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Hydromorphone

    DEA Class; Rx

    Common Brand Names; Dilaudid, Dilaudid-HP, Exalgo

    • Opioid Analgesics

    Semisynthetic, phenanthrene opioid agonist
    Immediate-release for moderate to severe pain; extended-release for continuous therapy for chronic severe pain in opioid-tolerant patients
    More rapid onset compared to morphine

    Indicated for moderate-to-severe pain

    For analgesia and/or sedation maintenance† in mechanically-ventilated intensive care patients.

    Hypersensitivity

    Anticholinergic: Dry mouth, palpitation, tachycardia, urinary retention

    Cardiovascular: Angina pectoris, bradycardia, cardiac arrest, circulatory depression, myocardial infarction, QT-interval prolongation, severe cardiac arrhythmias, shock, ST-segment elevation, syncope, ventricular tachycardia

    Central nervous system (CNS): Agitation, coma, dizziness, dysphoria, mental clouding or depression, euphoria, faintness, nervousness, restlessness, sedation, seizures, visual disturbances, weakness

    Gastrointestinal (GI): Constipation, nausea, vomiting, anorexia, abdominal distention, bilieary tract spasm, decreased appetite, decreased intestinal motility, gastroesophageal reflux disease, paralytic ileus,

    Respiratory: Respiratory depression, respiratory arrest, hypoxia, bronchospasm, dyspnea, rhinorrhea, flu-like symptoms (Exalgo)

    Other: Flushing, pruritus, sweating, urticaria, skin rash, hyperhidrosis, warmness of face/neck/upper thorax

    Dosing errors can result in accidental overdose and death; ensure dose is communicated clearly and dispensed accurately; a household teaspoon or tablespoon is not an adequate measuring device; given inexactitude of household spoon measure and possibility of using a tablespoon instead of a teaspoon, which could lead to overdosage, the enclosed measuring device should be used or a calibrated measuring device obtained from the pharmacist; health care providers should recommend a calibrated device that can measure and deliver the prescribed dose accurately, and instruct caregivers to use extreme caution in measuring the dosage

    Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper

    The oral solution or tablets are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus; may cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms

    Pregnancy category: C

    Lactation: Drug excreted in breast milk; use not recommended

    Adults

    With appropriate dosage titration, there is no maximum dose of hydromorphone.

    Geriatric

    With appropriate dosage titration, there is no maximum dose of hydromorphone.

    Adolescents

    With appropriate dosage titration, there is no maximum dose of hydromorphone. The safety and efficacy of extended-release tablets have not been established.

    Children

    With appropriate dosage titration, there is no maximum dose of hydromorphone. The safety and efficacy of extended-release tablets have not been established.

    Infants

    With appropriate dosage titration, there is no maximum dose of hydromorphone. The safety and efficacy of extended-release tablets have not been established.

    Neonates

    Safety and efficacy have not been established.

    Hydromorphone hydrochloride

    tablet: Schedule II

    • 2mg
    • 4mg
    • 8mg

    tablet, extended-release: Schedule II

    • 8mg
    • 12mg
    • 16mg
    • 32mg

    injection solution

    • 1mg/mL
    • 2mg/mL
    • 4mg/mL

    injection solution, preservative free: Schedule II

    • 10mg/mL

    oral liquid: Schedule II

    • 5mg/5mL

    suppository: Schedule II

    • 3mg

    Prefilled syringe: Schedule II

    • 0.2 mg/mL
    • 0.6 mg/mL