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Is Hydromorphone the same as Hydrocodone?

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Posted on Thu, 18 May 2017
Question: Is hydromorphone just a much stronger version of hydrocodone and basically the same thing? I don't really want to take it but my Dr. says I am getting too much tylenol from the hydrocodone/apap that I take daily at the moment but It has worked very well to control the pain without whacking me out, I can talk and think rationally on it but don't know about this hydromorphone stuff and internet is full of scary conflicting info..
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Answered by Dr. Bonnie Berger-Durnbaugh (24 minutes later)
Brief Answer:
Information

Detailed Answer:
Hello and welcome,

Hydrocodone and hydromorphone are slightly different opioid medications, but at the same dose, they are equivalent in terms of dosage, and duration. Hydromorphone is not considered stronger than hydrocodone. They are equivalent.

It's hard to know ahead of time how any particular medication will affect an individual, but these two medications are similar.

It is a good idea to watch the total amount of acetaminophen from all sources, and Vicodin is a combination of hydrocodone and acetaminophen. So it's reasonable to switch to hydromorphone. It is the closest substitute for the hydrocodone in the Vicodin.

If you are afraid that the hydromorphone is going to whack you out, make sure that the dose of it is the same as the dose of hydrocodone you were getting previously in the Vicodin. Then it will not be much of a change except for not having the acetaminophen in there with it.

Does that make sense to you? Please let me know if I can provide further information.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (1 hour later)
Thank you for assuaging some of my fears, I could not sleep 2nite without getting some sort of answer, and of course the pain is keeping me up, I suck it up during the day for the most part but absolutely need it to sleep. I have both medicines in front of me with a command from my Dr. to take the hydromorphone and not the "Vicodin". He says it is an equivalent dose to my 2 X 10/325 pills I have been taking nightly (I mis-wrote when I wrote daily before sorry). I have had knee surgery with 2 ligaments in the same knee simultaneously repaired with part of my own hamstring but recovery is going MUCH slower and much more PAINFULLY than I thought and was planned. OK, I am very confused about something, maybe should have started with this, so the hydromorph should be mg to mg the same amount? That would be 20mg, because that's sure not what my Dr. prescribed. I have a bottle full of 4mg hydromorph tabs and he told me to take 4mg or cut some in half at the score and take 1.5 pills=6mg of the hydromorph. Am I getting something catastrophically wrong? I'm sorry, I know Dr.'s hate irrelevant info so sorry for the first like five lines of this soliloquy but hey, I'm awake. in pain and writing distracts me for the moment.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (23 minutes later)
Brief Answer:
Information and correction

Detailed Answer:
No need to apologize for any of it.

And actually I need to apologize. My source for saying that the dosing of the 2 medications came from an old pharmacopoeia reference and now from every current source I look at, that information was wrong.

Hydromorphone is stronger and needs a lower dose.

So for 20 mg of Hydrocodone, 4-6 mg of Hydromorphone would be an appropriate dose to start with. But you may need to adjust the dose after you see how it works for you, because there is a wide range of "bioavailability" for this opiate which varies from person to person.

I am attaching links for 2 opiate conversion tables. You will need to copy and paste it into your address bar as I don't think it will "link" here:

http://www.med.umich.edu/1info/FHP/practiceguides/pain/dosing.pdf

http://clincalc.com/opioids/
(In the calculator, the term "PO" means per oral, in other words by mouth)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (32 minutes later)
OK, things makes more sense now, thanks again. Though one of the charts has something called "cross tolerance" that I am not familiar with, if you could give me a layman's explanation, would appreciate it, but I fully understand that 4-6 mg is the correct equiv. dosage for me, apparently my Dr. does know what he's doing (not that I really thought he didn't but I have been very upset at the slow pace of recovery past his "soft" predictions. So anyway, I don't mind losing an hour of sleep if starting with 4mg doesn't work then taking another 2mg after an hour, would you concur with that course of action? I also understand the concept of "bioavailability" making the dosage somewhat imprecise at times. The main thing is, can I be confident that when I take this in about 15 min, my mind will not go all XXXXXXX nilly and have crazy thoughts and do weird things that I've heard of on these types of drugs like oxy, fent, (don't tolerate codeine or morphine well - extreme nausea) and especially diff drugs like ambien - like going on a stroll, well - limping heavily with crutches, through my neighborhood naked or something whacko like that?
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (15 minutes later)
Brief Answer:
Thoughts on this.

Detailed Answer:
I think it would be reasonable to wait an hour, and take an additional 2 mg. With oral dosing, it takes around 30 minutes to kick in, but may take up to an hour to reach peak concentrations.

I can't guarantee that it will affect you one way or the other, but it would be very unusual to cause such extreme behavior as you are thinking might happen. Opiates mostly just relieve pain, and cause sedation, with some mood elevation. I would be more leery of Ambien but that is not in the same class of medication. It is unlikely that you would have crazy thoughts from an opiate, like a person might from a hallucinogen like LSD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (16 minutes later)
Thank you, I didn't want to reference LSD because I did try that in college like 13 years ago and it was not altogether a bad experience, in fact quite the opposite but I was with good friends at the time and one control (completely sober) person. I wanted to just say will I have something like a bad trip but just didn't want to say (write it) for some reason. I will now attempt to get to sleep on this new medication in the fashion we discussed and trust your undoubtedly many years of schooling to become an MD and trust my personal Dr. to be who he is trained to be. Once again thanks and this was money very well spent. I'm sure you have helped many, many people. G'nite Dr. Berger-Durnbaugh
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (13 minutes later)
Brief Answer:
Good night -

Detailed Answer:
I hope you have a good night and no troubles. Also wishing your leg a thorough recovery.

Best regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3138 Questions

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Is Hydromorphone the same as Hydrocodone?

Brief Answer: Information Detailed Answer: Hello and welcome, Hydrocodone and hydromorphone are slightly different opioid medications, but at the same dose, they are equivalent in terms of dosage, and duration. Hydromorphone is not considered stronger than hydrocodone. They are equivalent. It's hard to know ahead of time how any particular medication will affect an individual, but these two medications are similar. It is a good idea to watch the total amount of acetaminophen from all sources, and Vicodin is a combination of hydrocodone and acetaminophen. So it's reasonable to switch to hydromorphone. It is the closest substitute for the hydrocodone in the Vicodin. If you are afraid that the hydromorphone is going to whack you out, make sure that the dose of it is the same as the dose of hydrocodone you were getting previously in the Vicodin. Then it will not be much of a change except for not having the acetaminophen in there with it. Does that make sense to you? Please let me know if I can provide further information.