Two medicines, side by side
Meperidine vs hydromorphone
Meperidine and hydromorphone are both labeled for pain. Drugs@FDA records approvals of meperidine since 1942 and of hydromorphone since 1984. Pharmacies paid $0.157 per mL (Meperidine 50 mg/5 mL solution) and $0.219 per hydromorphone 4 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. How each works, in its label's words: Meperidine, “Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle.”; Hydromorphone, “Hydromorphone is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses.”
Check it at the source: the meperidine FDA label on DailyMed (effective November 29, 2025); the hydromorphone FDA label on DailyMed (effective May 14, 2026).
Highlights of the meperidine record
Meperidine (Demerol) · label of November 29, 2025
SERIOUS AND LIFE-THREATENING RISKS FROM USE OF MEPERIDINE HYDROCHLORIDE TABLETS Addiction, Abuse, and Misuse Because the use of Meperidine hydrochloride tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions [see Warnings and Precautions (5.2) ].
Used for
From the label: indicationsMeperidine hydrochloride tablets are indicated for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. […]
On the market
- Earliest approval on file
- November 10, 1942
- Generic labelers
- 3 labelers
- Pharmacy cost
- $0.157 per mL
Supply and safety
- Shortage
- Listed; available
- Recalls
- 0
Highlights of the hydromorphone record
Hydromorphone (Dilaudid) · label of May 14, 2026
SERIOUS AND LIFE-THREATENING RISKS FROM USE OF HYDROMORPHONE HYDROCHLORIDE WARNING: SERIOUS AND LIFE-THREATENING RISKS FROM USE OF HYDROMORPHONE HYDROCHLORIDE See full prescribing information for complete boxed warning. Ensure accuracy when prescribing, dispensing, and administering hydromorphone hydrochloride oral solution. Dosing errors due to confusion between mg and mL can result in accidental overdose and death.
Used for
From the label: indicationsHydromorphone hydrochloride oral solution and hydromorphone hydrochloride tablets are indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. […]
On the market
- Earliest approval on file
- January 11, 1984
- Generic labelers
- 13 labelers
- Pharmacy cost
- $0.219 per tablet
Supply and safety
- Shortage
- In shortage
- Recalls
- 30
Source: FDA drug labels via openFDA (Meperidine label of November 29, 2025, Hydromorphone label of May 14, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do meperidine and hydromorphone differ on the record?
How each works, in its label's words: Meperidine, “Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle.”; Hydromorphone, “Hydromorphone is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses.”
Both are in FDA's class opioid agonists.
Half-life, in each label's words: Meperidine, “Elimination The elimination half-life is 3 to 8 hours in healthy volunteers.”; Hydromorphone, “The terminal elimination half-life of hydromorphone after an intravenous dose is about 2.3 hours.”
Both labels carry a boxed warning; the records quote them.
Generics: meperidine since 1972; hydromorphone since 1995 (Drugs@FDA).
| Meperidine | Hydromorphone | |
|---|---|---|
| Labeled for | Pain | Pain |
| Pharmacologic class | Opioid Agonist | Opioid Agonist |
| How it works (label) | Meperidine is an opioid agonist with multiple actions qualitatively similar to those of morphine; the most prominent of these involve the central nervous system and organs composed of smooth muscle. | Hydromorphone is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of hydromorphone is analgesia. |
| Half-life (label) | Elimination The elimination half-life is 3 to 8 hours in healthy volunteers. | The terminal elimination half-life of hydromorphone after an intravenous dose is about 2.3 hours. |
| Earliest approval on file (Drugs@FDA) | November 10, 1942 | January 11, 1984 |
| First generic approved | April 26, 1972 | August 23, 1995 |
| Generic labelers (NDC) | 3 labelers | 13 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.157 per mL (Meperidine 50 mg/5 mL solution) | $0.219 per tablet (Hydromorphone 4 mg tablet) |
| 12-month price change | -2% | +11% |
| Boxed warning | Yes | Yes |
| Shortage now | Listed; available | In shortage |
| Recalls recorded | 0 | 30 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 9,161 | 91,453 |
| DEA schedule | CII | CII |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What do the labels say about using others of their kind?
Meperidine label, warnings and precautionsRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant use of meperidine hydrochloride tablets with benzodiazepines and/or other CNS depressants, including alcohol (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids …
Hydromorphone label, warnings and precautionsRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant use of hydromorphone hydrochloride oral solution and hydromorphone hydrochloride tablets with benzodiazepines and/or other CNS depressants, including alcohol (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants …
Source: FDA drug labels via openFDA
What next?
- Alternatives to meperidine
- every medicine labeled for the same conditions