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Does CBD Interact With Hydromorphone (Dilaudid)

CBD & Dilaudid (hydromorphone) are both used for managing pain & insomnia. This combination carries a mild-moderate level of risk for adverse effects.

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Daily CBD , last updated on January 4, 2022

Hydromorphone is an analgesic of the opioid family. It’s a semi-synthetic hydrogenated ketone derivative of morphine used to treat moderate to severe pain. 

Cannabidiol (CBD), a cannabinoid produced in hemp, is a popular herbal alternative to prescription painkillers. Some users report taking both substances together for increased effects or to reduce the dose of Dilaudid. 

Is this combination safe? What are the risks? 

Does CBD Interact With Hydromorphone (Dilaudid)?

Yes. CBD can interact with hydromorphone.

This interaction is considered mild to moderate. Side effects are generally mild in nature and don’t appear to pose any significant threat when used within the safe dosage recommendations. 

There are two main ways CBD and Dilaudid may interact if used at the same time:  

A) Slowed Elimination (Metabolic Inhibition)

The cytochrome 450 enzymes metabolize most of the drugs in the body. Metabolic inhibition occurs when two drugs require the same enzymes to get metabolized. Hence, they end up competing against each other for the said enzymes. This action could result in slowing down the metabolism of one or both drugs. 

Hydromorphone is metabolized by the CYP2D6 enzyme. This enzyme is also used to metabolize CBD. 

This competitive action may result in a rise in the plasma levels of hydromorphone. This effect is unlikely to lead to side effects from single doses. However, consistent daily doses of both can lead to a gradual accumulation of Dilaudid concentrations in the blood. Eventually, this dose may become high enough to produce side effects or even lead to overdose. 

Overdose on Dilaudid is extremely dangerous and can be fatal. 

B) Increased Effect (Agonistic Interaction)

An agonistic interaction happens when two or more items exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce effects in the same direction when consumed together.

Both Dilaudid and CBD exert a depressant effect on the central nervous system. This means both substances taken together could have an excessive suppressant action on the nervous system — leading to side effects ranging from sedation and dizziness to memory loss or inebriation. 

Similar Medications: CBD & Opioid Painkillers

Hydromorphone is classified as an opioid. CBD and opioids all share similar risks for interaction and side effects.

Always speak to your doctor before taking CBD alongside your opiate medications. 

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

  • Buprenorphine (Cizdol & Brixadi)
  • Codeine
  • Fentanyl (Abstral & Actiq)
  • Pethidine (Meperidine & Demerol)
  • Hydrocodone (Hysingla ER, Zohydro ER & Hycodan)
  • Methadone (Methadose & Dolophine)
  • Morphine (Kadian & Roxanol)
  • Oxycodone (Percodan, Endodan, Roxiprin, Percocet, Endocet, & OxyContin)
  • Tramadol (Ultram, Ryzolt & ConZip)
Green hemp, ganja leaf on white isolated background. Cannabis leaves, marijuana. Top view, photo wallpaper close up

Is It Safe to Take CBD & Hydromorphone (Dilaudid) Together?

If used in the safe recommended dosages and under the guidance of your primary care physician, CBD and hydromorphone are generally recognized as safe when taken together.

To further reduce the risk of side effects, many doctors recommend separating the dose of both substances by a window of about two hours. 

It’s also a good idea to take each substance on its own before mixing them together. Everybody responds differently to CBD and hydromorphone — so it’s a good idea to get a baseline of how each compound affects your body individually before combining them together. 

Is CBD A Viable Alternative to Hydromorphone (Dilaudid)?

CBD may offer a viable alternative to hydromorphone for managing mild to moderate pain. For severe pain or certain medical conditions, hydromorphone may still be the best option. 

Many people opt to try natural supplements like CBD first before moving on to stronger prescription medications. 

CBD hemp extract is effective in decreasing pain in patients with chronic pain. It can also improve the quality of life in these patients [1]. It may be effective as an alternative to the possible addiction-forming pain relievers like opioid analgesics. 

A study showed that while delta 9 tetrahydrocannabinol (THC), another cannabinoid from the cannabis plant, was effective in decreasing cough, CBD itself does not show such effects [3]. CBD is not an effective alternative to hydromorphone for managing cough.

What is Hydromorphone (Dilaudid)?

Hydromorphone is an opioid analgesic sold under the brand name Dilaudid. It’s used in the management of acute moderate to severe pain. The chemical structure classifies hydromorphone as a semi-synthetic hydrogenated ketone derivative of morphine. 

This medication is highly addictive, so it’s usually used when all other pain management has failed.

Hydromorphone (Dilaudid) Specs:

Drug Name Hydromorphone
Trade NamesDilaudid, Exalgo, Hydromorph Contin, Hydromorphone Hp Forte, Palladone, Vicoprofen
Classification Opioid analgesic
CYP Metabolism CYP2D6 
Interaction With CBD Metabolic inhibitor, Agonistic
Risk of Interaction Mild

What Does Hydromorphone (Dilaudid) Do?

Opioids like hydromorphone work by binding to specific opioid receptors in the nervous system. 

There are three main classes of opioid receptors called μ, κ, δ (mu, kappa, and delta). 

The abilities of an opioid depend on the receptor that it binds to. Each group of opioid receptors brings about a particular set of neurological responses. These receptors mediate both the psychoactive and the somatic effects of opioids. 

Hydromorphone can bind to different types of opioid receptors. Its analgesic effect relies specifically on its ability to activate the mu-opioid receptors. 

Dilaudid has also been noted to also have a minor affinity for the delta and kappa receptors. Here, it acts on the medulla, which allows it to depress the respiratory drive and suppress cough. 

Hydromorphone is suitable for pain relief in patients that do not tolerate the side effects of morphine or that suffer from renal failure or asthma. It’s 5-7 times more potent than morphine, with a shorter duration of effects.

When the opioids attach to their respective receptors, they block the pain signals sent from various parts of the body through the spinal cord to the brain. They also trigger the brain to release dopamine, the hormone responsible for the feeling of pleasure. It means every time you take hydromorphone, it can cause some sedation and give relief from the pain combined with the sense of wellbeing and happiness. This can cause this drug to become addictive. 

Side Effects of Hydromorphone (Dilaudid)

Hydromorphone is highly addictive and can lead to overdose with relative ease. Overdoses of this compound are often fatal without receiving immediate medical attention.

The overdose with hydromorphone is characterized by respiratory depression, increased sleepiness, muscle flaccidity, cold and clammy skin, constricted pupils, bradycardia, hypotension, apnea, circulatory collapse, and cardiac arrest. 

Addiction is also common with this medication. Most physicians try to avoid prescribing this medication for more than a couple of weeks. Dependence to this drug can form quickly, leading to addiction and withdrawal symptoms in a relatively short period of time. 

The potential side effects of hydromorphone (Dilaudid) include:

  • Constipation 
  • Decreased appetite 
  • Difficulty breathing
  • Dizziness 
  • Dry mouth 
  • Euphoria
  • Fatigue
  • Headaches
  • Low blood pressure
  • Muscle spasms 
  • Nausea 
  • Nervousness
  • Peripheral edema 
  • Pruritus 
  • Respiratory depression
  • Restlessness
  • Shock
  • Sleepiness
  • Syncope
  • Tinnitus 
  • Tremor 
  • Upper respiratory tract infection 
  • Urinary tract infection
  • Vomiting

Other Names For Hydromorphone (Dilaudid)

Hydromorphone is sold under many different names. All share the same risk and potential interactions.

Other names for hydromorphone include:

  • Dilaudid
  • Exalgo
  • Hydromorph Contin
  • Hydromorphone Hp Forte
  • Palladone
  • Vicoprofen

Key Takeaways: Is it Safe to Take Hydromorphone (Dilaudid) With CBD?

CBD can slow down the metabolism of hydromorphone in the body, causing it to last longer and increasing the potential for side effects. 

For this reason, it’s important to speak with your prescribing physician before you combine CBD (or any cannabinoids) with Dilaudid. 

In general, the risk of side effects with this combination is considered mild and uncommon when used within the safe recommended dosages for both substances. 


References

  1. Capano, A., Weaver, R., & Burkman, E. (2020). Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgraduate medicine, 132(1), 56-61. 
  2. Atalay, S., Jarocka-Karpowicz, I., & Skrzydlewska, E. (2020). Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants, 9(1), 21. 
  3. Gordon, R., Gordon, R. J., & Sofia, R. D. (1976). Antitussive activity of some naturally occurring cannabinoids in anesthetized cats. European journal of pharmacology, 35(2), 309-313. 

Learn More About CBD-Drug Interactions

Learn More About CBD-Drug Interactions

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