Dilaudid vs. Fentanyl for Pain: Important Differences and Potential Risks.

Key takeaways

Dilaudid (hydromorphone) and fentanyl (Fentora, Actiq) are prescription opioids. They treat pain that isn't relieved by non-opioid pain medications. Fentanyl is often used for cancer pain. They’re not first-choice options for pain since they have significant risks, such as misuse and overdose, that can be life-threatening. Common side effects, however, can often be managed at home. These include drowsiness, dizziness, and constipation. Both medications come in several forms. For example, Dilaudid is available as tablets, oral liquid, and injection. Fentanyl is available as patches, lozenges, an injection, and more. If you or someone in your household takes Dilaudid or fentanyl, you should carry naloxone (Narcan) with you. Naloxone can rapidly reverse the effects of an opioid overdose if needed.

Dilaudid

(hydromorphone)

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fentanyl patch

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Summary for Dilaudid

Prescription only

Dilaudid (hydromorphone) is an opioid medication that's used to help with pain when non-opioid medications don't provide enough pain relief. Dilaudid (hydromorphone) is available as pills, liquids, and rectal suppositories. The dosage depends on what form of Dilaudid (hydromorphone) you're using. In addition, some forms are immediate-release that help control sudden pain quickly, but others are extended-release for more long-lasting (chronic) pain. The most common side effects include dizziness, sleepiness, and nausea, among others. Dilaudid (hydromorphone) is available as a brand and generic medication.

Indications for Dilaudid

Pain that isn't relieved by non-opioid medications

Pros and Cons for Dilaudid

Pros

Relieves pain that isn't controlled with non-opioid pain medications
Can help with quick, sudden pain or chronic pain (depending on the form of the medication)
Available in liquid form and rectal suppositories for people who have trouble swallowing pills
Available as a lower-cost generic version

Cons

Can commonly cause constipation
Risk of dependence and tolerance with long-term use
Must slowly lower the dose before stopping if you've been taking for a long time to prevent bothersome side effects and uncontrolled pain
A controlled substance, so there are special requirements to get a prescription filled (highly regulated by the federal government because of risk of misuse)

Common Side Effects for Dilaudid

Lightheadedness
Dizziness
Sleepiness
Nausea
Vomiting
Constipation
Sweating
Flushing
Intense happiness (euphoria)
Distress
Dry mouth
Itchy skin

Warnings for Dilaudid

Risk of accidental overdose
Potential for addiction and misuse
Potentially life-threatening slowed breathing (respiratory depression)
Harm to newborn babies when taken during pregnancy
Low hormone levels
Low blood pressure
Higher risk of seizures in people with seizure conditions
Physical dependence and withdrawal
Difficulty concentrating and extreme sleepiness
Contains sulfites

Summary for Fentanyl

Prescription only

The fentanyl transdermal patch, previously known by the brand name Duragesic, is an opioid. It's a patch that's applied on the skin every 3 days to manage severe, long-term or chronic pain. The fentanyl patch is only approved for people who are "opioid tolerant" whose pain isn't controlled well enough with other treatment options. Fentanyl is a very powerful opioid, so the medication can be especially dangerous for those who aren't opioid tolerant because of their high risk for extremely slowed breathing and overdose. Some side effects include nausea, vomiting, and sleepiness.

Indications for Fentanyl

Severe, chronic pain in people who are opioid tolerant

Pros and Cons for Fentanyl

Pros

A possible option for severe, chronic pain if you've already tried other treatments and they don't work well enough for you
A possible choice if you have trouble swallowing pills
Replaced on the skin every 3 days

Cons

Only approved for people who are already taking opioids around-the-clock (opioid tolerant)
High risk for dangerously slow breathing, misuse, and addiction
Not intended to use as needed, for short-term pain, or for mild pain

Common Side Effects for Fentanyl

Nausea (41%)
Vomiting (26%)
Sleepiness (19%)
Dizziness (10%)
Trouble sleeping (10%)
Constipation (9%)
A lot of sweating (6%)
Tiredness (6%)
Feeling cold (6%)

Warnings for Fentanyl

Potential for misuse and addiction
Life-threatening slowed breathing (respiratory depression)
Risk for opioid overdose
Life-threatening risks with accidental exposure
Life-threatening risks with patch exposure to high temperatures (e.g., heat, high fever)
Difficulty concentrating and extreme sleepiness
Physical dependence and withdrawal
Harm to newborn babies
Drug interactions
Serotonin syndrome
Low blood pressure and slow heart rate
Low adrenal hormone levels
Seizures