DrugBuyers.Com: Dilaudid

For most people, hydromorphone (Dilaudid) will have a milligram strength about 6 to 8 times that of morphine, when the drugs are taken orally (source: Goodman and Gilman, Pharmacological Basis of Therapeutics 9th Ed -- this is an introductory text for medical students and laymen). Since hydrocodone is approximately the same potency as morphine when taken orally, a single 2 mg Dilaudid tablet should be the equivalent of roughly 15 mg hydrocodone, and perhaps as much as 20 mg of hydrocodone!

Your experience -- 4 mg hydromorphone seems weaker than 15 mg hydrocodone -- is probably very rare, but it could be explained by one or more of the following:

1. Dilaudid tablets are hydromorphone hydrochloride as a single drug entity, with no APAP or other actives. While I doubt that APAP contributes much in the way of analgesia in comparison to 15 mg of hydrocodone or 2 mg of hydromorphone for most people, you might be someone who responds exceptionally well to APAP. Since your Dilaudid tablets have no APAP, you perceive them as weaker.

2. You may have taken the Dilaudid under different circumstances than existed when you last took hydrocodone. Your pain might be worse now, making it seem that hydromorphone is weaker than it really is. Another distinct possibility is that your opioid tolerance is higher than you thought (alas, it develops quickly whether you're taking hydrocodone or hydromorphone). If your physician will let your needs determine your prescription (as well it should, but unfortunately, not all physicians are as well trained as your distinguished provider), then you could certainly increase the dose, with all due caution, to find out what dose of hydromorphone you need.

3. You may have an idiosyncratic lack of response to hydromorphone. If everybody responded ideally to hydromorphone, hydrocodone, morphine, or any particular drug, why, we'd need only that drug in the pharmacy. But this isn't so, so there is a place for all of these drugs, and for better such drugs in the future. In this regard, it is known that 10% of people hardly respond to codeine at all, which is a major reason why hydrocodone and oxycodone are replacing codeine more and more. It could be that, despite the well-placed faith that your physician has in the effectiveness of hydromorphone, that you're simply someone who doesn't respond to the medication. Ok, then, just move on. The most sensible thing would be to move back to hydrocodone/APAP, since that worked for you in the past (but of course, you need to understand what "side effects" your physician was trying to avoid by switching you to Dilaudid).

4. You didn't say how long you've tried the Diluadid, but assuming it hasn't been too long and your experience is limited to just the tablets dispensed by one pharmacy on one occasion, there is a possibility that you got some outdated meds, or even the wrong medicine entirely. Such errors are VERY COMMON and a major cause of problems for patients (up to and including death). Check your Dilaudid pills, and make sure you got what you were prescribed (the brand medication is easily identified using the PDR and other resources; the generics can be decoded from the imprint codes (you can post here for help, if needed). And ask the pharmacist to verify you got fresh medicine.

I do hope you get to the bottom of this and keep us posted. In the meantime, I think you can rest assured that your physician has your best interests at heart, since he has prescribed one of the most effective pain medications (for most people, anyway) available, and wants to let your medical needs determine the amount he prescribes. I'm sure you'll want to include him in your future decision making on this matter.