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All about: Hydromorphone Hydrochloride

Big Image Pronouncation: (HIGH-droe-moRE-phone HIGH-droe-KLOR-ide)
Class: Opioid analgesic

Trade Names:
Dilaudid
- Tablets 1 mg
- Tablets 2 mg
- Tablets 3 mg
- Tablets 4 mg
- Tablets 8 mg
- Injection 1 mg/mL
- Injection 2 mg/mL
- Injection 4 mg/mL
- Suppositories 3 mg

Trade Names:
Dilaudid-HP
- Injection 10 mg/mL
- Powder for Injection, lyophilized 250 mg

Dilaudid-HP Plus (Canada)
Dilaudid Sterile Powder (Canada)
Dilaudid-XP (Canada)
Hydromorph Contin (Canada)
Hydromorphone HP 10 (Canada)
Hydromorphone HP 20 (Canada)
Hydromorphone HP 50 (Canada)
Hydromorphone HP Forte (Canada)
PMS-Hydromorphone (Canada)

Mechanism of Action

Pharmacology

Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, inhibition of cough reflex, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting, and increased bladder tone.

Pharmacokinetics

Distribution

The mean Vd is 91.5 L. Hydromorphone hydrochloride is rapidly removed from the bloodstream and distributed to skeletal muscles, kidneys, liver, intestinal tract, lungs, spleen, and brain. Hydromorphone also crosses placental membranes.

Metabolism

Hydromorphone is metabolized in the liver as glucuronidated conjugate (major metabolite) and 6-hydroxy (minor metabolite).

Elimination

The mean t 1/ 2 is approximately 2.64 h. Hydromorphone is excreted primarily as the glucuronidated conjugate.

Onset

Onset of hydromorphone is 15 min (parenterally) and 30 min (oral).

Peak

Time to peak effect is 0.5 to 1 h.

Duration

Duration is longer than 5 h.

Indications and Usage

Relief of moderate to severe pain; control of persistent nonproductive cough.

Contraindications

Hypersensitivity to similar compounds, depressed ventilatory function; acute asthma; diarrhea caused by poisoning or toxins; patients not already receiving large amounts of parenteral narcotics; patients with respiratory depression without access to resuscitative equipment; labor.

Dosage and Administration

Adults

PO/Tablet 2 mg every 4 to 6 h as needed; at least 4 mg every 4 to 6 h for more severe pain. PO/Liquid 2.5 to 10 mg every 4 to 6 h. Subcutaneous/IM 1 to 2 mg every 4 to 6 h as needed; 3 to 4 mg every 4 to 6 h for more severe pain. IV May give slowly over 2 to 5 min. Use high potency (10 mg/mL) only for patients tolerant to other opiates. PR 3 mg every 6 to 8 h.

Antitussive

PO 1 mg every 3 to 4 h as needed.

Storage/Stability

Store at room temperature and protect from light.

Drug Interactions

CNS depressants (eg, tranquilizers, sedatives, alcohol)

Additive CNS depression.

Barbiturate anesthetics

May have additive effects.

Laboratory Test Interactions

Increased amylase and lipase may occur up to 24 h after dose.

Adverse Reactions

Cardiovascular

Hypotension; orthostatic hypotension; bradycardia; tachycardia.

CNS

Lightheadedness; dizziness; sedation; disorientation; incoordination; lethargy; anxiety.

Dermatologic

Sweating; pruritus; urticaria.

GI

Nausea; vomiting; constipation; abdominal pain.

Genitourinary

Urinary retention or hesitancy.

Respiratory

Respiratory depression; laryngospasm; depression of cough reflex.

Miscellaneous

Tolerance; psychological and physical dependence with chronic use.

Precautions

Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

May need to reduce dose.

Hepatic Function

May need to reduce dose.

Special Risk Patients

Use with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume, or circulatory shock.

Drug dependence

Hydromorphone has abuse potential.

Overdosage

Symptoms

Miosis, respiratory and CNS depression, apnea, bradycardia, hypotension, circulatory collapse, seizures, cardiopulmonary arrest, death.

Patient Information

  • Instruct patient to take medication before pain becomes severe.
  • Advise patient to take medication with food or milk to decrease stomach upset.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Advise patient to eat high-fiber diet and to maintain adequate fluid intake. A stool softener or bulk laxative may be recommended to prevent constipation.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Instruct patient to discontinue drug and notify health care provider if difficulty in breathing or persistent nausea, vomiting or constipation occurs.
  • When medication is used for acute pain, caution patient about potential for addiction and explain that medication should be for short-term use only.

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