Hydromorphone Detox Guide: Withdrawal Symptoms and Timeline
Hydromorphone, also known by the brand names Dilaudid and Exalgo, is a prescription opioid medicine used to treat chronic (long-lasting), severe pain.1 It is a legal medical drug but also a Schedule II controlled substance, which means it has a high potential for abuse and addiction. Hydromorphone, like other prescription opioids, may be misused for its ability to reduce pain and cause feelings of pleasure or euphoria. Long-term use or misuse of hydromorphone and other opioids can lead to addiction, overdose, or even death.2 This article will explore common hydromorphone withdrawal symptoms and timeline, as well as how to get help.
Hydromorphone Withdrawal Symptoms
Long-term hydromorphone and other opioid use can lead to tolerance and dependence.4 Tolerance is when the body and brain no longer respond to the drug the way they first did, and you need a higher and higher dose to feel the same effects.3 Dependence is when your body and brain are so used to the drug that you will have withdrawal symptoms if you suddenly reduce your dose or stop taking it.3,4 Both tolerance and dependence can happen even if you take opioids exactly as your doctor tells you to and may also lead to hydromorphone addiction.3 Opioid addiction (or opioid use disorder, or OUD) is a disease in which you can’t control or stop your opioid use, no matter the negative consequences of using.
Hydromorphone withdrawal symptoms are similar to those of other opioids and may include:4,5
- Runny nose.
- Stomach cramps, diarrhea, nausea (feeling sick to your stomach), or vomiting.
- High blood pressure (hypertension).
- Bone and muscle aches.
- Enlarged (dilated) pupils.
- Trouble sleeping (insomnia).
- Strong opioid cravings (a strong desire to seek out and use opioids)
Withdrawal symptoms can be distressing and uncomfortable, which may lead a person to relapse (return to drug use after a period of not using to avoid or ease symptoms.
What is the Hydromorphone Withdrawal Timeline?
Hydromorphone or other opioid withdrawal impacts people in different ways, so the timeline may be different from one person to the next. When withdrawal symptoms first appear, how bad symptoms are, and how long they last depend on certain factors, such as:9
- How much hydromorphone or other opioids you take.
- How often you take it and how you take it.
- How long you’ve been taking it.
- Your overall physical and mental health.
- If you use other substances, especially alcohol, benzodiazepines, z-drugs (zolpidem, or Ambien), and kratom.
In general, hydromorphone withdrawal symptoms start 8 to 24 hours after your last dose.8 Symptoms may slowly get worse over the next 1 to 3 days before starting to get better.8 Total withdrawal usually lasts about 7 to 10 days.8
How to Deal with Hydromorphone Withdrawal Symptoms
Hydromorphone withdrawal symptoms may be intense and unpleasant, and you may be tempted to start using again to ease these symptoms.10 Relapse is perhaps the most dangerous complication of withdrawal. Your hydromorphone tolerance builds up after long-term use and it decreases greatly during detox. Returning to opioid use with a lowered tolerance increases your risk of a fatal overdose, especially if you take the same dose you took before detox.
But don’t lose hope. Medically supervised withdrawal management (also called professional detox) can offer a safer, more comfortable experience with a reduced risk of relapse.9
Often accompanied by FDA-approved treatment medicines for opioid use disorder, detox can help:6,7
- Ease withdrawal pain and discomfort.
- Reduce opioid cravings.
- Reduce the risks of relapse and overdose.
- Manage mental health symptoms that often go along with withdrawal, such as anxiety.
Detox is only the first step in the treatment and recovery process, and a medical detox can help connect you to the next step of recovery. This may include rehab, counseling, and support groups.
Opioid Withdrawal Medicines
Two medicines that are FDA-approved for the treatment of OUD may be started during detox. Buprenorphine and methadone reduce cravings and ease withdrawal symptoms. Some patients take these medicines after detox as well to help prevent relapse and overdose.7,8
The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that OUD treatment medicines help people stay in treatment, as well as reduce prescription opioid misuse and illicit (illegal) opioid use. They also help reduce the risk of opioid overdose and overdose death. 8
Other medicines that are sometimes used during medically managed opioid withdrawal include:7,8,9,11
- Clonidine, which can reduce anxiety, sweating, and irritability.
- Lofexidine, which can help ease insomnia, stomach pain, and fast heartrate (tachycardia).
- Ondansetron or metoclopramide to treat nausea.
- Loperamide to treat diarrhea.
- Diphenhydramine or trazadone for insomnia.
- Aspirin or other over-the-counter pain medicine for muscle aches, bone pain, and headaches.
Can Hydromorphone Withdrawal be Dangerous?
Because many opioid withdrawal symptoms are very unpleasant and distressing, some people return to using hydromorphone or other opioids again to ease these symptoms.12 This increases the risk of overdose and in fact, many overdose deaths happen right after detox.4 This is because withdrawal lowers your tolerance, so you can overdose on smaller doses than you’re used to taking.4
Regular use of other substances may also further complicate withdrawal. Before starting a professional medical detox, you will be fully assessed for possible health risks to ensure both your safety and reduce discomfort.
Finding Hydromorphone Addiction Treatment
Don’t let fear of withdrawal symptoms keep you from getting the help you need. Supervised medical detox can help manage unpleasant symptoms while keeping you as safe and comfortable as possible.7,9
American Addiction Centers (AAC) is a leading provider of detox and addiction treatment, with treatment centers across the nation. If you need help choosing safe and effective addiction treatment for you or your loved one, we’re here to help. Call us any time, day or night, at .
- U.S. National Library of Medicine. (2021, January 15). Hydromorphone.
- University of Michigan Health. (2019, October 17). Hydromorphone (oral).
- National Institute on Drug Abuse. (2017, January, 12). Tolerance, dependence, addiction: What’s the difference?
- S. National Library of Medicine. (2020, May 10). Opiate and opioid withdrawal.
- Shah, M. & Huecker, M. R. (2021, May 21). Opioid withdrawal. In: StatPearls (Internet]. Treasure Island (FL): StatPearls Publishing.
- Providers Clinical Support System. (2021, June 11). Medically supervised withdrawal (detoxification) from opioids.
- National Institute on Drug Abuse. (2020, September 18). Principles of drug addiction treatment: A research-based guide.
- Substance Abuse and Mental Health Services Administration. (2021). Tip 63: Medications for opioid use disorder.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment.
- National Institute on Drug Abuse. (2020, May). Prescription opioids drug facts.
- U.S. National Library of Medicine. (2018, August 15). Lofexidine.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Sethi, R., Hoang, N., Ravishankar, D. A., McCracken, M., & Manzardo, A. M. Kratom (Mitragyna speciosa): friend or foe? Prim Care Companion CNS Disord., 22(1):19nr02507