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Both morphine and Dilaudid (hydromorphone) are opioid analgesics used to treat severe pain associated with cancers and major surgeries. Morphine is a derivative of opium which, in turn, is obtained from poppy flowers. It has been used as a potent analgesic since the beginning of the nineteenth century. Dilaudid is a derivative of morphine. That is why both of these medicines have a similar chemical structure. Apart from their analgesic properties, both these medicines can cause respiratory depression, are highly addictive in nature, and are widely abused.

As both morphine and Dilaudid are used in similar conditions, patients are often in a dilemma about which drug to choose. Let us compare the different properties of morphine and Dilaudid in order to make the picture clearer.

  • Strength: When taken in a similar quantity, Dilaudid has been found to be stronger compared to morphine. In fact, it is believed to be three to four times more potent than morphine. Therefore, if a patient is advised to switch from morphine to Dilaudid, he should start with a smaller dose.

  • Time to act: Dilaudid is more soluble and has a quicker onset of action compared to morphine. This is one of the main reasons why surgeons prefer it over morphine to provide analgesia after major surgeries.

  • Pain relieving qualities: Hydromorphone (Dilaudid) provides better short-term analgesia than morphine. A meta-analysis published in the British Journal of Anesthesia analyzed the quality of analgesia in 410 patients who received morphine and 405 patients who received Dilaudid for pain relief. Patients who received Dilaudid reported better pain relief than patients who received morphine.

  • Side effects: The more common side effects of taking Dilaudid and morphine are nausea, vomiting and itching. When taken in larger doses, both these medicines can cause dangerous respiratory depression. However, morphine takes a longer time to cross the blood-brain barrier. It can therefore cause a delayed respiratory depression which may prove to be fatal. Compared to morphine Dilaudid acts faster, so the chances of accidental respiratory depression are reduced when the medicine is taken in the prescribed dosage. Moreover, the concentration of Dilaudid at the effect site does not increase after titration, unlike morphine. The dangers of side effects resulting from a delayed peak in concentration at the effect site are minimized.

Morphine produces an active metabolite which is eliminated through the kidneys, making it potentially dangerous for patients with renal failure. There is no such problem with Dilaudid.

Although both morphine and Dilaudid are associated with cognitive distortion when taken in high doses, morphine can cause significantly more cognitive distortion and depression.

  • Potential for abuse: Both morphine and Dilaudid are frequently abused as they produce a high similar to opium, alcohol and heroin. But Dilaudid is slightly less addictive than morphine.

After comparing the various properties of morphine and Dilaudid, we can conclude that both these medicines are potent analgesics and should not be used casually. A patient who is not showing an adequate response to Dilaudid or is finding it difficult to bear its side effects can easily switch to morphine and vice-versa. However, patients should be careful while making the switch because of the difference in potency of both the medicines.

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