Drug Interactions, Kratom Guides

Why Mixing Kratom & Hydromorphone Is Dangerous

Hydromorphone is a potent opioid and a potentially harmful medication. Kratom, on the other hand, is relatively safe when used responsibly.

This might mistakenly lead some to believe that combining kratom and hydromorphone is relatively safe — it’s not!

The statistics are clear: combining kratom and opioids can result in fatalities and serious health events.

Medically reviewed by Dr. Devin Carlson

Last updated 5 months ago by Wade Paul

Why Mixing Kratom & Hydromorphone Is Dangerous

Does Kratom Interact With Hydromorphone?

Yes — mixing kratom and opioids like hydromorphone will increase your risk of an overdose as well as other adverse effects.

Kratom and hydromorphone are both central nervous stimulants that act on opioid receptors. In this way, they work towards the same effects and have similar mechanisms of action.

These agonistic relationships usually tend to increase the incidence of harmful events due to a drug buildup. Kratom rarely causes death, but most deaths that involve kratom also involve opioids.

Hydromorphone is not processed by the CYP450 enzymes like other opioid analgesics [1].

This means that kratom and hydromorphone have separate metabolic pathways and are not competitors in this sense.

Hydromorphone Specs

Drug NameHydromorphone
Trade NameDilaudid, Exalgo, Palladone, Hydromoprh
ClassificationOpioid analgesic
CYP MetabolismHydromorphone is not metabolized by the CYP system. It is metabolized by glucuronidation in the liver.
Interaction With KratomNo metabolic interaction
Risk of InteractionHigh

Is it Safe to Take Kratom With Hydromorphone?

No  — this interaction carries significant risk.

Hydromorphone is a hazardous compound and should not be combined with other drugs unless under strict doctor supervision.

Kratom is relatively safe — deaths involving kratom are almost always linked to other, more dangerous compounds such as heroin [2].

 So, as safe as kratom is, combining it with a powerful opioid such as hydromorphone is an unsafe and dangerous choice.

What is Hydromorphone?

Hydromorphone, sold under the brand name Dilaudid, is a prescription opioid analgesic.

Hydromorphone is a potent medication. According to the DEA, it is 2-8x more powerful than regular morphine.

The precise mechanism of action for hydromorphone is not known, but it works by activating opioid receptors in the brain and spinal cord.

Hydromorphone is a Schedule II substance, meaning it has recognized medical uses but also carries a high potential for abuse and dependence.

Hydromorphone may be administered through the mouth or by injection. Its effects usually take an hour to begin and last up to five hours.

Hydromorphone is on the World Health Organization’s List of Essential Medicines and is available as a generic medication.

What is Hydromorphone Used for?

Hydromorphone is prescribed to treat severe pain, usually the kind that has not responded well to alternative treatments.

Since it is such a powerful compound with a substantial risk of adverse effects, you shouldn’t use hydromorphone except in severe cases like cancer.

Although there are differences, hydromorphone possesses a similar profile to other opioid analgesics such as morphine and oxycodone.

Hydromorphone is usually given to patients that respond negatively to morphine [3].

Hydromorphone is more potent than other opioid analgesics, but studies attempting to distinguish the traits of these drugs have not found conclusive results [4].

What’s the Dose of Hydromorphone?

Hydromorphone is a dangerous medication. You should only be taking it if you have a legitimate doctor’s prescription.

Only take hydromorphone according to your prescription. Generalized dosage recommendations on the internet can never consider all the necessary factors.

Additionally, drugs such as hydromorphone are usually carefully titrated, slowly exposing the drug to the body to limit the potential of side effects. A licensed physician best handles titration.

Also, certain conditions like renal impairments can affect the proper dosage of hydromorphone.

In conclusion, only take hydromorphone as instructed by a doctor. Otherwise, you run a significant risk.

Generic & Brand Name Versions

The brand name versions of hydromorphone are:

  • Dilaudid
  • Dilaudid-5
  • Exalgo
  • Palladone
  • Contin

What Are the Side Effects of Hydromorphone

Hydromorphone has comparable side effects to other opioid analgesics.

The use of hydromorphone carries the risk of the following adverse effects:

  • Withdrawal symptoms
  • Respiratory depression
  • Adrenal Insufficiency
  • Severe hypotension
  • Hormone imbalance
  • Depression

The concomitant use of hydromorphone with benzodiazepines or other CNS depressants carries an even greater risk of a serious event.

Hydromorphone use during pregnancy is heavily discouraged.

Less severe side effects include:

  • Headaches
  • Dry mouth
  • Drowsiness/lightheadedness
  • Anxiety
  • Sweating
  • Stomach pain

What is Kratom?

Kratom is made out of the leaves of the Mitragyna speciosa tree — a species of an evergreen tree native to Southeast Asia.

Southeast Asian farmers and indigenous peoples have known about kratom for a while, but it’s just starting to become known in the west.

Kratom has a vast suite of psychoactive properties, and despite the lack of controlled studies, it has many beneficial properties.

Kratom is used in many different ways: you can try a relaxing cup of kratom tea, or if you don’t enjoy the taste, go for the crushed powder pills.

What is Kratom Used for?

We’re only now beginning to study kratom, but what we do know shows promise. Kratom has many uses, but we’ll focus on the main ones.

Low doses are capable of increasing mental energy and display mood-enhancing properties.

At medium to high doses, the effects begin to change, and it has analgesic and anxiolytic benefits.

Furthermore, kratom has been used successfully as a weight-loss supplement

With further research, we can surely expect more uses to be discovered.

What’s the Dose of Kratom?

In general, dose recommendations are not reliable — there are too many factors to consider.  Use the following as a starting point, but remember that things like your weight, the effects you want, and whether you’ve eaten or not will greatly affect how much you need.

There are several factors that these recommendations do not take into account. The most important thing to keep in mind is to go slow and listen to your body, especially if you’re a newcomer to kratom.

The general kratom dosage recommendations are:

  • Low dose (1-5 g)
  • Medium dose (5-10 g)
  • High dose (10-15 g)

Related: How Long Should I Wait Between Kratom Doses?

What Are the Side Effects of Kratom?

Kratom is pretty forgiving. If you accidentally take too much, you’ll probably end up nauseous and dizzy, but that’s about it. Kratom has a few side effects to be aware of, but they’re minor.

Kratom’s common side effects are:

  • Constipation
  • Dizziness
  • Insomnia
  • Nausea

More severe side effects include:

  • Itchiness in the skin
  • Loss of muscle coordination
  • Low blood pressure
  • Low libido
  • Nausea
  • Poor appetite
  • Seizures
  • Tremors

If you’re experiencing too many side effects due to kratom, you most likely need to cut back the amount you’re ingesting.

Remember: kratom has the potential to cause symptoms of mental and physical dependence.

What Are the Different Types of Kratom?

Good news for all who like to tweak their consumption to find the perfect experience: kratom is available in various strains and offers unique effects.

These strains contain the same basic properties, but they each emphasize certain effects to differing extents.

Make sure to try out different strains in order to find the one that works best for you. Just remember that even though they are all named after a specific color, they’ll look the same once processed.

A) White Vein Kratom

White vein kratom offers mind-based, nootropic benefits, such as increased attention span, creativity, a general improvement in mental energy, and euphoria.

If qualities sound like what you’re looking for, then you should try a white-veined strain.

B) Red Vein Kratom

As opposed to white vein kratom, the red-veined kratom strains are analgesic and anxiolytic, making them quite popular with those who suffer from anxiety and chronic pain.

C) Green Vein Kratom

Green vein kratom is a jack of all trades. It has an outstanding balance between the alkaloid profiles of white and red-veined strains.

If you’re new to kratom and want to try a strain that emphasizes all of the kratom’s benefits, green is the choice for you.

Just remember that you are forgoing the more targeted experience of a white or a red.

D) Yellow Vein Kratom

Yellow vein kratom is similar to green-veined strains.

The major difference is that yellow-veined strains are milder, making them perfect for beginners or those who have a sensibility to kratom.

Key Takeaways: Is it Safe to Mix Kratom & Hydromorphone?

No, there are many risks when combining kratom and hydromorphone.

Kratom has shown promise in treating opioid withdrawal symptoms and could help someone wean off hydromorphone.

If this is a strategy you’re looking to implement, contact your doctor for guidance.

Besides that, the combination of hydromorphone and kratom is best avoided. 


  1. Gregory, T. B. (2013). Hydromorphone: evolving to meet the challenges of today’s health care environment. Clinical therapeutics, 35(12), 2007-2027.
  2. Corkery, J. M., Streete, P., Claridge, H., Goodair, C., Papanti, D., Orsolini, L., … & Hendricks, A. (2019). Characteristics of deaths associated with kratom use. Journal of psychopharmacology, 33(9), 1102-1123.
  3. Quigley, C. (2002). Hydromorphone for acute and chronic pain. Cochrane Database of Systematic Reviews, (1).
  4. Bao, Y. J., Hou, W., Kong, X. Y., Yang, L., Xia, J., Hua, B. J., & Knaggs, R. (2016). Hydromorphone for cancer pain. Cochrane Database of Systematic Reviews, (10).