Hydromorphone Side Effects

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. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

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, slow or irregular heartbeat
• lightheadedness, dizziness, or fainting
• mood or mental changes
• rapid breathing
• severe stomach pain, cramping, or burning
• 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 frequency of urination or urine amount
• difficulty in passing urine (dribbling)
• dizziness
• fast or weak pulse
• headache
• irregular, fast or slow, or shallow breathing
• loss of appetite
• noisy breathing
• painful urination
• pale or blue lips, fingernails, or skin
• sweating
• tightness in the chest
• trouble sleeping

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

Symptoms of overdose:

• Cold, clammy skin
• convulsions (seizures)
• drowsiness that is so severe you are not able to answer when spoken to or, if asleep, cannot be awakened
• pinpoint (small) pupils in the eyes
• slow heartbeat
• very slow or troubled breathing

Minor Side Effects

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
• joint pain
• muscle pain or stiffness
• nausea

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
• clumsiness
• continuing ringing or buzzing or other unexplained noise in the ears
• crying
• delusions of persecution, mistrust, suspiciousness, or combativeness
• difficulty with swallowing
• difficulty with walking
• double vision
• excess air or gas in the stomach or intestines
• feeling of constant movement of self or surroundings
• full feeling
• increased appetite
• joint pain, stiffness, or swelling
• loss in sexual ability, desire, drive, or performance
• loss of balance
• low body temperature
• muscle aches
• muscle twitching or jerking
• overactive reflexes
• rhythmic movement of muscles
• runny nose
• 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

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
• itching
• muscle stiffness or tightness
• numbness of the feet, hands, and around the mouth
• redness of the face, neck, arms, and occasionally, upper chest
• relaxed and calm feeling
• shaking
• uncontrolled eye movements
• upper stomach pain

Applies to hydromorphone: injection powder for solution, injection solution

In addition to its needed effects, some unwanted effects may be caused by hydromorphone. In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking hydromorphone, check with your doctor or nurse immediately:

Incidence not known:

• Abdominal or stomach pain
• blurred vision
• change in consciousness
• change in the ability to see colors, especially blue or yellow
• chest pain or discomfort
• cold, clammy skin
• confusion
• cough
• difficult or troubled breathing
• dizziness
• fast, pounding, or irregular heartbeat or pulse
• headache
• irregular, fast, slow, or shallow breathing
• lightheadedness, dizziness, or fainting
• loss of appetite
• noisy breathing
• pale or blue lips, fingernails, or skin
• severe constipation
• severe vomiting
• slow or irregular heartbeat
• sweating
• tightness in the chest
• trouble with sleeping
• unusual tiredness
• very slow heartbeat or pulse
• vomiting

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

Symptoms of overdose:

• Change in consciousness
• cold and clammy skin
• convulsions (seizures)
• drowsiness that is so severe you are not able to answer when spoken to or, if asleep, cannot be awakened
• pale or blue lips, fingernails, or skin
• pinpoint (small) pupils in the eyes
• sleepiness or unusual drowsiness
• slow heartbeat
• unable to speak
• very slow or troubled breathing
• weak muscle tone

Minor Side Effects

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:

Incidence not known:

• Anxiety
• bad, unusual, or unpleasant (after) taste
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• change in taste
• chills
• constricted, pinpoint, or small pupils (black part of the eye)
• decrease in the frequency or amount of urination
• diarrhea
• difficulty having a bowel movement (stool)
• difficulty in passing urine (dribbling)
• double vision
• dry mouth
• false or unusual sense of well-being
• fast or rapid breathing
• feeling of warmth
• hives or welts
• irritability
• itching
• loss of appetite
• muscle stiffness or tightness
• nausea
• painful urination
• redness, pain, or swelling at the injection site
• redness of the face, neck, arms, and occasionally, upper chest
• relaxed or calm feeling
• seeing, hearing, or feeling things that are not there
• seeing double
• shaking
• sleepiness
• uncontrolled eye movements
• upper stomach pain
• weight loss

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

General

The most common adverse effects are lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus.^[Ref]

Gastrointestinal

Very common (10% or more): Constipation (up to 31%), nausea (up to 28%), vomiting (up to 14%),
Common (1% to 10%): Dry mouth, dry mouth, abdominal pain, diarrhea, dyspepsia
Uncommon (0.1% to 1%): Ileus, cramps, taste alteration, gastritis, diverticulitis
Rare (less than 0.1%): Anal fissure, bezoar, duodenitis, impaired gastric emptying, painful defecation
Frequency not reported: Flatulence, dysphagia, hematochezia, abdominal distension, hemorrhoids, abnormal feces, intestinal obstruction, eructation, diverticulum, gastrointestinal motility disorder, large intestine perforation
Postmarketing reports: Oropharyngeal swelling^[Ref]

Nervous system

Very common (10% or more): Somnolence (up to 15%), headache (up to 12%), dizziness (up to 11%)
Common (1% to 10%): Lightheadedness, sedation, memory impairment, hypoesthesia, paresthesia
Uncommon (0.1% to 1%): Tremor, nystagmus, increased intracranial pressure, taste alteration, involuntary muscle contractions
Rare (less than 0.1%): Hyperreflexia
Frequency not reported: Balance disorder, encephalopathy
Postmarketing reports: Convulsions, drowsiness, dyskinesia, hyperalgesia, myoclonus^[Ref]

Psychiatric

Common (1% to 10%): Dysphoria, euphoria, insomnia, anxiety, depression, nervousness, nightmares, mood swings
Uncommon (0.1% to 1%): Agitation, altered mood, hallucination, disorientation, abnormal dreams
Frequency not reported: Floating feelings, dreams, apprehension, panic attack, suicide ideation, aggression
Postmarketing reports: Confusional state^[Ref]

Hypersensitivity

Postmarketing reports: Anaphylactic reactions, hypersensitivity reactions^[Ref]

Respiratory

Common (1% to 10%): Dyspnea
Uncommon (0.1% to 1%): Bronchospasm, laryngospasm
Frequency not reported: Respiratory depression, apnea, respiratory arrest, rhinorrhea, respiratory distress, hypoxia, sneezing, hyperventilation
Postmarketing reports: Dyspnea^[Ref]

Cardiovascular

Common (1% to 10%): Flushing, hypotension, peripheral edema, chest pain
Uncommon (0.1% to 1%): Tachycardia, bradycardia, palpitations, syncope, presyncope, hypertension
Frequency not reported: Circulatory depression, cardiac arrest, shock, extrasystoles
Postmarketing reports: Peripheral edema^[Ref]

Dermatologic

Common (1% to 10%): Sweating, pruritus, hyperhidrosis, rash
Uncommon (0.1% to 1%): Urticaria, diaphoresis
Frequency not reported: Erythema
Postmarketing reports: Angioedema^[Ref]

Local

Uncommon (0.1% to 1%): Injection site urticaria
Postmarketing reports: Injection site reactions^[Ref]

Genitourinary

Common (1% to 10%): Urinary retention, urinary hesitancy
Postmarketing reports: Erectile dysfunction^[Ref]

Hepatic

Uncommon (0.1% to 1%): Biliary tract spasm
Rare (less than 0.1%): Biliary colic
Postmarketing reports: Hepatic enzyme increased^[Ref]

Other

Common (1% to 10%): Asthenia (up to 11%), pain, pyrexia, fall
Uncommon (0.1% to 1%): Weakness, abnormal feeling, chills
Rare (less than 0.1%): Feeling drunk
Frequency not reported: Neonatal withdrawal syndrome, addiction, abuse, misuse, overdose, drug withdrawal syndrome, vertigo, tinnitus, malaise
Postmarketing reports: Fatigue, lethargy^[Ref]

Metabolic

Common (1% to 10%): Anorexia/decreased appetite, decreased weight, dehydration
Uncommon (0.1% to 1%): Fluid retention, increased appetite, hyperuricemia^[Ref]

Musculoskeletal

Common (1% to 10%): Arthralgia, muscle spasms, back pain, extremity pain
Uncommon (0.1% to 1%): Muscle rigidity
Frequency not reported: Myalgia^[Ref]

Ocular

Uncommon (0.1% to 1%): Blurred vision, diplopia, miosis, visual impairment
Frequency not reported: Dry eye^[Ref]

Renal

Uncommon (0.1% to 1%): Antidiuretic effects^[Ref]

Endocrine

Uncommon (0.1% to 1%): Decreased libido, sexual dysfunction
Rare (less than 0.1%): Hypogonadism,^[Ref]

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