Dilaudid vs. oxycodone: Key differences, effectiveness, and safety

In this article:

• Key differences
• Conditions treated
• Insurance coverage and cost
• Side effects
• Interactions and warnings

In this article

• Key differences
• Conditions treated
• Insurance coverage and cost
• Side effects
• Interactions and warnings

When severe pain strikes—whether from injuries, surgery, or other trauma—Dilaudid (hydromorphone) and oxycodone are two of the most potent and fast-acting prescription painkillers available. They’re both powerful opioids approved to treat moderate-to-severe acute and chronic pain, blocking pain signals by binding to opioid receptors in the brain and body. While Dilaudid and oxycodone both work the same way, they have some significant differences too, and we’ve outlined them all here. 

Is Dilaudid better than oxycodone? 

Neither is inherently better than the other. Rather, each one is ideal for different situations. For example, Dilaudid is more potent than oxycodone, although some research suggests that oxycodone might have a slightly longer duration (when comparing immediate-release versions). So Dialudid is more commonly used for severe acute pain, while oxycodone may be more common for chronic pain. 

Both opioids, however, are very effective for pain management. A 2018 study on cancer patients showed that hydromorphone and oxycodone had similar efficacy in treating pain, while a 2014 study showed similar results. 

Yet healthcare providers often need to use them with caution, since both hydromorphone and oxycodone are Schedule II controlled substances, which means they can lead to abuse and physical dependence. The risk appears to be similar for both drugs, since studies have found that they have comparable abuse liability profiles. 

When deciding which to prescribe, Dr. Pamela Tambini, MD, medical director at Engage Massachusetts, says she considers pain severity, patient history, and the side effect profile. “Hydromorphone is often reserved for severe acute pain or when other opioids aren’t effective, whereas oxycodone is used for moderate-to-severe pain (usually outside the hospital setting),” she says. “Additionally, previous opioid exposure can tell me if a patient is tolerant to opioids and should be moved to hydromorphone, or if a patient had a poor response or side effect to one medication and needs to try the other.”

Ultimately, it’s not about which drug is more effective. It’s about which one is better for your specific condition, and that’s entirely up to your healthcare provider. Always consult them before taking any drug, especially ones that run the risk of abuse or addiction. 

Dilaudid vs. oxycodone: Insurance coverage and cost comparison

As a brand-name drug, Dilaudid usually costs more than generics like oxycodone. Without insurance coverage or any other savings, a 30-day supply of 2 mg Dilaudid tablets usually costs around $100, while a 30-day supply of 5 mg oxycodone tablets costs around $40. 

That said, when a healthcare provider prescribes either one for acute or chronic pain, insurance or Medicare will often cover them. The coverage, however, may vary based on the specific plan. For example, some plans may prefer generic hydromorphone over the brand-name Dilaudid or offer lower copays for other generic treatment options. Additionally, since these are both controlled substances, insurance companies may impose quantity limits on the prescriptions or require prior authorization before issuing coverage. 

For anyone paying out-of-pocket, SingleCare offers free coupons for Dilaudid and oxycodone that can reduce their costs by half or more. All you need to do is sign up for a coupon card, then present it at any participating pharmacy. 

Oxycodone vs. Dilaudid side effects

Anyone taking or considering one of these drugs should be aware of their possible side effects. According to clinical trials, the most common side effects of Dilaudid are lightheadedness, dizziness, sedation, and nausea. Oxycodone’s label says its most common adverse effects include nausea, constipation, vomiting, and headache.

Both drugs can also cause more serious side effects, which may include respiratory depression, respiratory arrest, circulatory depression, cardiac arrest, hypotension, or shock. These are rare, but they’re possible with any opioid analgesic drug. 

Additionally, since these drugs may cause physical dependence, discontinuing them can also cause withdrawal. “Symptoms can include nausea, vomiting, insomnia, sweating, aches, and more. These can be extremely uncomfortable,” says Dr. Jefferey Chester, DO, medical director of The Ohana Rehab. “To avoid this, follow your doctor’s directions very carefully. If you need to stop these medications, tapering (with the help of your healthcare provider) can help.”

This isn’t a complete list of side effects. For a comprehensive list, consult a healthcare professional for guidance. 

Dilaudid and oxycodone drug interactions and warnings

As controlled substances with various side effects and drug interactions, there are some precautions to understand before taking either opioid. 

Addiction and Abuse

The most important warning for either drug concerns their potential for abuse and addiction. And that also means there’s a risk of overdose. The CDC reported that in 2023, approximately 80,000 people in the US died from opioid overdoses—76% of all drug overdose deaths. To reduce the risk of abuse and dependence, take Dilaudid or oxycodone only as your healthcare provider directs, avoid taking them with alcohol or illicit drugs, and tell your healthcare provider if you have a history of substance use disorder. 

“The principle is always to use these medications only when the benefits clearly outweigh the risks, and never without safeguards in place. It is best to use the lowest effective dose for the shortest possible duration and explain that the drugs are for pain relief, not for anxiety or sleep,” Dr. Tambini says. “Additionally, the need should be reassessed frequently and avoid automatic refills, instead requiring in-person or telehealth check-ins and urine drug screens when appropriate.” 

Other Medical Concerns

Opioids can also cause severe respiratory depression in rare cases, so “people with significant breathing disorders should avoid these medications unless they are prescribed in a very controlled circumstance, like during a hospitalization,” Dr. Chester says. You should also tell your healthcare provider if you have ever had brain tumors, head injuries, gastrointestinal issues, seizures, or disease of the heart, kidneys, lungs, liver, or pancreas. 

Pregnant mothers can technically take these medications, but it’s typically not recommended, since they may cause respiratory depression, slowed growth, birth defects, or life-threatening withdrawals in the newborn baby—particularly when they’re abused. 

Drug Interactions

Opioid analgesics like Dilaudid and oxycodone may also interact with the following drugs:

• CNS Depressants: Taking opioids with other central nervous system depressants may cause sedation, low blood pressure, slowed breathing, or coma. 

• MAO Inhibitors: These antidepressants, like opioids, can raise serotonin levels, resulting in a potentially life-threatening condition called serotonin syndrome. 

• Triptans: These drugs can also raise serotonin levels. 

• Benzodiazepines: Like opioids, these drugs (Xanax, Valium, etc.) can suppress breathing and impair cognitive functions, increasing the risk of overdose. 

• SSRIs or SNRIs: These can increase the amount of opioids in the blood, increasing the risk of overdose. They may also contribute to serotonin syndrome. 

• Tricyclic Antidepressants: When combined with opioids, they can increase the risk of severe side effects and serotonin syndrome. 

• Beta blockers: These drugs lower blood pressure, but may lower it too much in combination with opioids. 
• Anticholinergics: These drugs may increase the risk of side effects while taking opioids. 

That might seem like an intimidating list of warnings and interactions, but when you take Dilaudid or oxycodone under the supervision of a healthcare professional, and you take it exactly as directed, they’re typically safe. Which is the better option? Only your healthcare provider—who knows your medical history, other medications, and health details—can make that call. Be sure to talk everything through with them before you begin treatment.