How Long Does Hydromorphone Stay in Your System?

Hydromorphone in Your Blood, Urine, Hair, & Saliva

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Hydromorphone, sold under the brand names Dilaudid and Exalgo, is an opiate analgesic used to relieve pain. It's prescribed for people who need relief for severe pain for an extended period of time and who are already familiar with how opioids affect them.

Hydromorphone is available in liquid form, as a tablet, or as an extended-release tablet that only needs to be taken once a day. Hydromorphone is a Schedule II drug in the United States, which means it's considered a drug with a high potential for misuse, potentially leading to severe psychological or physical dependence. The potency of hydromorphone is two to eight times higher than morphine.

How Long Does Hydromorphone Stay in Your System?

Blood: Up to 48 hours

Urine: Up to five days

Saliva: Up to five days

Hair: Up to three months

How Long Does It Take to Feel the Effects?

The way in which hydromorphone affects your system depends on the route of administration. It can be taken as a pill, a liquid, injected intravenously (IV), intramuscularly (IM), or inserted rectally.

  • Oral administration: When hydromorphone is taken orally in pill or liquid form, it begins to work quickly, often in about 15 minutes, and usually reaches its peak effect in 30 minutes to an hour.
  • Intravenous (IV) injection: IV injections of hydromorphone begin to take effect in about five minutes.
  • Intramuscular (IM) injection: IM injections of hydromorphone begin to work in about 15 minutes.
  • Rectal administration: Administration of hydromorphone rectally, which may be used in cases of severe nausea or when you can't have an injection, should take effect in about 30 minutes.

Hydromorphone can make you drowsy, so until you know how it affects you, it's safer to not drive or operate heavy machinery for two days after taking it.

Common side effects of hydromorphone include:

  • Headache
  • Sleep difficulties
  • Sweating
  • Dry mouth
  • Anxiety
  • Feeling lightheaded
  • Sleepiness
  • Pain in your muscles, joints, or back
  • Itching
  • Abdominal pain
  • Depression

Hydromorphone can cause serious or life-threatening breathing problems, especially during the first two days of taking it. You should be carefully monitored when you start taking this medication.

Serious side effects of hydromorphone include:

  • Shallow, weak, or very slow breathing
  • Slow heart rate or pounding heartbeats
  • Confusion
  • Lightheadedness or fainting
  • Cold, clammy skin
  • Seizures (convulsions)
  • Wheezing
  • Severe weakness or drowsiness
  • Extreme mood changes
  • Difficulty urinating

How Long Does Hydromorphone Last?

The half-life of hydromorphone, or how long it takes for half of the drug to leave your system, also depends on the route of administration:

  • Oral administration: About four hours
  • IV: About two hours
  • IM: Three hours
  • Rectal: Four to five hours

It generally takes four to five half-lives for a drug to be effectively eliminated from the body.

If you have been prescribed Dilaudid or Exalgo and need to take a urine drug test for employment or other purposes, tell the testing lab that you have been prescribed the drug so that they are able to interpret the test appropriately.

Urine

Hydromorphone is detected in urine drug screens for two to five days after the last use.

Blood

For most healthy individuals, it will take one to two days for hydromorphone to fully clear the blood.

Saliva

The drug can be detected in a saliva test for one to five days after the last dose is taken.

Hair

Hydromorphone can be detected in a hair follicle test for up to three months (90 days).

Factors That Affect Detection Time

The amount of time that hydromorphone is detectable in your body depends on a number of variables, including which kind of drug test is being used, your metabolism, age, and overall health. All of these factors make it nearly impossible to determine an exact amount of time hydromorphone will show up on a drug test since it may be different for everyone.

Age

Older adults can take longer than younger adults to metabolize and eliminate the drug.

Metabolism

Your metabolic rate plays a role in the detection time of hydromorphone. In general, the slower your metabolism, the longer hydromorphone will remain in your system.

Liver and Kidney Function

People with liver or renal impairment tend to have longer elimination half-lives.

Dosage

Hydromorphone comes in an extended-release form, which can impact the amount of time it takes for your body to metabolize the drug.

How to Get Hydromorphone Out of Your System

The best way to get hydromorphone out of your system is to stop using the drug so your body has time to process and eliminate it. That said, it's best to work with your doctor to taper off hydromorphone in order to safely avoid unpleasant symptoms of withdrawal.

Symptoms of Overdose

The extended-release form of hydromorphone is used to relieve severe pain around the clock in people who need continuous pain relief. In order to avoid a possible accidental overdose, make sure you take your medication at the same time every day.

As a form of morphine, too much hydromorphone of any dosage can cause deep sleep and can slow your respiration. If more of the drug is taken before it's completely metabolized out of your system, an overdose can occur. Follow your doctor's instructions carefully.

Even when taken as directed, hydromorphone can cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours after you begin taking the medication or after an increase in dosage.

If you take the extended-release tablet, be sure to swallow it whole. Crushing, chewing, or dissolving the tablet causes the medication to be released too quickly in your body instead of slowly over 24 hours, which can cause breathing difficulties, overdose, or even death.

Some of the symptoms of a hydromorphone overdose include:

  • Difficulty breathing
  • Slowed or stopped breathing
  • Excessive sleepiness
  • Dizziness
  • Fainting
  • Limp or weak muscles
  • Narrowing or widening of the pupils
  • Cold, clammy skin
  • Slow or stopped heartbeat
  • Blue color of skin, fingernails, lips
  • Loss of consciousness or coma

If you believe a loved one has overdosed on hydromorphone, call for emergency help immediately. First responders will likely be able to revive your loved one with Narcan (naloxone), a drug that treats opioid overdoses, but the success of the treatment depends on how quickly you get help.

Dangerous Interactions

Certain medications can change the way hydromorphone affects your body by increasing, decreasing, or prolonging the effects. It is very important to discuss all prescriptions, over-the-counter medications, vitamins, and herbs that you are taking with your doctor or pharmacist so they can advise you and adjust your prescriptions properly for safety.

Specific medications that interact with hydromorphone include:

You must not drink alcohol, use any medications that contain alcohol, or use illegal drugs while taking hydromorphone because these all increase your risk of serious side effects or a fatal overdose.

Getting Help

It is critical to continue to take hydromorphone on the schedule provided by your doctor. If you suddenly stop taking it after you have been taking it for several days, you are likely to go through withdrawal, which can be dangerous. Only reduce your hydromorphone when advised to do so by your doctor and follow the schedule provided.

Symptoms of hydromorphone withdrawal include:

  • Severe cravings for hydromorphone
  • Sweating
  • Fever or chills
  • Headaches
  • General aches and pains
  • Nausea
  • Vomiting
  • Diarrhea
  • Rapid breathing
  • Rapid heartbeat
  • High blood pressure
  • Tremors and muscle spasms
  • Anxiety, depression, or suicidal thoughts
  • Restlessness, agitation, or trouble sleeping
  • Decreased appetite

People are more likely to relapse and make poor decisions when withdrawal symptoms are at their peak. Physical symptoms can lead to many cognitive issues as well, such as attention deficit problems, issues with problem-solving, and memory function.

When used properly, and during the early portion of recovery, hydromorphone is typically not an issue. The illicit use of hydromorphone, meaning without a prescription or without medical necessity, can lead to addiction.

If you or someone you love is showing signs of hydromorphone dependency or opioid use disorder, help is available. Your doctor may prescribe an alternative medication to help you taper off the drug and refer you to a mental health professional or addiction specialist who may recommend treatment and support.

The Substance Abuse and Mental Health Services Administration is also a good resource. You can call 1-800-662-4357 or try their online tool to locate an addiction treatment resource in your area. 

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Article Sources
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  1. Yang Y, Wu J, Li H, et al. Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: Impact on mood, opioid adverse effects, and recoveryBMC Anesthesiol. 2018;18(1):37. doi:10.1186/s12871-018-0500-1

  2. Merck Professional Manual. Hydromorphone. Published online, no date.

  3. Drugs.com. Professional Medfacts: Hydromorphone. Updated online, April 22, 2019.

  4. Drugs.com. Professional Medfacts: Hydromorphone. Updated April 22, 2019

  5. U.S. Food and Drug Administration. NDA 19-034/S-018-Label Dilaudid and Diladid HP-Injection.

  6. Mazer-amirshahi M, Motov S, Nelson LS. Hydromorphone use for acute pain: Misconceptions, controversies, and risksJ Opioid Manag. 2018;14(1):61-71. doi:10.5055/jom.2018.0430

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