Exalgo: Uses, Dosage & Side Effects

Exalgo was the brand name for a prescription opioid medication. Although the brand name Exalgo has been discontinued, the drug is still available as its generic, hydromorphone hydrochloride extended-release tablets. Exalgo is prescribed to manage pain in people who are opioid-tolerant and who require daily, around-the-clock, long-term treatment.

What Is Exalgo?

Exalgo was a brand name for a prescription opioid medication. Although the brand name Exalgo has been discontinued, the drug is still available as its generic, hydromorphone hydrochloride extended-release tablets. Exalgo is prescribed to manage pain in opioid-tolerant people who require daily, around-the-clock, long-term treatment. Exalgo is reserved for people who don’t respond to other treatment options. Opioid tolerance means someone is receiving a minimum of 60 mg of oral morphine per day, 25 mcg of transdermal fentanyl per hour or 25 mg of oral oxymorphone per day for at least a week or longer. In 2012, the FDA approved a very high 32 mg dose. The drug is extended-release and used to treat moderate-to-severe chronic pain. Before the FDA approved the 32 mg dose of Exalgo, there were already 8 mg, 12 mg and 16 mg tablets available. Exalgo is a unique opioid pain reliever because it’s a drug delivery system that offers controlled release. It’s also difficult to misuse Exalgo by crushing, chewing or dissolving it.

Certain warnings come with Exalgo use. For example, it shouldn’t be used by anyone not previously taking another opioid pain medicine. Those with asthma, breathing problems or bowel blockages shouldn’t use Exalgo. Exalgo is a controlled substance, like other opioid pain medicines. Since Exalgo is available in such high dosages as a controlled-release drug, there is a significant risk of fatal respiratory depression associated with its use.

What Does Exalgo Look Like?

Exalgo and its generic are sold as tablets. For the brand-name Exalgo, the 8 mg dosage was round, red and printed with EXH 8. A 12 mg dosage of Exalgo was yellow, round and printed with 12 mg. The 16 mg dosage of Exalgo was also round and yellow and printed with EXH 16. Finally, the 32 mg dosage of Exalgo was round, white and printed with EXH 32. 

In contrast, the generic form of the drug can look different depending on the manufacturer.

It’s important to keep this drug out of the reach of young people or anyone who could be at risk for using it without a prescription because it can cause deadly respiratory depression in people who aren’t tolerant of opioids.

How Is Exalgo Used?

The generic for Exalgo is prescribed for chronic pain. The pain should be severe enough to require an opioid and round-the-clock treatment. Because of its potency, the drug should only be used in those who already take opioids and are tolerant to them. Although any doctor can prescribe Exalgo, the package labeling recommends that only doctors who are experts in pain management should prescribe the drug.

How Exalgo Works

Like other opioids, Exalgo works by activating the mu opioid receptors in the central nervous system. This blocks your perception of pain, leading to an analgesic effect. As a Schedule II controlled substance, Exalgo can also impact the brain’s reward system, increasing the risk of abuse, addiction and dependence.

Drug Interactions With Exalgo

Exalgo’s drug interactions are similar to those of other opioids and include:

• Benzodiazepines and other central nervous system depressants, like muscle relaxants, due to the risk of worsening Exalgo’s side effects and increasing overdose risk
• Antidepressants and other drugs that increase serotonin, like MAOIs, due to the risk of serotonin syndrome
• Other opioids can intensify Exalgo’s side effects or, in some cases, interfere with the drug’s activity
• Diuretics, which may not work as well if you take Exalgo
• Anticholinergic drugs, due to the risk of retained urine and intestinal blockage

Pharmacology of Exalgo

Exalgo is a long-acting drug that gradually increases hydromorphone in your body. After a single dose, your blood levels of Exalgo will increase over the next six to eight hours, and these levels will be maintained for about 18–24 hours. After about three to four days of once-daily dosing, the drug reaches an equilibrium in your body where the blood levels should remain relatively constant if you take it regularly.

Exalgo Dosage and Administration

Exalgo and its generic come in multiple available doses, including:

• 8 mg 
• 12 mg
• 16 mg
• 32 mg

The drug should be taken no more than once daily. The dose may be increased by 4–8 mg every three to four days if needed to control pain.

Exalgo tablets should be swallowed intact and not crushed, chewed or broken to reduce the risk of an accidental overdose. Those with kidney or liver problems will likely start with a lower dose of the medication.

Exalgo Side Effects

Exalgo’s side effects are similar to other opioids. Although not all side effects will happen in all people who take the drug, adverse effects include:

• Constipation
• Nausea and vomiting
• Sleepiness
• Headache
• Itchy skin
• Dizziness
• Insomnia
• Dry mouth
• Swelling
• Excessive sweating
• Decreased appetite
• Joint pain
• Abdominal pain
• Muscle spasms
• Weight loss

As an opioid, Exalgo also carries a risk of abuse, addiction, dependence and overdose. As a result, it is vital to take the drug only as prescribed by your doctor.

Precautions for Exalgo Use

Most people can take Exalgo without a problem as long as they do so according to a doctor’s orders. However, others need to be more careful with their Exalgo use or may need to avoid the drug entirely. It is important to be aware of these considerations before taking the drug.

When Not To Use Exalgo

Some people should avoid Exalgo entirely and instead be started on a different pain management regimen. This includes those who:

• Are new to opioids
• Have slowed breathing
• Have uncontrolled asthma or an asthma attack
• Have an intestinal obstruction or a narrowed gastrointestinal tract
• Are allergic to hydromorphone or any other of the drug’s ingredients

Considerations Prior To Use

Doctors must carefully consider the risks and benefits of Exalgo in certain people. Although doctors may still choose to use Exalgo in people with certain medical histories, they will usually need even closer monitoring than others who take the drug. This includes those with a history of:

• Chronic lung disease
• Being elderly, frail or debilitated
• Adrenal insufficiency
• Severely low blood pressure
• Increased intracranial pressure
• Brain tumors
• Head Injury
• Impaired consciousness or coma

Exalgo Addiction

As a Schedule II controlled substance, Exalgo and its generic equivalent carry the risk of abuse, addiction and dependence. If you or a loved one have been prescribed Exalgo, it is important to be aware of the drug’s addictive potential. Monitoring for signs and symptoms of addiction is crucial to keep yourself and your loved ones safe while taking the drug.

Is Exalgo Addictive?

Since Exalgo is an opioid or narcotic drug with the generic name hydromorphone, it is addictive. There is always the risk of misuse, addiction and dependence with any opioid medication. Certain safeguards are built into Exalgo to help reduce the risk of misuse, such as the fact that it’s difficult to crush or dissolve. However, if it is misused, it is addictive. Opioids like hydromorphone are addictive because of their effect on the brain’s reward and pleasure centers. Opioids trigger dopamine to rush into the patient’s brain, creating a high. This is the case with not only prescription pain relievers but also heroin. Over time, the brain adjusts to the presence of opioids, and dependence forms. Before a doctor prescribes Exalgo or any opioid pain medication to a patient, they should go through their medical history. They should especially focus on whether or not the patient has a history of substance misuse or addiction, personally or in their family. When prescribing Exalgo, physicians are instructed to regularly assess the patient’s history and monitor them for signs of misuse or addiction.

Exalgo Overdose

Exceeding the recommended dosage of Exalgo can lead to an overdose due to its high potency. Several scenarios may increase the risk of an Exalgo overdose, including:

• Taking Exalgo more frequently than prescribed
• Consuming a higher dose of Exalgo than prescribed
• Using Exalgo without having developed a tolerance to opioids
• Chewing Exalgo instead of taking it as directed
• Crushing Exalgo tablets for snorting purposes
• Dissolving Exalgo to inject it
• Combining Exalgo with other opioid medications or heroin
• Concurrent use of Exalgo with benzodiazepines or other prescription central nervous system depressants
• Mixing Exalgo with alcohol, which also acts as a central nervous system depressant

It is crucial to strictly follow the prescribed dosage and usage instructions to minimize the risk of an Exalgo overdose. Any concerns or questions regarding the medication should be discussed with a healthcare professional.

Exalgo Withdrawal and Detox

If someone is dependent on Exalgo, they will likely experience withdrawal symptoms if they stop using it. Opioid withdrawal is not typically life-threatening, but it can be very mentally and physically uncomfortable. This can increase the chances of the person using Exalgo again. The following are some of the symptoms of Exalgo withdrawal:

• Muscle aches and pains
• Cravings for Exalgo
• Cramps
• Difficulty sleeping
• Cold sweats
• Diarrhea
• Nausea and vomiting
• Restlessness and irritability
• Shaking and tremors
• Feelings of depression or anxiety
• Suicidal thoughts or behaviors
• Low blood pressure
• Panic attacks
• Loss of pleasure in daily activities
• Runny nose
• Teary eyes

If you or someone you know is experiencing Exalgo withdrawal symptoms, please seek professional help. Many resources are available to help people through withdrawal, and getting the support you need is important.

Exalgo Withdrawal Timeline

Exalgo is a long-acting, controlled-release version of hydromorphone. This means it takes longer for the drug to leave the body, and withdrawal symptoms may not appear for several days after the last dose.

Within the first 30 hours of withdrawal, people may experience symptoms such as:

• Nausea
• Restlessness
• Anxiety
• Drug cravings

These symptoms will peak within about a week but can continue longer. In some cases, people may experience ongoing withdrawal symptoms for weeks or even months after stopping Exalgo.

Ongoing withdrawal symptoms are usually psychological. These can include:

• Anxiety
• Depression
• Suicidal thoughts or behaviors
• Cognitive impairment, especially related to memory, focus, attention and problem-solving

Exalgo Detox

Detoxification is the process of removing Exalgo from the body. It can be a difficult and uncomfortable process, but it is important to remember you are not alone. There are many resources available to help you through this difficult time. There are two main ways to detox from Exalgo:

• Medical detox is a supervised detox process in a hospital or treatment center. Medical detox can help manage withdrawal symptoms, such as nausea, vomiting and anxiety.
• Outpatient detox is a less intensive detox process that takes place outside of a hospital or treatment center. Outpatient detox may involve receiving medications to help manage withdrawal symptoms, counseling and support from a medical professional.

The best way to detox from Exalgo depends on your needs and circumstances. If you are struggling with addiction, it is important to talk to your doctor about your best option.

Treatment for Exalgo Addiction

The treatment options for Exalgo addiction can range from medical detox to inpatient and outpatient rehab. There are also medications available for opioid addiction treatment. When medications are used with other forms of addiction treatment, this is known as medication-assisted treatment (MAT). 

The best treatment option for Exalgo addiction will vary depending on the individual’s needs and circumstances. If you are struggling with addiction, it is important to talk to your doctor about the best treatment option for you.

Inpatient Exalgo Rehab

Inpatient Exalgo rehab is a type of treatment that takes place in a residential facility. This type of rehab is more intensive than outpatient rehab and typically involves a longer stay. Inpatient rehab can benefit people struggling with addiction who need a high level of support and supervision.

The length of stay in an inpatient Exalgo rehab program can vary but typically lasts 30–90 days. The program may begin with a medical detox period, followed by cognitive behavioral therapy (CBT) or group therapy. Inpatient rehab can also include life skills training.

In addition to the treatment itself, inpatient rehab programs also offer many other services, such as:

• Support groups: Inpatient rehab programs often offer support groups for people struggling with addiction. These groups can provide a safe space for people to share their experiences and get support from others who understand what they are going through.
• Aftercare planning: Inpatient rehab programs also help people develop aftercare plans. This includes planning for what will happen after the person leaves the facility. This may include participating in an outpatient treatment program, living in a sober house or joining a 12-step program.

Outpatient Exalgo Rehab

Outpatient Exalgo rehab is a type of treatment that occurs outside a residential facility. This type of rehab is less intensive than inpatient rehab and typically involves shorter sessions. Outpatient rehab can benefit people struggling with addiction who can maintain their jobs, family and other commitments.

Outpatient Exalgo rehab typically includes sessions held each week. These sessions can be on an individual basis or in group therapy. The sessions may focus on topics such as:

• Addiction education: Outpatient rehab sessions may provide education about addiction and how to manage it.
• Counseling: Outpatient rehab sessions may include counseling to help people address the underlying issues that led to their addiction.
• Support groups: Outpatient rehab sessions may include support groups for people struggling with addiction. These groups can provide a safe space for people to share their experiences and to get support from others who understand what they are going through.

How Long Does Exalgo Stay In Your System?

The half-life of Exalgo is typically 11 hours, but this can vary depending on many factors. These factors include:

• Metabolism: People with faster metabolisms tend to excrete drugs more quickly, so Exalgo will stay in their system for a shorter period.
• Age: Older people may eliminate drugs from their system more slowly than younger people.
• Health conditions: Certain health conditions and chronic diseases can also affect how long Exalgo stays in the system. For example, people with liver impairment may eliminate the drug more slowly.
• Hydration: Well-hydrated individuals will often see faster drug elimination times. This is because water helps flush drugs from the body.
• Physical activity: Physical activity can also speed up how long a drug takes to leave a patient’s system. This is because physical activity helps increase blood flow, which can help to remove drugs from the body.

It is important to note that these are just general guidelines. The actual half-life of Exalgo in any individual may vary. If you are concerned about how long Exalgo will stay in your system, you should talk to your doctor.

Mixing Exalgo and Alcohol

Mixing alcohol and opioids is always dangerous and can lead to serious health problems, including overdose and death. Alcohol and Exalgo are central nervous system depressants, meaning they slow down the brain and nervous system activity. When these substances are mixed, the effects of each are amplified, which can lead to a range of serious side effects, including:

• Drowsiness
• Dizziness
• Lightheadedness
• Problems concentrating
• Impaired thinking and judgment
• Low blood pressure
• Trouble breathing
• Fainting
• Coma
• Death

Mixing alcohol and opioids can increase the risk of overdose. This is because both substances can depress breathing, and when they are combined, the respiratory depression can be so severe that it can lead to death. 

Get Help for Exalgo Addiction Today

Recovery is a real, viable option, but you must take the first step. Whether you are struggling with addiction or want to help a loved one, contact The Recovery Village today.

Common Questions About Exalgo

Can you take Exalgo while pregnant?

Your doctor will carefully weigh the risks and benefits of taking Exalgo during pregnancy. It is best to avoid Exalgo when possible due to the risk of neonatal opioid withdrawal syndrome. In addition, in studies of Exalgo used in pregnant animals, researchers noticed reduced survival of animal babies, developmental delays and abnormal behaviors.

Is Exalgo safe for children?

Exalgo has not been studied in children under the age of 17. As such, it is best to avoid Exalgo in children.

Can you drive or operate machinery after taking Exalgo?

Because Exalgo is a central nervous system depressant, you should avoid driving or operating heavy machinery until you know how you respond to the drug. While some people may tolerate Exalgo without a problem, others may have side effects that make driving or using machinery dangerous.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more