Drug interactions
Diamorphine + Hydromorphone
Severity: Major
Diamorphine and Hydromorphone: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Diamorphine (heroin) is metabolized to morphine and is a potent opioid agonist like hydromorphone. Using both produces additive sedation and respiratory depression with a risk of overdose.
What this interaction means in plain words
Diamorphine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive mu-opioid receptor agonism causing CNS and respiratory depression.
What to do
Avoid combining unless switching between opioids under supervision; calculate equianalgesic doses with a reduction for incomplete cross-tolerance and monitor respiration and sedation.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Diamorphine with Hydromorphone?
MediHelp rates the interaction as major. Diamorphine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Diamorphine (heroin) is metabolized to morphine and is a potent opioid agonist like hydromorphone. Using both produces additive sedation and respiratory depression with a risk of overdose.
How serious is the interaction between Diamorphine and Hydromorphone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining unless switching between opioids under supervision; calculate equianalgesic doses with a reduction for incomplete cross-tolerance and monitor respiration and sedation.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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