fentanyl vs hydromorphone
Side-by-side comparison of fentanyl and hydromorphone Data from FDA drug databases (Orange Book, NDC Directory, recalls, shortages) covering 20,000+ approved drugs, plus CMS pricing; see our methodology.
Duragesic, Actiq
Dilaudid
Fentanyl Citrate Injection is a strong opioid pain medicine. It is used to provide short-term pain relief, often during and after surgery.
Hydromorphone (Dilaudid) is a strong pain medicine. It is used to treat severe pain when other pain medicines do not work well enough.
Fentanyl Citrate Injection is used to manage pain during and after surgery. It can be used alone or with other medicines during general or regional anesthesia. It may also be used with oxygen for high-risk patients during certain surgeries.
This medicine treats severe pain that requires an opioid pain medicine. It is for use when other treatments are not adequate. Do not use it for long periods unless your pain stays severe and other options are still not adequate. This medicine carries risks of addiction, abuse, and misuse.
Fentanyl is an opioid that works by binding to receptors in the brain and spinal cord. This binding decreases the feeling of pain. It can also cause sleepiness and slow breathing.
Hydromorphone works by binding to receptors in the brain and spinal cord. This blocks pain signals from reaching the brain. This results in a decreased feeling of pain.
- • Nausea
- • Vomiting
- • Dizziness
- • Blurred vision
- • Lightheadedness
- • Dizziness
- • Sleepiness
- • Nausea
- • Vomiting
- Misuse of drugs 10,453
- Pain 7,248
- Drug addiction 6,027
- Harmful effect from drugs 5,847
- Taking too much of a drug 5,722
- Addiction to the drug 35,077
- Taking too much of the drug 22,994
- Pain 22,132
- Emotional upset 17,685
- Death 14,869
Fentanyl Citrate Injection can cause serious and life-threatening risks: * Addiction, abuse, and misuse can lead to overdose and death. Your doctor will assess your risk before prescribing and monitor you regularly. * Life-threatening respiratory depression (slowed or stopped breathing) can occur, especially when starting the medicine or after a dose increase. Proper dosing is essential. * Taking fentanyl with benzodiazepines (like Valium or Xanax) or other CNS depressants (including alcohol) can cause severe sleepiness, slowed breathing, coma, and death. This combination should be avoided unless there are no other options. * Using fentanyl with certain other medicines (CYP3A4 inhibitors or inducers) can change the amount of fentanyl in your blood, leading to dangerous side effects or withdrawal symptoms. Your doctor will monitor you closely if these medicines are used together.
This medicine has a boxed warning. It can cause serious and life-threatening risks. Taking too much can cause overdose and death. It can cause addiction, abuse, and misuse. It can also cause very slow or stopped breathing. Accidental intake, especially by a child, can cause a fatal overdose. Taking with alcohol or other depressants can cause coma and death. If you are pregnant, long-term use can cause withdrawal symptoms in the newborn.
Using fentanyl for a long time during pregnancy can cause withdrawal symptoms in the newborn. Fentanyl is not recommended during labor or delivery because it can cause breathing problems in the baby.
Using this medicine for a long time during pregnancy can cause withdrawal symptoms in the baby after birth. Talk to your doctor if you are pregnant or plan to become pregnant. This medicine may not be recommended during labor.
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How to Read This fentanyl vs hydromorphone Comparison
fentanyl is classified in the Opioid Analgesic drug class, while hydromorphone sits within the Opioid Analgesic class. Because both drugs share the same classification, they are often considered interchangeable in theory — but clinical outcomes rarely track that cleanly. Both drugs are prescription-only, so a licensed provider must authorize use.
Adverse event totals above are pulled from the FDA's Adverse Event Reporting System (FAERS). For these top-ranked reactions alone, fentanyl has 35,297 submissions while hydromorphone has 112,757. Those figures reflect cumulative reporting volume — not per-patient risk — so older, widely dispensed drugs typically look worse on count alone. No direct interaction between these two drugs is listed in our FDA-derived dataset, though co-prescription still warrants pharmacist review. Serious warnings, pregnancy guidance, and contraindications can differ even when indications overlap.
A table cannot substitute for clinical judgment. Effectiveness, tolerability, drug-drug interactions with your other medications, kidney and liver function, pregnancy status, insurance formulary, and price all feed into a decision that only a licensed prescriber can make responsibly. Data here is sourced from FDA Structured Product Labels (SPL) and FAERS, both of which update as manufacturers and clinicians submit new information. This page is for educational purposes only, is not medical advice, and should not be used to self-switch between fentanyl and hydromorphone — always consult your physician or pharmacist first.
Important: This comparison is for informational purposes only. Drug effects vary between individuals. Always consult your doctor or pharmacist for personalized medical advice.