What Does Hydromorphone Look Like? | Identifying Dilaudid

Manish Mishra, MBBS

Medically Reviewed By: Manish Mishra, MBBS

on March 12, 2023
Fikret Terzic

Written by: Fikret Terzic MD, MS

Brand name Dilaudid pills are available in 2, 4, and 8 mg strengths. The 2 mg pills are white, circular, and imprinted with an “a” or “k” on one side and a “2” on the other. The 4 mg pills are yellow, curricular, and imprinted with an “a” and “4,” while the 8 mg pills are white, triangular, and imprinted with an “aa” and “8.”

Dilaudid is a strong brand name medication prescribed to treat severe pain. It is made with hydromorphone hydrochloride, a semi-synthetic opioid agonist and Schedule II controlled-substance. 

Exalgo is another brand name hydromorphone product with an extended-release design intended as a pain reliever for managing serious chronic pain.

Generic formulations of hydromorphone pain medications are also available.

What Does Dilaudid Look Like?

Dilaudid is an immediate-release drug used to provide fast-acting pain relief over a limited amount of time. In tablet form, brand name Dilaudid comes in white or yellow:

  • Dilaudid orange pills: 2 mg tablets, shaped as a flat-faced beveled circle, marked with an “a” or “k” on one face and a “2” on the other
Dilaudid 2 mg
  • Dilaudid yellow pills: 4 mg tablets, also circular, marked with an “a” on one face and a “4” on the other
Dilaudid 4 mg
  • Dilaudid white pills: 8 mg tablets, shaped as a bisected rounded triangle, marked with an “aa” on one side and an “8” on the other
Dilaudid 8 mg

Variations of liquid Dilaudid include:

  • Dilaudid oral liquid, produced in a brown bottle
  • prefilled injection syringes
  • glass vials for injection
Liquid Dilaudid

What Does Exalgo Look Like?

Exalgo extended-release tablets contain higher doses of hydromorphone than Dilaudid but feature a time-delay formulation, allowing a single dose to control pain for a much longer period of time.

Exalgo tablets are circular and come in the following forms:

  • Exalgo red pills: 8 mg tablets marked with “EXH 8” on one side
Exalgo 8 mg
  • Exalgo dark yellow pills: 12 mg tablets marked with “EXH 12” on one side
Exalgo 12 mg
  • Exalgo yellow pills: 16 mg tablets marked with “EXH 16” on one side
Exalgo 16 mg
  • Exalgo white pills: 32 mg tablets marked with “EXH 32” on one side
Exalgo 32mg

What Does Generic Hydromorphone Look Like?

Generic hydromorphone tablets and pills vary widely in shape, color, and markings, including:

  • white, round, marked “2” and “M” (2 mg)
  • white, round, bisected, marked “2” and “54 743” (2 mg)
  • white, round, marked “4” and “M” (4 mg)
  • white, round, marked “4” and “54 196” (4 mg)
  • white, round, marked “4” and “54 609,” bisected (4 mg)
  • white, round, marked “54 425,” bisected (8 mg)
  • white, round, marked “8” and “E” (8 mg)
  • white, round, marked “54 403,” bisected (8 mg)
  • white, triangular, marked “P,” inverted “P,” and “8,” bisected (8 mg)
  • orange, round, marked “2” and “P” (2 mg)
  • blue, round, marked “2” and “E” (2 mg)
  • beige, round, marked “4” and “E” (4 mg)
  • yellow, round, marked “WPI 3739” (12 mg)
  • yellow, round, marked “WPI 3630” (16 mg)
  • brown, round, marked “WPI 3629” (8 mg)

Can You Identify Fake Dilaudid?

Common signs that a drug is counterfeit include: 

  • variations in color, size, shape, or texture
  • errors in the font or lettering
  • unusual packaging
  • strange taste
Fake Hydromorphone

Only use pain medication prescribed by a licensed healthcare professional and dispensed at a legitimate pharmacy.

Any Dilaudid purchased on the street, from sketchy online pharmacies or dark web sites, or handed off from an acquaintance could be dangerous fakes made with fentanyl or other unknown ingredients. 

The only way to identify fake Dilaudid is by using a fentanyl test kit or another drug test kit to identify the substances in the illicit product.

Side Effects Of Dilaudid

Typical side effects associated with use of hydromorphone may include:

  • nausea
  • vomiting
  • constipation
  • lightheadedness
  • dizziness
  • drowsiness
  • sweating
  • flushing
  • dry mouth

Seek medical advice or emergency medical help if other severe side effects and adverse reactions, including allergic reactions, occur.

Dilaudid Overdose

If Dilaudid is taken without a prescription, or if you take more of the medication than directed, it may lead to a hydromorphone overdose. And, mixing hydromorphone with alcohol, benzodiazepines, or other opiates like codeine, hydrocodone, or oxycodone also increases your risk of overdose.

As a strong central nervous system (CNS) depressant, Dilaudid can generate opioid overdose signs and symptoms such as:

  • severe drowsiness/sedation
  • impaired motor control
  • mental confusion
  • pinpoint pupils
  • cold, clammy skin
  • blue-colored lips and fingernails nails
  • gurgling or gasping
  • breathing problems, including stopped, slow, or shallow breathing
  • slow heart rate
  • low blood pressure
  • becoming unresponsive or losing consciousness

Dilaudid overdoses and the respiratory depression they cause are dangerous, life-threatening medical emergencies. If you suspect an overdose has occurred, contact 911 and provide first-aid until help arrives, including the use of the opioid antidote naloxone (Narcan) if it is available.

Treating Dilaudid Abuse & Addiction

At Ohio Recovery Center our healthcare providers offer treatment for drug abuse, physical dependence, and addiction to all opioid analgesics, including:

To learn more, please contact us today.

  1. Drug Enforcement Administration — One Pill Can Kill https://www.dea.gov/onepill
  2. Food And Drug Administration (FDA) — DILAUDID® ORAL SOLUTION and DILAUDID® TABLETS HIGHLIGHTS OF PRESCRIBING INFORMATION https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019891s024,019892s029lbl.pdf
  3. National Library of Medicine: MedlinePlus — Hydromorphone https://medlineplus.gov/druginfo/meds/a682013.html#:~:text=Hydromorphone%20is%20used%20to%20relieve,be%20treated%20with%20other%20medications.
  4. University of Michigan Medicine — hydromorphone (oral) https://www.uofmhealth.org/health-library/d00255a1

Written by Ohio Recovery Center Editorial Team

© 2024 Ohio Recovery Center | All Rights Reserved

* This page does not provide medical advice.

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