Dilaudid and fentanyl are opioid medications prescribed for pain management when weaker analgesics fail to provide sufficient pain relief or aren’t tolerated. Although both are highly potent, fentanyl is considerably more powerful than Dilaudid. Nonetheless, both are as effective in relieving pain as they are dangerous, and taking them may lead to dependence.
This article will provide a comparison of Dilaudid vs. fentanyl to help you better understand their uses, effects, chemical compositions, and risks.
What Is Dilaudid, and How Does It Work?
Dilaudid (hydromorphone) is a prescription painkiller used to relieve moderate-to-severe pain resistant to non-opioid pain medications. It is also available as a generic drug and marketed under Exalgo®, Palladone®, and other brand names.
Dilaudid comes as an oral liquid, injectable solution, and tablet, whereas generic hydromorphone is also available in rectal suppositories and other forms.
Regardless of the method of administration, Dilaudid works by binding to opioid receptors in the central nervous system (CNS), thereby blocking pain signals from reaching the brain. It can also trigger a dopamine rush, inducing feelings of deep relaxation and euphoria that contribute to the drug’s potential for abuse and addiction.
Although it can only be legally obtained by prescription, Dilaudid is also a popular street drug. It is known as D, Dust, and Dillies, among other street names.
With over 1.5 million prescriptions issued to more than 500,000 Americans, hydromorphone was one of the most frequently prescribed opioids in the United States in 2022. That year, it was abused by more than 100,000 Americans above the age of 12.
What Is Fentanyl, and How Does It Work?
As one of the most potent opioids, fentanyl is prescribed for severe pain that cannot be managed with weaker pain relievers. It is most commonly used for intraoperative and postoperative analgesia. In some cases, it can also be administered as anesthesia.
Fentanyl is available in numerous forms, including:
- Injection (Sublimaze®)
- Sublingual sprays (Subsys®)
- Transdermal patches (Duragesic®)
- Buccal (Fentora®) and sublingual (Abstral®) tablets
Fentanyl works just like Dilaudid: it attaches to opioid receptors, inhibiting the transmission of pain signals between the body and the brain. It can also cause intense euphoria and relaxation.
Although fentanyl is approved for medical use, it has become one of the most dangerous drugs in the United States. Due to its low cost and ease of manufacture, it is often found in other illicit drugs, such as counterfeit oxycodone, which significantly increases the risk of opioid overdose. TNT, Murder 8, Jackpot, and Dragon’s Breath are some common street names for fentanyl.
Without further ado, let’s explore Dilaudid vs. fentanyl differences.
Key Differences Between Dilaudid vs. Fentanyl
The key difference between Dilaudid vs. fentanyl is potency. While Dilaudid is up to 8 times more potent than morphine, fentanyl can be as many as 100 times as potent as morphine.
With this in mind, let’s compare Dilaudid to fentanyl in terms of effectiveness, chemical composition, addictiveness, cost, and overdose risk.
Dilaudid vs. Fentanyl Effectiveness
Despite the significant difference in Dilaudid vs. fentanyl potencies, both opioids are highly effective in relieving pain.
Researchers from the United Kingdom Churchill Hospital found no difference between the analgesic efficacy of oral hydromorphone and oral transmucosal fentanyl. However, fentanyl tends to relieve pain faster than hydromorphone, as it has a rapid onset of action. The duration of analgesic effects, on the other hand, was found to be longer with hydromorphone.
In other words, Dilaudid and fentanyl provide similar pain relief. Although fentanyl alleviates pain quicker, the pain-relieving effects of hydromorphone last longer.
Dilaudid vs. Fentanyl Chemical Composition
The most significant difference in Dilaudid vs. fentanyl chemical compositions is that Dilaudid is a semi-synthetic opioid, whereas fentanyl is synthetic.
Hydromorphone (molecular formula C17H20ClNO3)—is derived from and structurally resembles morphine, a naturally occurring opium alkaloid. By contrast, fentanyl (molecular formula C22H28N2O) is a synthetic opioid, meaning it is fully human-made and contains no opiates.
Dilaudid vs. Fentanyl Addictiveness
Dilaudid and fentanyl have a very high potential for abuse, dependence, and addiction, which is why they are both classified as Schedule II controlled substances. Taking them as prescribed reduces the risk of fentanyl or Dilaudid addiction, but it doesn’t eliminate it. Anyone taking these drugs for a prolonged time risks developing opioid dependence and addiction.
However, fentanyl is considerably more potent than hydromorphone. It also has a very rapid onset of action, producing effects minutes after consumption.
Dilaudid vs. Fentanyl Cost
The cost of Dilaudid vs. fentanyl primarily depends on the drug’s formulation, prescription strength, and other factors. Generic medications are always cheaper than their brand-name versions, and your insurance may cover them.
For instance, a 4 mg oral tablet of generic hydromorphone costs around $0.07–$0.36, whereas that of Dilaudid® may cost you upwards of $4.
Meanwhile, a 400 mcg fentanyl oral transmucosal lozenge costs around $20.50. By contrast, the price of 400 mcg Actiq® can be as high as $116.
Dilaudid vs. Fentanyl Overdose
Although both Dilaudid and fentanyl can cause a potentially life-threatening overdose, the overdose risk is significantly higher with fentanyl. This is because it is exceptionally potent; a tiny amount of fentanyl can dangerously suppress your breathing.
For this reason, many forms of fentanyl, including transdermal patches, are not prescribed for opioid-naïve patients.
Furthermore, fentanyl plays a pivotal role in the third wave of the U.S. opioid epidemic. In 2023 alone, synthetic opioids—primarily fentanyl—claimed the lives of more than 74,000 Americans. By contrast, over 10,000 Americans have lost their lives to an overdose involving natural and semi-synthetic opioids, including Dilaudid, in 2023.
Next, let’s look into the side effects of Dilaudid vs. fentanyl.
Dilaudid vs. Fentanyl Side Effects
Dilaudid and fentanyl side effects tend to be similar, as both drugs belong to the opioid family.
Some common side effects of Dilaudid and fentanyl include:
- Nausea
- Vomiting
- Itchy skin
- Dizziness
- Headache
- Dry mouth
- Drowsiness
- Constipation
- Abdominal pain
- Loss of appetite
- Trouble urinating
- Difficulty breathing
While both drugs can cause sedation, the United Kingdom Churchill Hospital study mentioned above found that it is more common with fentanyl than Dilaudid.
If you experience any unwanted effects while taking Dilaudid or fentanyl, consult your doctor. Severe side effects, such as allergies and breathing problems, may require immediate medical care.
Furthermore, taking Dilaudid or fentanyl for a prolonged time may lead to:
- Tolerance
- Dependence
- Opioid addiction
- Fertility problems
- Sleep disturbances
- Chronic constipation
- Liver, heart, and other organ disease
Opioid abuse, i.e., taking Dilaudid or fentanyl in any way other than prescribed, such as mixing it with other substances, significantly increases the risk of serious side effects, overdose, and death.
On this note, let’s discuss Dilaudid vs. fentanyl drug interactions.
Dilaudid and Fentanyl Drug Interactions
Dilaudid and fentanyl can interact with numerous drugs, including:
- Other opioids
- Antihistamines
- Muscle relaxers
- Antidepressants
- Sleep medications
- Anxiety medications
These are just a few examples of Dilaudid and fentanyl drug interactions. Inform your doctor about any drugs (including supplements and herbal medicines) you’re taking to ensure these can be safely taken with opioids.
Furthermore, grapefruit and grapefruit juice may interact with Dilaudid and fentanyl, inhibiting their metabolism and increasing the risk of opioid toxicity.
Never mix Dilaudid or fentanyl with alcohol. This dangerous combination can cause seizures, hallucinations, liver damage, respiratory depression, overdose, and even death. Polysubstance abuse, including mixing opioids with alcohol, also increases the risk of substance use disorders (SUDs).
Other Risk Factors of Dilaudid and Fentanyl
Other risk factors of Dilaudid and fentanyl that may increase the risk of side effects and other adverse events associated with these drugs include:
- Seizures
- Head injury
- Liver disease
- Lung disease
- Heart disease
- Thyroid disease
- Allergy to opioids
- Difficulty urinating
- Low blood pressure
- Substance use disorders
Before opting for Dilaudid or fentanyl therapy, discuss your medical history with your healthcare provider. If you have kidney problems, opioid pain management may not be the best option for you, as renal disease may affect the half-life of Dilaudid or fentanyl, increasing the risk of toxicity.
Furthermore, using Dilaudid or fentanyl while pregnant can lead to neonatal abstinence syndrome (NAS), miscarriage, congenital disabilities, and other adverse fetal and maternal events. If you’re pregnant, breastfeeding, or trying to conceive, consult with your doctor to determine the best course of action.
Physical Dependence and Addiction to Opioids
Physical dependence and addiction to opioids are distinct conditions, though they often co-occur.
Dilaudid and fentanyl gradually alter brain chemistry, increasing the production of opioid receptors and inhibiting that of endorphins. Therefore, if you take these medications for an extended time, you’ll inevitably become dependent on them. In other words, your body will need these drugs to function normally.
If you don’t treat Dilaudid or fentanyl dependence, it can develop into an addiction. Unlike dependence, opioid addiction is mainly psychological. Those addicted cannot stop taking drugs, even when it destroys their health, relationships, or careers.
Although both opioid dependence and addiction are treatable, it’s in your best interest to seek professional help as soon as you notice the first signs of opioid dependence.
Signs and Symptoms of Opioid Dependence
Whether caused by Dilaudid or fentanyl use, opioid dependence is characterized by two symptoms:
- Tolerance. Opioids cause the brain to create more and more opioid receptors, leading to dependence. Once you become tolerant to Dilaudid or fentanyl, your original dose will lose its effects. If this happens, talk to your doctor. Do not increase your dosage without their permission; this can lead to a Dilaudid or fentanyl overdose.
- Withdrawal symptoms. Opioid withdrawal symptoms occur when people attempt to get off opioids after becoming dependent. Both physical and psychological withdrawal symptoms, such as vomiting, muscle aches, depression, cravings, and sleep disturbances, can be extremely hard to bear. Sadly, it’s not unusual for people to keep taking opioids just to avoid them.
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Key Takeaways
Hopefully, our Dilaudid vs. fentanyl guide helped you better understand the differences between these pain medications.
Let’s go over the key points we covered today:
- Dilaudid (hydromorphone) is a semi-synthetic opioid drug used to relieve moderate-to-severe pain, whereas fentanyl is a synthetic opioid prescribed for severe pain relief.
- Dilaudid and fentanyl provide comparable pain relief; however, fentanyl exerts its effects faster, whereas Dilaudid works longer.
- ANR is an ultra-modern treatment that can help you break the chains of opioid dependence within a matter of days by restoring normal brain function.
Dilaudid vs. Fentanyl FAQ
Fentanyl is considerably stronger than Dilaudid. Compared to morphine, Dilaudid is 2–8 times more potent, whereas fentanyl is up to 100 times more potent. Therefore, fentanyl can be roughly 12–50 times more potent than Dilaudid.
You should never take Dilaudid and fentanyl together, as this can result in an opioid overdose. If not treated promptly, it can be fatal. Mixing opioids, including Dilaudid and fentanyl, also increases the risk of abuse, dependence, opioid use disorder (OUD), and severe side effects, such as breathing problems.
The main difference in the dosage forms of Dilaudid and fentanyl is that fentanyl comes in more forms than Dilaudid. Dilaudid is available as an oral tablet, oral liquid, and solution for injection. Meanwhile, fentanyl comes in injectable solutions, transdermal patches, nasal sprays, and oral transmucosal forms, such as buccal and sublingual tablets.
Dilaudid is safer than fentanyl since it is significantly less potent. Nonetheless, neither fentanyl nor Dilaudid is safe; both medications can cause dependence, addiction, and other adverse effects, including a life-threatening overdose. Therefore, opioid pain management should be your last resort.
