What is Fentanyl?
Fentanyl is a synthetic opioid known for its exceptional pain-relieving abilities, making it a common choice in surgical settings and for managing severe, chronic pain [1]. As a full synthetic opioid, it works by strongly activating µ-opioid receptors in the central nervous system, leading to effects such as euphoria, sedation, and anaesthesia. However, at higher doses, it can cause dangerous side effects like respiratory depression [2]. Remarkably potent, Fentanyl is up to 100 times stronger than other opioids like morphine, heroin, or oxycodone [3]
Uses of Fentanyl
Fentanyl is available in several forms to cater to different pain management needs. In surgical settings, it is used to manage severe pain during and after procedures, often combined with other medications to enhance anesthetic effects [4]. For long-lasting relief, Fentanyl patches are commonly prescribed for continuous, around-the-clock pain, especially in cancer patients.
Fentanyl is also available in fast-acting forms, such as nasal sprays, lollipops, injections, and sublingual tablets. These are typically used for breakthrough pain—sharp flare-ups that occur even while regular pain medications are being used for chronic or persistent pain [3].
Specifically for cancer patients, Fentanyl is used to manage breakthrough cancer pain, a sudden and intense flare of pain that occurs despite the ongoing use of pain relievers [5]. However, it is only prescribed to individuals who are already on narcotic pain medications.
What is Dilaudid?
Dilaudid, or hydromorphone, is an opioid used to manage moderate to severe pain. As a narcotic analgesic, it works by affecting the central nervous system to provide pain relief [6, 7, 8]. Available in multiple forms, Dilaudid can be taken as oral tablets, oral liquids, or injections. For patients who have developed a tolerance to opioids, extended-release capsules and tablets are often prescribed to offer continuous, round-the-clock pain relief [9, 10].
Uses of Dilaudid
Dilaudid is typically used in situations where other pain treatments have not been effective. It is intended for managing chronic or severe pain and is unsuitable for treating mild, temporary, or "as-needed" pain [9, 7, 8, 10].
Due to its potential for habit-forming and dependence, Dilaudid should be used with caution. While the risk of dependence exists, individuals with ongoing pain should not let this deter them from appropriate pain management. If the medication needs to be discontinued, it should be tapered gradually to avoid severe withdrawal symptoms [9, 7, 8, 10].
Fentanyl vs Dilaudid: Side effects
Fentanyl is known for its effectiveness in managing severe pain, but it can also bring along some common side effects. If you’re using a Fentanyl patch, you might notice skin irritation or redness at the application site. Other side effects can include nausea, vomiting, fatigue, dizziness, trouble sleeping, constipation, excessive sweating, feeling cold, headaches, diarrhoea, and even a reduced appetite [1].
Dilaudid, on the other hand, has its own list of potential side effects. Users might experience constipation, nausea, or vomiting, as well as feelings of dizziness and drowsiness. Some people report flushing (a sensation of warmth or redness), sweating, itching, dry mouth, or even mood changes [2].
While both medications are effective in managing pain, knowing their side effects can help you prepare and discuss any concerns with your healthcare provider.
Serious side effects
Fentanyl can cause serious side effects such as severe breathing problems, dangerously low blood pressure, physical addiction, dependence, withdrawal symptoms when stopping the drug, adrenal insufficiency, and androgen deficiency [11].
Dilaudid can lead to slow or stopped breathing, severe drowsiness, light-headedness, and low cortisol levels, which may result in nausea, vomiting, loss of appetite, dizziness, and increased fatigue or weakness [12].
Addiction
Both Fentanyl and Dilaudid carry a significant risk of addiction, especially with long-term use. Chronic use can lead to tolerance, where higher doses are needed to achieve the same effect, followed by dependence and, ultimately, addiction [13].
Signs of addiction may include restlessness, irritability, anxiety, trouble sleeping, and physical symptoms like increased blood pressure, rapid breathing, and a fast heart rate. Other indicators include dilated pupils, nausea, vomiting, loss of appetite, diarrhoea, stomach cramps, sweating, chills, muscle aches, and back pain [11].
Drug interactions
Fentanyl and Dilaudid, as we know, are both incredibly strong opioids often prescribed for pain relief, but mixing them—or using them alongside certain other medications—can be risky.
Fentanyl, for instance, can interact with drugs like diltiazem, which slows down its metabolism by affecting the cytochrome P450 3A4 enzymes. This can cause fentanyl to build up in the body, potentially leading to dangerous side effects like delirium [14].
Dilaudid also has a long list of medications it doesn’t play well with. Some, like Nalmefene, Naltrexone, Safinamide, and Samidorphan, are best avoided entirely when taking Dilaudid. Others, including Alfentanil, Alprazolam, Amitriptyline, Baclofen, Buprenorphine, and even Fentanyl, may require careful dose adjustments or timing changes to prevent complications [7, 8, 10].
While there’s no specific mention of how Fentanyl and Dilaudid directly interact with each other, using them together could increase the risk of severe side effects like slowed breathing, heavy sedation, or even an overdose. Always talk to your doctor before combining these medications or making changes to your treatment plan.
Choosing between fentanyl and Dilaudid
When deciding between fentanyl and Dilaudid, both of which are powerful opioids, several factors must be considered, including the patient's specific pain condition, how quickly relief is needed, potential side effects, and personal preference.
Fentanyl is often chosen for its rapid onset and effectiveness in managing severe pain. It comes in various forms, like transdermal patches, buccal tablets, and nasal sprays, offering flexibility in administering it. This makes it a popular choice depending on the patient's condition and preferred method of use.
In conclusion, the choice between fentanyl and Dilaudid should be made in consultation with a healthcare provider, taking into account the patient's specific circumstances, the nature of their pain, their overall health status, and their personal preferences.
Dosage and Administiring
Fentanyl offers multiple routes of administration, including intravenous (IV), intramuscular (IM), and transdermal. For preoperative pain relief, a single IV or IM dose of 50 to 100 mcg is typically given 30 to 60 minutes before surgery. As an adjunct to anesthesia, the dose can vary from 2 to 50 mcg/kg/dose IV. Post-operatively, Fentanyl may be administered as 50 to 100 mcg IV/IM every 1 to 2 hours as needed, or a continuous IV infusion at 0.5 to 1.5 mcg/kg/hour. For patient-controlled analgesia (PCA), a dose of 10 to 20 mcg IV every 6 to 20 minutes as needed can be used [15].
Fentanyl can also be administered through a patient-controlled transdermal system (PCTS). In one study, participants received fentanyl HCl PCTS at 40 micrograms, with the absorption of fentanyl increasing over time depending on the duration of use [16].
For Dilaudid (hydromorphone), the dosing and administration details vary, but specific dosing information was unavailable in the referenced articles. It's essential to refer to the prescribing guidelines or consult a healthcare provider for precise dosing recommendations.
Given that both fentanyl and Dilaudid are potent opioids with significant risks of addiction and overdose, they should only be used under the close supervision of a healthcare provider. Dosing must be tailored to the individual’s condition, age, and other personal factors to ensure safe and effective pain management.