Dilaudid-HP Side Effects

Generic Name: hydromorphone

Note: This page contains information about the side effects of hydromorphone. Some of the dosage forms included on this document may not apply to the brand name Dilaudid-HP.

Not all side effects for Dilaudid-HP may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to hydromorphone: oral capsule extended release, oral liquid, oral solution, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by hydromorphone (the active ingredient contained in Dilaudid-HP). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking hydromorphone:

Less common or rare
  • Agitation
  • bloody, black, or tarry stools
  • blurred vision
  • changes in behavior
  • chest pain or discomfort
  • convulsions
  • decreased urination
  • dry mouth
  • fast, pounding, or irregular heartbeat or pulse
  • lightheadedness, dizziness, or fainting
  • mood or mental changes
  • rapid breathing
  • severe stomach pain, cramping, or burning
  • severe vomiting
  • slow or irregular heartbeat
  • stiff neck
  • sunken eyes
  • thoughts of killing oneself
  • trouble breathing
  • unusual tiredness
  • vomiting of material that looks like coffee grounds, severe and continuing
  • wrinkled skin
Incidence not known
  • Bluish lips or skin
  • change in the ability to see colors, especially blue or yellow
  • cold, clammy skin
  • confusion
  • cough
  • decrease in the frequency of urination
  • decrease in urine volume
  • difficulty in passing urine (dribbling)
  • dizziness
  • fast, weak pulse
  • headache
  • heart stops
  • irregular, fast or slow, or shallow breathing
  • loss of appetite
  • no pulse or blood pressure
  • noisy breathing
  • not breathing
  • painful urination
  • pale or blue lips, fingernails, or skin
  • sweating
  • tightness in the chest
  • trouble sleeping
  • unconscious

If any of the following symptoms of overdose occur while taking hydromorphone, get emergency help immediately:

Symptoms of overdose
  • Decreased awareness or responsiveness
  • increased sensitivity of the eyes to light
  • no muscle tone or movement
  • sleepiness or unusual drowsiness

Some of the side effects that can occur with hydromorphone may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Difficulty having a bowel movement (stool)
  • difficulty with moving
  • muscle pain or stiffness
  • nausea
  • pain in the joints
Less common
  • Acid or sour stomach
  • back pain
  • belching
  • bloating or swelling of the face, arms, hands, lower legs, or feet
  • diarrhea
  • discouragement
  • feeling sad or empty
  • heartburn
  • indigestion
  • irritability
  • loss of interest or pleasure
  • muscle spasms
  • pain in the arms or legs
  • stomach discomfort, upset, or pain
  • tingling of the hands or feet
  • trouble concentrating
  • unusual weight gain or loss
Less common or rare
  • Being forgetful
  • bleeding after defecation
  • change in taste
  • changes in the patterns and rhythms of speech
  • clumsiness
  • continuing ringing or buzzing or other unexplained noise in the ears
  • crying
  • decreased interest in sexual intercourse
  • delusions of persecution, mistrust, suspiciousness, or combativeness
  • difficulty with swallowing
  • difficulty with walking
  • double vision
  • excess air or gas in the stomach or intestines
  • extra heartbeats
  • feeling of constant movement of self or surroundings
  • full feeling
  • hearing loss
  • inability to have or keep an erection
  • increased appetite
  • joint pain, stiffness, or swelling
  • loss in sexual ability, desire, drive, or performance
  • loss of balance
  • loss of taste
  • low body temperature
  • muscle aches
  • muscle twitching or jerking
  • overactive reflexes
  • passing gas
  • rhythmic movement of muscles
  • runny nose
  • seeing double
  • seeing, hearing, or feeling things that are not there
  • sensation of spinning
  • shivering
  • slurred speech
  • sneezing
  • swelling of the feet or lower legs
  • trouble with speaking
  • uncomfortable swelling around the anus
  • weak or feeble pulse
Incidence not known
  • Bad, unusual or unpleasant (after) taste
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chills
  • constricted, pinpoint, or small pupils (black part of the eye)
  • deep or fast breathing with dizziness
  • drowsiness
  • dry mouth
  • false or unusual sense of well-being
  • fear or nervousness
  • feeling of warmth
  • hives or welts
  • muscle stiffness or tightness
  • numbness of the feet, hands, and around the mouth
  • redness of the face, neck, arms, and occasionally, upper chest
  • redness of the skin
  • relaxed and calm
  • shaking
  • skin itching
  • uncontrolled eye movements
  • upper abdominal or stomach pain

For Healthcare Professionals

Applies to hydromorphone: compounding powder, injectable powder for injection, injectable solution, intravenous solution, oral capsule extended release, oral liquid, oral tablet, oral tablet extended release, rectal suppository

Nervous system

Nervous system side effects have included mental depression, respiratory depression (which is sometimes fatal), stupor, delirium, somnolence, agitation, increased intracranial pressure, and dysphoria. Myoclonus has also been reported.[Ref]

Opioids may result in psychotic symptoms in some patients.[Ref]


Other side effects have included withdrawal symptoms which have occurred following either abrupt cessation or fast tapering of narcotic analgesics and have included agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting, and sweating.[Ref]


Cardiovascular side effects have occurred rarely and have included hypotension, shock, and arrhythmias.[Ref]


Gastrointestinal side effects have included constipation, nausea, vomiting, biliary tract spasm, and dry mouth.[Ref]


Dermatologic side effects including rashes and systemic contact dermatitis have been reported rarely.[Ref]

Narcotic-induced rashes may be related to direct stimulation of histamine release.[Ref]


Local side effects have included redness, swelling and pain which develop at the site of subcutaneous injection of hydromorphone (the active ingredient contained in Dilaudid-HP) Two cases of fatal neurologic events have been reported following intravenous injection of hydromorphone. In one case, a known intravenous drug abuser injected two melted hydromorphone suppositories into the right antecubital vein and suffered a stroke. In the other, a known intravenous drug abuser injected ground hydromorphone tablets and presented in an akinetic mute state and later died.[Ref]


Genitourinary side effects including urinary retention have been reported for other narcotic analgesics.[Ref]


1. D'Souza M "Unusual reaction to morphine." Lancet 07/11/87 (1987): 98

2. White MJ, Berghausen EJ, Dumont SW, et al "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82

3. Eisele JH, Jr Grigsby EJ, Dea G "Clonazepam treatment of myoclonic contractions associated with high- dose opioids: case report." Pain 49 (1992): 231-2

4. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1

5. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8

6. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13

7. Miller RR "Clinical effects of parenteral narcotics in hospitalized medical patients." J Clin Pharmacol 20 (1980): 165-71

8. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.

9. Miser AW, Chayt KJ, Sandlund JT, Cohen PS, Dothage JA, Miser JS "Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates." Am J Dis Child 140 (1986): 603-4

10. Portenoy RK, Foley KM "Chronic use of opioid analgesics in non-malignant pain: report of 38 cases." Pain 25 (1986): 171-86

11. de Cuyper C, Goeteyn M "Systemic contact dermatitis from subcutaneous hydromorphone." Contact Dermatitis 27 (1992): 220-3

12. Shraberg D, D'Souza T "Coma vigil masquerading as psychiatric illness." J Clin Psychiatry 43 (1982): 375-6

13. Bitar S, Gomez CR "Stroke following injection of a melted suppository." Stroke 24 (1993): 741-3

14. Bruera E, Macmillan K, Selmser P, MacDonald RN "Decreased local toxicity with subcutaneous diamorphine (heroin): a preliminary report." Pain 43 (1990): 91-4

15. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8

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