Drug interactions
Hydrocodone + Hydromorphone
Severity: Major
Hydrocodone and Hydromorphone: major interaction.
Last updated
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
Using two full opioid agonists together produces additive respiratory depression, sedation and hypotension, with a risk of coma and death. It also represents therapeutic duplication with little added analgesic benefit.
What this interaction means in plain words
Hydrocodone 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.
Hydrocodone belongs to Musculoskeletal; Hydromorphone belongs to Musculoskeletal.
Why it happens
Additive mu-opioid receptor agonism causing CNS and respiratory depression.
What to do
Avoid routine concurrent use and consolidate to a single opioid where possible. If both are unavoidable, use the lowest doses for the shortest time and monitor sedation and respiratory rate.
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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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Other interactions of Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
Frequently asked questions
Can I take Hydrocodone with Hydromorphone?
MediHelp rates the interaction as major. Hydrocodone 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. Using two full opioid agonists together produces additive respiratory depression, sedation and hypotension, with a risk of coma and death. It also represents therapeutic duplication with little added analgesic benefit.
How serious is the interaction between Hydrocodone 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 routine concurrent use and consolidate to a single opioid where possible. If both are unavoidable, use the lowest doses for the shortest time and monitor sedation and respiratory rate.
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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