Yes

Analgesic, Narcotic

Management of moderate to severe pain; antitussive at lower doses

C-II

B/D (if used for prolonged periods or in high doses at term)

Hypersensitivity to hydromorphone or any component or other phenanthrene derivative

Tablet and cough syrup contain tartrazine which may cause allergic reactions; hydromorphone shares toxic potential of opiate agonists, and precaution of opiate agonist therapy should be observed; extreme caution should be taken to avoid confusing the highly concentrated injection with the less concentrated injectable product, injection contains benzyl alcohol; use with caution in patients with hypersensitivity to other phenanthrene opiates, in patients with respiratory disease, or severe liver or renal failure; tolerance or drug dependence may result from extended use

Percentage unknown: Antidiuretic hormone release, biliary tract spasm, urinary tract spasm, miosis, histamine release, physical and psychological dependence, increased AST, ALT

>10%:

Cardiovascular: Palpitations, hypotension, peripheral vasodilation

Central nervous system: Dizziness, lightheadedness, drowsiness

Gastrointestinal: Anorexia

1% to 10%:

Cardiovascular: Tachycardia, bradycardia, flushing of face

Central nervous system: CNS depression, increased intracranial pressure, fatigue, headache, nervousness, restlessness

Gastrointestinal: Nausea, vomiting, constipation, stomach cramps, xerostomia

Genitourinary: Decreased urination, ureteral spasm

Hepatic: Increased LFTs

Neuromuscular & skeletal: Trembling, weakness

Respiratory: Respiratory depression, dyspnea, shortness of breath

<1%: Hallucinations, mental depression, pruritus, rash, urticaria, paralytic ileus

Symptoms of overdose include CNS depression, respiratory depression, miosis, apnea, pulmonary edema, convulsions

Maintain airway, establish I.V. line; naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as necessary up to a total of 10 mg.

Increased toxicity: CNS depressants, phenothiazines, tricyclic antidepressants may potentiate the adverse effects of hydromorphone

Protect tablets from light; do not store intact ampuls in refrigerator; a slightly yellowish discoloration has not been associated with a loss of potency; I.V. is incompatible when mixed with minocycline, prochlorperazine, sodium bicarbonate, tetracycline, thiopental

Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough supression by direct central action in the medulla; produces generalized CNS depression

Onset of analgesic effect: Within 15-30 minutes

Peak effect: Within 0.5-1.5 hours

Duration: 4-5 hours

Metabolism: Primarily in the liver

Bioavailability: 62%

Half-life: 1-3 hours

Elimination: In urine, principally as glucuronide conjugates

Doses should be titrated to appropriate analgesic effects; when changing routes of administration, note that oral doses are less than half as effective as parenteral doses (may be only one-fifth as effective)

Pain: Older Children and Adults:

Oral, I.M., I.V., S.C.: 1-4 mg/dose every 4-6 hours as needed; usual adult dose: 2 mg/dose

Rectal: 3 mg every 6-8 hours

Antitussive: Oral:

Children 6-12 years: 0.5 mg every 3-4 hours as needed

Children >12 years and Adults: 1 mg every 3-4 hours as needed

Dosing adjustment in hepatic impairment: Should be considered

Alcohol: Additive CNS effects, avoid or limit alcohol; watch for sedation

Food: Glucose may cause hyperglycemia; monitor blood glucose concentrations

Can be given S.C. or I.M.; for IVP, must be given slowly over 2-3 minutes (rapid IVP has been associated with an increase in side effects, especially respiratory depression and hypotension)

Pain relief, respiratory and mental status, blood pressure

Drowsiness and dizziness are common; may cause nervousness or restlessness; may rarely cause hallucinations or depression

Concurrent use with psychotropics may produce additive sedation

No information available to require special precautions

Dry mouth and nausea in 10% of patients

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause dizziness, drowsiness, impaired coordination, or blurred vision (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); loss of appetite, nausea, or vomiting (frequent mouth care, small frequent meals, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, or dietary fruit and fiber may help - if constipation remains an unresolved problem, consult prescriber about use of stool softeners). Report chest pain, slow or rapid heartbeat, acute dizziness, or persistent headache; swelling of extremities or unusual weight gain; changes in urinary elimination; acute headache; back or flank pain or spasms; or other adverse reactions. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Breast-feeding is not recommended.

Observe patient for oversedation, respiratory depression, implement safety measures

Injection, as hydrochloride:

Dilaudid®: 1 mg/mL (1 mL); 2 mg/mL (1 mL, 20 mL); 3 mg/mL (1 mL); 4 mg/mL (1 mL)

Dilaudid-HP®: 10 mg/mL (1 mL, 2 mL, 5 mL)

Liquid, as hydrochloride: 5 mg/5 mL (480 mL)

Powder for injection, as hydrochloride: (Dilaudid-HP®): 250 mg

Suppository, rectal, as hydrochloride: 3 mg (6s)

Tablet, as hydrochloride: 1 mg, 2 mg, 3 mg, 4 mg, 8 mg

"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.

Ferrell BA, "Pain Management in Elderly People," J Am Geriatr Soc, 1991, 39(1):64-73.

Honigberg IL, and Stewart JT, "Radioimmunoassay of Hydromorphone and Hydrocodone in Human Plasma," J Pharm Sci, 1980, 69(10):1171-3.

Inturrisi CE, "Narcotic Drugs," Med Clin North Am, 1982, 66(5):1061-71.

Kaiko RF, Wallenstein SL, Rogers AG, et al, "Narcotics in the Elderly," Med Clin North Am, 1982, 66(5):1079-89.