What is the Difference Between Dilaudid&Reg; and Morphine?

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  • Originally Written By: wiseGEEK Writer
  • Revised By: C. Mitchell
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  • Last Modified Date: 14 November 2018
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The biggest difference between Dilaudid® and morphine is where each comes from: morphine is usually derived directly as an opiate from poppy plants, while Dilaudid®, which is a trade name for hydromorphone, is made by synthesizing morphine once it’s been isolated. As such the two share something of a derivative relationship, and are often used interchangeably. They both treat pain, for instance, and both can be habit forming. There are some important differences when it comes to strength and dosing, though, and the side effects with each tend to vary, too. It’s usually the case that there are more similarities than differences, but patients deciding between the two should usually take the time to understand the specifics of each drug before making a choice.

Where Each Comes From

Both drugs are used primarily to treat extreme pain, and both get this ability primarily from opium poppies, a specific type of plant known to have narcotic effects. The specifics of how they get it is where things diverge, though. Making morphine requires a direct synthesis of the plant, usually by boiling or chemically isolating the opiate particles. Manufacturers of Dilaudid® typically start with already synthesized morphine and hone it further into a new version of essentially the same medication.


Dilaudid® is a brand of hydromorphone, which most experts class as a “semi-synthetic” drug. It is a member of the morphine family but wasn’t created till nearly 100 years after morphine itself was isolated and developed into a mainstream medication. It is metabolized differently by the body and has a different suspension in water which affects how it is stored and dosed, but in most cases it has the same general goal of pain relief. A simplistic way to think about this relationship is by analogy to parents and children. Both are individuals, but they have a lot in common and one is derived from the other.

Strength Differences

The drugs have different strengths, which is to say that, by volume, the amount of opiate or narcotic in each varies. Most experts say that hyrdomorphone is about four times as strong as morphine when both are presented in pure form. As a result, a smaller milligram dose of Dilaudid® may be equivalent to a larger dose of morphine. Patients who are switching from one to the other need to bear in mind they may take a lower or higher dose in order to keep the results consistent. In the appropriate dosage strength both drugs are usually found to be equally effective for pain, though.

Side Effects

There is considerable debate when it comes to differentiating the side effects of Dilaudid® and morphine. Both drugs can cause sleepiness, constipation, dizziness, cognitive distortion, and nausea that leads to vomiting; both can also lead to feelings of euphoria, depression, or both. Some reports suggest that Dilaudid® is less likely to create nausea or vomiting, and others link morphine to a higher level of cognitive distortion and mood depression.

Conclusions about side effects are usually based on trials and they may not provide an accurate representation of how individuals will respond. To some extent this is why many people who have chronic pain issues prefer one drug to the other. Patients who are having significant side effects with one of these medicines frequently switch and find the alternative preferable.


The differences between Dilaudid® and morphine may ultimately be fewer than the similarities. Both drugs are first line treatments for extreme pain and are available in a variety of formulations and forms; they each come in pills, liquid suspensions, and injectable solutions. In addition they share a tendency to be addictive, the ability to cause respiratory depression, and, in most places, a very high price. Neither is usually considered appropriate for casual use or for less profound pain issues that can be addressed with lower strength opioids like hydrocodone, codeine, or oxycodone, or with less intensive over-the-counter pain relievers.


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Post 6

Why weren't you on a variety of pain medicine, short term lower to long term higher. With Fentanyl and Oxycontin, not codone, and some creative control, it sounds like you may want to talk to the pain manage doc again or get a second opinion.

I took very high levels of narcotics for over 12 years and managed very well. Once my doc retired, nobody would touch me, it took eight days and a strong wife for me to get off the drugs at home without med assistance.

Post 5

@anon334702: Maybe 70mg Dilaudid, I think.

Post 4

My understanding is that these are highly addictive and should only be used short term, like two weeks, for patients who are not on a palliative care program.

Post 2

@anon334702: About 28-48mg, but everyone is different. I was taking 300 mg morphine and eventually switched to 240mg oxycontin. I now manage with 72 mg hydromorphone. I can go up to 100mg with the doctor's approval, but we going up slow and in 12mg increases. I haven't upped my meds in over six months now. Hope you are managing with your pain.

Post 1

If a patient took 100 milligrams of morphine daily, what percent of dosage in hydromorphe would a patient need to equal out her dosage

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