Anyone Else Tried Exalgo (hydromorphone ER)?

Eva 33

I want to THANK everyone who helped me with advice re: my problems with Avinza (oral morphine). I am a pain management patient. I’ve been taking Avinza 270 mg. for over 2 years, but I was having lots of trouble with one side effect of Avinza: profuse sweating. The sweating was VERY annoying and embarrassing. I also felt like the Avinza wasn’t helping my pain as much as it should. (My pain is really severe).

At my previous pain doctor’s appointment, I FINALLY asked my pain doc for a different long-acting med. I have no idea WHY I didn’t ask for a different med earlier; I think I thought that ALL long-acting opioids would cause sweating. Thank goodness for this forum and for all of the helpful people on here!

My pain doc prescribed Exalgo, the new long-acting form of Dilaudid. (I also take short-acting Dilaudid for breakthrough pain). At first my health insurance denied the Exalgo, and I was really disappointed about that. But my pain doc filled out the “prior authorization” form and submitted it to my insurance, and now my insurance has approved Exalgo! I couldn’t be happier.

The knowlegable people on this forum were correct about the difference in side effects from morphine (Avinza) vs. Dilaudid (Exalgo). The Avinza had me sweating like I’d just run a marathon, but I have NO sweating from the Exalgo. I’m amazed at the lack of negative side effects from Exalgo.

The Exalgo also helps my PAIN MUCH MORE than the Avinza. Both I and my pain doc hypothesized that I may be becoming tolerant to Avinza. I had no idea just how tolerant I was! The Exalgo works MUCH better on my pain.

The pharmacy just filled my Exalgo script today, so when I woke up this morning I still had to take my Avinza (I took 180 mg.). My pain doc gave me #120 Exalgo, 8 mg. per pill.

For the next month, I can take 1 or 2 Exalgo tablets per day. My pain doc plans to slowly titrate me UP on the Exalgo, while simulataneously slowly titrating me DOWN on the Avinza. (I had thought that I could just immediately substitute one opiate med for the other, but my pain doc warned me that I could experience withdrawal symtoms if I switch too suddenly). I can’t wait to get completely OFF of the Avinza and ON to the Exalgo. Apparently switching from one long-acting opiate to another can be a rather complex process.

I just wanted to post that I’m really happy with my med switch. As people on here told me, Dilaudid has far fewer side effects than morphine. I understand that both meds have poor oral bioavailability, but I guess the fact that Dilaudid is a synthetic is what makes it better?

NO sweating and vastly improved pain relief—I couldn’t have asked for anything better! Exalgo is way better than I expected it to be. I should have switched long-acting meds LONG AGO.

Even though I take short-acting Dilaudid for breakthrough pain several times a day, I’m actually feeling a little bit spacy or “high” from the 8 mg. Exalgo pill. Nothing weird or unpleasant, though. Just MUCH BETTER PAIN RELIEF! My nose itches a tiny bit, which I know is a common side effect of opiate use. (Interestingly, neither Avinza nor ANY of the short-acting opiates ever caused me to feel “itchy”.) Oh, well. I’d MUCH rather feel a bit “itchy” than be SWEATING all the time!

Thanks again to everyone who advised me about the different opiates and their side effect profiles. My pain doc knew what he was doing by prescribing Exalgo. Can anyone help me with a conversion from 270 mg. Avinza to whatever mg. of Exalgo? I have no idea what dose of Exalgo I’ll need and my pain doc says that the conversion tables aren’t always accurate. But I wonder if anyone could give me a rough estimate? Thanks.

Has anyone else here tried Exalgo? What were your experiences like? What dose did you take?


Yeah, hydromorphone (Exalgo) is often better, more consistant and has less side effects than oral morphine. It’s hard to come up with an accurate dose conversion, as your Dr said, it’s complex and the conversion tables are not accurate, they are just the median from the range of a sample population that was studied, (often just with single-dose use). It depends a lot on the individual (your unique metabolism/brain/body), on how long you’ve been taking the previous opioid, etc. All you can really do is go with your Dr’s plan to slowly titrate you up on the Exalgo, while simulataneously slowly tapering you down on the Avinza, and then increase (or lower) the Exalgo dose if necessary. If you want a very rough average you could just go with the conversion tables, one lists 270mg ER oral morphine as equivalent to ~50mg ER hydromorphone, for example. But everyone is very different. Sounds like you have a good doctor 🙂

The itchiness may improve with time.