Dilaudid vs. Percocet: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Have you or a family member ever had a serious injury or surgery which required strong pain medication? Dilaudid and Percocet are two prescription drugs used for the treatment of severe pain. Both drugs are approved by the United States Food and Drug Administration (FDA).

Dilaudid and Percocet are classified in a group of medications called opioid, or narcotic, analgesics. Opioid analgesics work by binding to mu opioid receptors in the brain, weakening and blocking pain signals. By doing this, they relieve severe pain.

Dilaudid and Percocet are classified by the Drug Enforcement Agency (DEA) as Schedule II drugs because they have a high potential for abuse and psychological or physical dependence/opioid addiction. Dilaudid and Percocet have many similarities, but also have some differences. Continue reading below to learn more about Dilaudid and Percocet.

What are the main differences between Dilaudid and Percocet?

Dilaudid (What is Dilaudid?) is a drug used to manage severe, acute pain. It contains the ingredient hydromorphone, or hydromorphone hydrochloride. Dilaudid is available as a tablet, liquid, injection, and rectal suppository.

Percocet (What is Percocet?) is a combination drug used for the management of severe, acute pain. Percocet contains oxycodone and acetaminophen. Acetaminophen is the generic of Tylenol and is also referred to as APAP, so the drug name may appear as oxycodone/APAP on your prescription label. Percocet is available in tablet form.

Both Dilaudid and Percocet are available in brand name and generic form. Dilaudid and Percocet are intended to be used for short-term pain relief; however, some patients with chronic pain continue taking Dilaudid or Percocet for longer, depending on the healthcare provider’s instruction. All patients who take Dilaudid or Percocet should be closely monitored.

Conditions treated by Dilaudid and Percocet

Dilaudid and Percocet are used for the management of pain that is severe enough to require an opioid analgesic, but should only be prescribed when other treatments (non-opioids) are not tolerated or not adequate to control the pain.

Is Dilaudid or Percocet more effective?

There are no studies directly comparing the two (immediate-release) drugs head-to-head. One study reviewed hydromorphone in comparison to other opioids for cancer pain, but admittedly had “low-quality evidence,” due to small samples and risk of bias. The review found little difference in efficacy between hydromorphone and other opioids, including oxycodone and morphine.

Another review of studies determined that hydromorphone for moderate to severe cancer pain was effective and tolerable in comparison to morphine and oxycodone, but did not show hydromorphone to be better or worse in comparison.

Efficacy is also based on the dosage and frequency of administration. With appropriate dosing, results should be similar. While either medication can be effective in the management of severe, acute pain, Dilaudid or Percocet should only be used if other non-opioid medications are not effective and/or can’t be tolerated. Your healthcare provider can determine if one of these medications is right for you, and if so, which one.

Coverage and cost comparison of Dilaudid vs. Percocet

State laws may limit the first fill of a narcotic prescription to a small quantity. Dilaudid is covered in its generic form by most insurance and Medicare Part D plans. A typical prescription of brand-name Dilaudid would be for 20 tablets of hydromorphone 4 mg and cost approximately $20 out-of-pocket. You can save money on generic Dilaudid with a SingleCare card, dropping the price down to about $12 at participating pharmacies.

Percocet is covered in its generic form by most insurance and Medicare Part D plans. A typical prescription of Percocet would be for 20 tablets of generic oxycodone/APAP 5/325 mg and costs about $50 out-of-pocket. You can save money on generic Percocet with a SingleCare card, lowering the price to approximately $12.

Common side effects of Dilaudid vs. Percocet

Serious adverse effects that can occur with Dilaudid or Percocet are respiratory depression (slowed breathing and not getting enough oxygen), apnea, respiratory arrest, low blood pressure, and shock.

The most common side effects of Dilaudid are lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, feeling either very happy or unhappy, dry mouth, and itching. Side effects seem to occur more in ambulatory patients (patients who can walk unassisted) and in patients who are not in severe pain.

The most common side effects of Percocet are lightheadedness, dizziness, drowsiness, sedation, nausea, and vomiting. Other side effects include feeling either very happy or very unhappy, constipation, and itching.

Serotonin syndrome is a serious, life-threatening reaction that could potentially occur with Dilaudid or Percocet, especially when taken in combination with other medications that increase serotonin.

This is not a full list of side effects. Other side effects may occur. Consult your healthcare professional for a complete list of side effects of Dilaudid and Percocet.

Source: DailyMed (Dilaudid), DailyMed (Percocet)

Drug interactions of Dilaudid vs. Percocet

Benzodiazepines or other CNS depressants (including other opioids) combined with Dilaudid or Percocet can cause low blood pressure, slowed breathing, profound sedation, coma, or even death. Generally, this combination should not be used. However, if no other combination is feasible, the patient should be very closely monitored and take the combination of medications at the lowest dose(s) and the shortest duration possible.

Taking Dilaudid or Percocet with other medications that raise serotonin levels can increase the risk of serotonin syndrome, which is a very serious, potentially life-threatening condition. These other drugs include antidepressants, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of Dilaudid or Percocet), and triptans.

If you are taking Percocet, remember that it contains Tylenol (APAP), and many over-the-counter cough and cold medications and pain relievers contain APAP as well. Check with your pharmacist, who can help you select an OTC medication that does not contain APAP.

Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions of Dilaudid and Percocet.

Warnings of Dilaudid and Percocet

Both Dilaudid and Percocet have boxed (black box) warnings, which is the strongest warning required by the FDA.

• There is the potential for abuse, misuse, and addiction, which can result in overdose and death. Take your medication as prescribed, and only for the purpose for which it was prescribed. Do not take extra doses or use the medication for other conditions than for which it was prescribed.
• Serious, life-threatening respiratory depression can occur. Patients should be monitored, especially during the beginning of treatment and with any change in dose. Elderly patients, patients who are cachectic or debilitated, and patients with lung problems are at higher risk for respiratory depression.
• Accidental ingestion by anyone, especially children, may cause a fatal overdose.
• Using opioids for a prolonged time during pregnancy can result in neonatal opioid withdrawal syndrome, which can be life-threatening.
• Using opioids with benzodiazepines or other central nervous system (CNS) depressants can cause serious respiratory depression, profound sedation, coma, or even death. If the combination of an opioid and a benzodiazepine cannot be avoided, the lowest dose should be prescribed, and the medication should be used for the shortest duration possible. The patient should be closely monitored.

Percocet only:

Tylenol (acetaminophen) has been associated with liver problems, which could potentially result in the need for a liver transplant, or death. Patients should be aware of the maximum daily dose of acetaminophen (ask your healthcare provider) and should not use other products that contain acetaminophen. NOTE: Acetaminophen is in Percocet, but not in Dilaudid.

In rare cases, acetaminophen (found in Percocet but not Dilaudid) can cause serious skin reactions, including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which may be fatal. If a skin reaction occurs, stop the drug immediately and seek emergency treatment. Acetaminophen can also cause hypersensitivity reactions, which may include swelling around the lips and face, or skin reactions. If this occurs, seek emergency treatment.

Dilaudid only:

Dosing errors may occur with the liquid formulation. Household measuring devices should not be used to measure Dilaudid liquid. You should only use the measuring device that comes with the prescription and is provided by the pharmacist, or another calibrated measuring device obtained from the pharmacy. Use caution in measuring, as incorrect measuring could lead to accidental overdose and death.

Both Dilaudid tablets and liquid contain sodium metabisulfite. This is a sulfite that can rarely but potentially cause allergic reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes. It is more common in patients with asthma. Patients with a hypersensitivity to sulfite-containing medication should not take Dilaudid.

Other warnings include:

• Low blood pressure may occur—blood pressure should be monitored while on Dilaudid or Percocet.
• Opioids should not be used in patients who have a head injury, or impaired consciousness. Also, patients with gastrointestinal obstruction should not take
• Patients with seizure disorders have an increased risk of seizures when taking opioids.
• When discontinuing an opioid, taper the medication gradually, as directed by your healthcare provider, to avoid symptoms of withdrawal. Never stop taking the medication abruptly.
• Do not drive or operate machinery until you know how you react to the medication.
• Do not drink alcohol at any time while taking Dilaudid or Percocet.
• Keep your medication out of the reach of children and others, preferably in a locked cabinet or drawer. When you are finished with your course of treatment, do not save the medication. Click here to find out how to safely dispose of your opioid medication.
• Opioids should not be taken during pregnancy, because they can cause harm to the fetus. Using opioids for a prolonged time during pregnancy can lead to a life-threatening condition called neonatal opioid withdrawal syndrome.

Frequently asked questions about Dilaudid vs. Percocet

What is Dilaudid?

Dilaudid is an opioid pain reliever that contains hydromorphone. It should only be used for severe, acute pain, and for a short amount of time. Because it can lead to abuse and dependence, Dilaudid is classified by the DEA as a Schedule II drug.

What is Percocet?

Percocet is an opioid pain reliever and contains oxycodone and acetaminophen. It should only be used for severe, acute pain, for a short period of time, unless otherwise instructed by your healthcare provider. Like Dilaudid, Percocet can lead to abuse and dependence and is classified as a Schedule II drug.

Are Dilaudid and Percocet the same?

Dilaudid and Percocet have some similarities as well as differences. Both contain a strong opioid painkiller. Dilaudid contains hydromorphone, while Percocet contains oxycodone. Percocet also contains acetaminophen (the same active ingredient found in Tylenol). Dilaudid and Percocet are both used for short-term treatment of acute pain when other alternatives are not sufficient and/or cannot be tolerated.

Is Dilaudid or Percocet better?

There are no clinical studies directly comparing the two medications. Your healthcare provider can determine if you need an opioid analgesic, and if so, which is better for you, based on your individual condition and history.

Can I use Dilaudid or Percocet while pregnant?

No. Taking Dilaudid or Percocet for a prolonged period of time during pregnancy can cause neonatal opioid withdrawal syndrome (also known as neonatal abstinence syndrome), which can be life-threatening.

Can I use Dilaudid or Percocet with alcohol?

No, you should drink alcohol while taking Dilaudid or Percocet. The combination could increase the risk of CNS and respiratory depression, which could lead to a coma or even death. Also, the combination of alcohol and acetaminophen (in Percocet) can increase the risk for liver problems.

Which is more potent, oxycodone, or Dilaudid?

Opioids have different potencies, and the potency also depends on how the opioid is administered—by mouth or by injection. When you compare oxycodone and hydromorphone (Dilaudid), the hydromorphone is much more potent. For example, if you took 5 mg of oral hydromorphone, you would have to take 20 mg of oral oxycodone to get a safe clinical effect. Always check with your pharmacist or prescriber before taking an opioid, and do NOT assume one opioid is the same as another. This could lead to a life-threatening complication.

How long does Dilaudid stay in your system?

One dose of Dilaudid can stay in your system for about 15-18 hours until it’s completely cleared. A dose should help with pain for about three to four hours.

How long does Dilaudid help with pain?

An oral dose of Dilaudid should reach maximum efficacy in about 30-60 minutes. A dose should last about three to four hours. You will likely be prescribed a dose every four to six hours, so your next dose will generally be before the pain returns.