Hydromorphone Hydrochloride
This medication is a Schedule II drug.
Brand Names: Exalgo, Dilaudid
Generic Available
Common Dosage Forms:
Tablets, immediate-release (Dilaudid): 2 mg, 4 mg, 8 mg
Tablets, extended-release (Exalgo): 8 mg, 12 mg, 16 mg, 32 mg
Injection: 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL
Suppositories: 3 mg
Liquid: 1 mg/mL
FDA Indications/Dosages:
For the management of pain (immediate-release): The usual starting dose is 2-4 mg orally every 4-6 hours.
For the management of moderate to severe pain in opioid-tolerant patients requiring opioid analgesia for an extended period of time (extended-release): 8-64 mg orally once a day.
Pharmacology/Pharmacokinetics: Hydromorphone is a pure opioid agonist. Analgesia is produced centrally via action on the central opiate receptors. Other therapeutic effects include anxiolysis, euphoria, and feelings of relaxation.Respiratory depression occurs via direct action on brain stem respiratory centers. Depression of the cough reflex occurs via direct action on the cough center in the medulla. Hydromorphone causes a reduction in the motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Extended-release tablets are designed to provide a steady release of drug over a 24 hour period.
Drug Interactions: May enhance the actions of antipsychotics, general anesthetics, sedatives, hypnotics, alcohol, and skeletal muscle relaxants. Agonist/antagonist analgesics may precipitate withdrawal symptoms. Do not use within 14 days of a MAO inhibitor. Avoid use with anticholinergics.
Contraindications/Precautions: Contraindicated in patients with respiratory depression in the absence of resuscitative equipment, and in patients with acute or severe bronchial asthma. Extended-release tablets are contraindicated in patients who are not opioid-tolerant, in any patient who has or is suspected of having a paralytic ileus, and in patients with GI obstruction or narrowing. Use with caution in patients with problems in blood pressure control, increased intracranial pressure, head injury, severe hepatic or renal impairment, biliary tract disease, Addison’s disease, hypothyroidism, prostatic hypertrophy or urethral stricture, supraventricular tachycardia, seizure disorders, acute abdominal conditions, in pregnancy and lactation, and in asthma or other respiratory compromising conditions. OPIOIDS CAN BE ADDICTIVE, ABUSED, AND MISUSED WHICH CAN LEAD TO OVERDOSE AND DEATH. SERIOUS, LIFE-THREATENING RESPIRATORY DEPRESSION MAY OCCUR. ACCIDENTAL EXPOSURE CAN BE FATAL, ESPECIALLY IN CHILDREN. USE IN PREGNANCY CAN CAUSE NEONATAL WITHDRAWAL SYNDROME. CONCOMITANT USE WITH BENZODIAZEPINES, ALCOHOL, OR OTHER CNS DEPRESSANTS CAN RESULT IN RESPIRATORY DEPRESSION, COMA, AND DEATH. Pregnancy Category C.
Adverse Effects: The most common adverse effects are constipation, nausea, dizziness, somnolence, headache, fatigue, vomiting, diarrhea, pruritus, insomnia, edema, dry mouth, and sweating.
Patient Consultation:
Extended-release tablets must be taken whole, and are not to be broken, chewed, or crushed. Taken broken, chewed, or crushed extended-release tablets could lead to the rapid release and absorption of a potentially toxic dose.
May cause drowsiness. Use caution while operating machinery or when mental alertness is required.
Avoid alcohol while taking this medication.
May take with food or milk to avoid GI upset.
If a dose is missed, take it as soon as possible and reschedule your remaining doses based upon the schedule your physician prescribed. Do not double doses.
WARNING: This medication may be habit-forming.
This prescription cannot be refilled.
Store in a cool, dry place away from sunlight and children.
Contact a physician if the above side effects are severe or persistent.
