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Exalgo 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 Exalgo.

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 Exalgo). 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, 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

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
  • 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


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


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]


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]


Postmarketing reports: Anaphylactic reactions, hypersensitivity reactions[Ref]


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]


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]


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


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


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


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


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]


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


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


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


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


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


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

2. "Multum Information Services, Inc. Expert Review Panel"

3. "Product Information. Exalgo (hydromorphone)." Covidien, Mansfield, MA.

4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

5. Cerner Multum, Inc. "Australian Product Information." O 0

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

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.