only about five to seven times stronger than morphine.[1] 

Both drugs have similar side effects, including respiratory depression, which can be life-threatening. Fentanyl’s higher potency makes it the riskier option, however, especially in cases of misuse or opioid use disorder (OUD). 

An overdose on either drug can be reversed if treated promptly with medications like naloxone. Because fentanyl is so strong, multiple doses may be required to reverse an overdose. Quick action is essential to prevent serious harm or death in either case.

The Differences Between Fentanyl & Dilaudid (Hydromorphone)

This table breaks down the differences between fentanyl and Dilaudid:[1-4]

How Potent Is Fentanyl?

Fentanyl is an incredibly strong synthetic opioid used to manage severe pain. It’s estimated to be 50 to 100 times more powerful than morphine and about 50 times stronger than heroin. Even tiny amounts of fentanyl can seriously affect the body, possibly causing breathing problems and overdose, which can be fatal.[5]

Medical experts use fentanyl carefully in situations where strong pain relief is necessary, like during surgery. Fentanyl is rarely prescribed for use at home because it is so strong. 

The risks associated with fentanyl do not stop with diverted medical prescriptions. This synthetic opioid is most often made and sold on the street. It is used to cut other products like heroin, or it is molded into the shape of pills that people commonly ask for, like oxycodone. In these cases, the risks associated with its potency come from the fact that people may not even realize that they have bought or used fentanyl until it’s too late. 

Side Effects of Fentanyl

While individual responses may vary, these are common side effects of fentanyl:[5]

• Nausea 
• Vomiting
• Constipation
• Drowsiness 
• Dizziness
• Headache
• Pale skin
• Itchiness 
• Rash
• Excessive sweating
• Dry mouth
• Weakness 
• Fatigue
• Hypotension
• Respiratory depression

How Potent Is Dilaudid?

Dilaudid (hydromorphone) is a strong pain-relieving opioid medication that is roughly five to seven times more powerful than morphine but nowhere near as strong as fentanyl.[6]

Doctors usually prescribe Dilaudid for the treatment of severe pain, like after surgery or for people who are living with chronic pain. The drug comes in different forms, including pills and a liquid. The drug is prescribed for use in a clinical setting as well as for home use.

Though Dilaudid is not as strong as fentanyl, it is still potent with an addictive nature and potential for misuse. Only take the drug as prescribed. Avoid mixing it with other substances, including alcohol, to decrease the risk of overdose and other ill effects. 

Side Effects of Dilaudid

Like fentanyl, Dilaudid may not affect all users in exactly the same way, but some commonly reported side effects include the following:[1] 

• Nausea 
• Vomiting
• Constipation 
• Drowsiness 
• Dizziness
• Stomach pain
• Itchiness
• Rash
• Sweating
• Dry mouth
• Shallow, weak or very slow breathing
• Respiratory depression

Is One More Dangerous Than the Other? 

Both fentanyl and Dilaudid (hydromorphone) are potent opioid medications that share similar risks, but fentanyl’s exceptional potency brings a higher level of danger. Milligram for milligram, the risks associated with even accidentally inhaling fentanyl make it far more dangerous than Dilaudid.

While Dilaudid is an opioid and deadly in its own right, fentanyl is produced on the street and commonly mixed in with other substances. This practice has triggered a surge in overdose fatalities.[5] 

Because it is sold by weight, many drug dealers will cut drugs like heroin or illicit prescription painkillers with innocuous substances to stretch a batch. Then, they mix in fentanyl, which is far cheaper, to boost its potency. Buyers get a much stronger hit than they are prepared for, and many overdose. 

While Dilaudid is also potent, it is not used in the same way that fentanyl is on the street. Nonetheless, its misuse or excessive consumption can result in significant health hazards. Similar to fentanyl, Dilaudid can induce respiratory depression, particularly when consumed in high doses or in conjunction with other depressants like alcohol.[1]  

When used outside of the bounds of a prescription, both drugs can be deadly. Both foster the development of OUD and all associated risks, including the regular risk of overdose with each use of either drug.

Are Overdoses on Fentanyl & Dilaudid Reversible?

Overdoses involving either fentanyl or Dilaudid can be fatal if untreated, but they are  reversible with prompt medical intervention. The administration of naloxone, an opioid reversal medication also known by the brand name Narcan, can effectively counteract the effects of either drug in the system and reverse the overdose.[7,8] 

In both cases, time is critical. Immediate naloxone administration and medical treatment are needed to reverse the overdose before the brain has been without oxygen for too long. If Narcan isn’t given in time, the overdose cannot be reversed, and it may be fatal. 

It’s also important to note that because fentanyl is so much stronger than Dilaudid, more than one dose of naloxone may be needed to fully stop the effect of the drug during overdose.[9]