hydromorphone hydrochloride

hy·dro·mor·phone hydrochloride (hdr-môrfn)

n.

A synthetic derivative of morphine used as a respiratory sedative and analgesic that is more potent than morphine.

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hydromorphone hydrochloride

[-môr′fōn]

an opioid analgesic.

indication It is used to treat moderate to severe pain.

contraindications It is used with caution in many conditions, including head injuries, asthma, impaired renal or hepatic function, or unstable cardiovascular status. Known hypersensitivity to this drug prohibits its use.

adverse effects Among the most serious adverse effects are drowsiness, dizziness, nausea, constipation, respiratory and circulatory depression, and drug addiction.

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hydromorphone hydrochloride Warning - High-alert drug!

Dilaudid, Dilaudid-5, Dilaudid-HP, PMS-Hydromorphone (CA)

Pharmacologic class: Opioid agonist

Therapeutic class: Opioid analgesic, antitussive

Controlled substance schedule II

Pregnancy risk category C (with long-term use or at term with high doses: D )

FDA Boxed Warning

• Drug is a potent Schedule II opioid agonist with highest abuse potential and risk of causing respiratory depression. Alcohol, other opioids, and CNS depressants potentiate respiratory depressant effects, increasing risk of potentially fatal respiratory depression.

Action

Binds to opiate receptors in spinal cord and CNS, altering perception of and response to painful stimuli while producing generalized CNS depression. Also subdues cough reflex and decreases GI motility.

Availability

Injection: 1 mg/ml, 2 mg/ml, 4 mg/ml, 10 mg/ml

Oral solution: 5 mg/5 ml

Rectal suppositories: 3 mg

Tablets: 1 mg, 2 mg, 3 mg, 4 mg, 8 mg

⊘Indications and dosages

➣ Moderate to severe pain

Adults weighing more than 50 kg (110 lb): 2 to 10 mg P.O. (tablets) q 4 to 6 hours p.r.n. or 2.5 to 10 mg P.O. (oral solution) q 4 to 6 hours p.r.n.; or 1 to 2 mg subcutaneously, I.M., or I.V. q 4 to 6 hours p.r.n., increased to 3 to 4 mg q 4 to 6 hours p.r.n. for severe pain; or 3 mg P.R. q 6 to 8 hours p.r.n.

Contraindications

• Hypersensitivity to narcotics or bisulfites
• Acute or severe bronchial asthma or upper respiratory tract obstruction
• Premature neonates

Precautions

Use cautiously in:
• increased intracranial pressure; severe renal, hepatic, or pulmonary disease; hypothyroidism; adrenal insufficiency; prostatic hypertrophy; alcoholism
• concurrent use of MAO inhibitors
• elderly patients
• pregnant or breastfeeding patients.

Administration

• For maximal analgesic effect, give before pain becomes severe.
• For I.V. infusion, mix with dextrose 5% in water, normal saline solution, or cFor I.V. infusion, mix with dextrose 5% in water, normal saline solution, or lactated Ringer's solution.
• Give single-dose I.V. injection slowly, over 2 to 5 minutes for each 2-mg dose.
• Rotate I.M. and subcutaneous sites to prevent muscle atrophy.
• Give oral form with food to avoid GI upset.

Route	Onset	Peak	Duration
P.O.	30 min	90-120 min	4 hr
I.V.	10-15 min	15-30 min	2-3 hr
I.M., subcut.	15 min	30-60 min	4-5 hr
P.R.	15-30 min	30-90 min	4-5 hr

Adverse reactions

CNS: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, anxiety, dizziness, drowsiness

CV: hypotension, hypertension, palpitations, bradycardia, tachycardia

EENT: blurred vision, diplopia, miosis, nystagmus, tinnitus, laryngeal edema, laryngospasm

GI: nausea, vomiting, constipation, abdominal cramps, biliary tract spasm, anorexia

GU: urinary retention, dysuria

Hepatic: hepatotoxicity

Respiratory: dyspnea, wheezing, bronchospasm, respiratory depression

Skin: flushing, diaphoresis

Other: physical or psychological drug dependence; drug tolerance; injection site pain, redness, or swelling

Interactions

Drug-drug. Antidepressants, antihistamines, MAO inhibitors, sedative-hypnotics: additive CNS depression

Antihypertensives, diuretics, guanadrel, guanethidine, mecamylamine: increased risk of hypotension

Atropine, belladonna alkaloids, difenoxin, diphenoxylate, kaolin and pectin, loperamide, paregoric: increased risk of CNS depression, severe constipation

Barbiturates: increased sedation

Buprenorphine, butorphanol, nalbuphine, pentazocine: precipitation of opioid withdrawal in physically dependent patients

Nalbuphine, pentazocine: decreased analgesia

Drug-diagnostic tests. Amylase, lipase: increased levels

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

☞ With I.V. use, monitor for respiratory depression. Keep resuscitation equipment and naloxone nearby.
• Assess for signs and symptoms of physical or psychological drug dependence.
• Monitor for constipation.

Patient teaching

☞ Instruct patient to take drug exactly as prescribed before pain becomes severe, but caution him that drug may be habit-forming.
• Tell patient to take oral form with food to avoid GI upset.
• Advise patient to report difficulty breathing, nausea, vomiting, or dizziness.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient to avoid alcohol while taking drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.