The Effects of Mixing Hydromorphone and Alcohol

Hydromorphone (brand names: Dilaudid or Exalgo) is a prescription opioid pain medication used to treat moderate-to-severe pain. It is a derivative of morphine and has similar effects; it is commonly administered in hospitals.

When used as prescribed, it has low overdose potential, however, when hydromorphone is taken recreationally, and especially when it is combined with other drugs and alcohol, the results can be dangerous and sometimes fatal.^1,2

Hydromorphone is often misused because of the euphoric high that it creates. Recreational users experience:^1,2

• Reduced anxiety.
• Sedation.
• Relaxation.
• Feelings of well-being.
• Numbing of physical and emotional pain.

When taken in higher doses and mixed with alcohol and other drugs, the high is often more intense and, thus, more dangerous. With continued use, the user develops tolerance and requires more of the drug to experience the same high. This significantly increases the risk of experiencing side effects and overdosing.^1,2

Side Effects of Taking Hydromorphone with Alcoholic Drinks

When you are prescribed hydromorphone, you are advised not to drink alcohol since the combination of the two may increase the risk of dangerous side effects and overdose.^1,3

Hydromorphone overdose can occur when you accidentally or intentionally take more than the prescribed dose, but may be even more likely when you combine it with alcohol or other drugs. Because tolerance builds, if you become addicted to the substance, you may begin to use increasingly higher doses to achieve the initial euphoria—raising your risk of overdose in the process.¹

Due to the risks of interaction, hydromorphone should never be combined with alcohol or other central nervous system (CNS) depressants, including:^1,3

• Other prescription painkillers.
• Sleep aids.
• Nighttime cold medications.
• Antihistamines.
• Sedatives.
• Barbiturates.
• Benzodiazepines.
• General anesthetics.

Opioid abuse, particularly when combined with alcohol or other CNS depressants, can result in long-term brain damage. Depressed respiration results in hypoxia, which lowers the amount of oxygen able to reach to the brain. This can induce coma, cause short-term and long-term neurological and psychological effects and create permanent brain damage.³

Common Side Effects

Common side effects of hydromorphone that may be worsened by combining it with alcohol include:³

• Nausea and vomiting.
• Headache.
• Dry mouth.
• Loss of appetite.
• Dizziness/lightheadedness.
• Drowsiness.
• Insomnia.
• Sweating.
• Flushing.
• Muscle, back, stomach and joint pain.
• Itching.
• Anxiety.
• Depression.

Severe Side Effects

More severe side effects that may occur include:

• Hives/rash.
• Seizures.
• Chest pain.
• Hoarseness.
• Difficult breathing or swallowing.
• Swelling of the eyes, tongue, lips, etc.
• Extreme drowsiness.
• Fainting.

Hydromorphone Overdose

The symptoms of hydromorphone overdose are:

• Breathing problems (shallow breathing, slow breathing or no breathing).
• Blue-colored fingernails and/or lips.
• Cold and clammy skin.
• Dizziness/lightheadedness.
• Fatigue/drowsiness.
• Confusion.
• Pinpoint pupils.
• Muscle twitches.
• Stomach spasms.
• Weakness.
• Low blood pressure.
• Weak pulse.
• Coma/loss of consciousness.

Concerns of Mixing Alcohol with Other Opiates

• Codeine
• Dilaudid
• Fentanyl
• Heroin
• Hydrocodone
• Lortab
• Methadone
• Morphine
• Norco
• Oxycodone
• Oxycontin
• Percocet
• Tramadol
• Vicodin

Treatment of Addiction to Hydromorphone and Alcohol

Treatment is available for those suffering from addiction to hydromorphone and alcohol. In cases of polysubstance abuse, individual recovery programs may vary. Because withdrawal from hydromorphone and alcohol can be severe and in many cases, dangerous, detox is the first step toward recovery.

With hydromorphone, withdrawal symptoms typically last for as long as 72 hours. Withdrawal may be complicated in the case of an individual with an additional history of alcohol abuse, as the symptoms of acute alcohol withdrawal can be quite dangerous and require close medical care and administration of anti-seizure medication. Medically-assisted detox is available at most treatment facilities.^2,4

Pharmacological treatments are available for the treatment of opiate addiction and withdrawal. These include opioid antagonists and partial agonists, such as naltrexone, methadone and buprenorphine, which can reduce cravings and eliminate withdrawal symptoms. Because some of these are also CNS depressants, alcohol should be avoided with these medications as well. Extra caution must be taken when people addicted to alcohol are prescribed these medications.⁴

Behavioral therapies are also an important part of recovery. These include:⁵

• Cognitive behavioral therapy (CBT).
• Motivational interviewing.
• 12-step programs.
• Family therapy, intervention, and counseling.

There are many rehabilitation programs available that offer a combination of behavioral and pharmacological therapies in both inpatient and outpatient settings. Inpatient rehabs are more intensive and thus are more effective for relapse prevention, especially in cases of severe addiction. Outpatient rehabilitation is a good choice for those wishing to maintain their personal and professional lives during treatment.^4,5

If you’re concerned that the co-abuse of alcohol and hydromorphone is impacting your health, or that of someone close to you, substance abuse treatment programs can help. Call us at to speak with a treatment support advisor about your recovery options.