Dangerous Drug: Hydromorphone Hydrochloride(hye droe mor’ fone)
Dilaudid, Dilaudid-HP, ExalgoDNC, Hydromorph Contin (CAN), Hydromorph HP 10, 20, 50 (CAN), Hydromorph HP Forte (CAN), PMS-Hydromorphone (CAN)
PREGNANCY CATEGORY C
PREGNANCY CATEGORY D
(LABOR AND DELIVERY)
CONTROLLED SUBSTANCE C-II
Drug class
Opioid agonist analgesic (phenanthrene)
Therapeutic Actions
Acts as agonist at specific mu-opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).
Indications
Relief of moderate to severe pain, acute and chronic pain
Treatment of moderate to severe pain when round-the-clock analgesia is needed for an extended period (ER tablets)
Contraindications and Cautions
Contraindicated with hypersensitivity to opioids, tartrazine (2- and 4-mg tablets, Dilaudid); physical dependence on an opioid analgesic (drug may precipitate withdrawal); severe or acute bronchial asthma, upper airway obstruction. Liquid and tablets contraindicated in labor and delivery and status asthmaticus. Extended-release tablets contraindicated with paralytic ileus, impaired pulmonary function, narrowed or obstructed GI tract, opioid nontolerant patients, mild pain or pain not expected to persist.
Use cautiously with pregnancy (readily crosses placenta; neonatal withdrawal if mother used drug during pregnancy); bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract disease, renal or hepatic impairment, lactation.
Available Forms
Injection—1, 2, 4, 10 mg/mL; tablets—2, 4, 8 mg; ER tabletsDNC—8, 12, 16 mg; suppositories—3 mg; powder for injection—250 mg/vial; oral solution—1 mg/mL; injection—1, 2, 4 mg/mL; injection concentrate—10 mg/mL
Dosages
Individualize to each patient.
Adults
Oral
Tablet, 2–4 mg every 4–6 hr; more than 4 mg may be needed for severe pain. Liquid, 2.5–10 mg every 3–6 hr. ER tablets, 8–64 mg PO once a day, titrated to patient needs; for opioid-tolerant patients only. (Exalgo)
Parenteral
1–2 mg IM, subcutaneously every 4–6 hr as needed. May be given by slow IV injection over 2–3 min if no other route is tolerated.
Rectal
3 mg every 6–8 hr.
Pediatric patients
Safety and efficacy not established. Contraindicated in premature infants.
Geriatric patients or patients with renal or hepatic impairment
Use caution; respiratory depression may occur in elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.
Pharmacokinetics
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