Hydromorphone

General

• Type: Opioids
• Dosage Forms: PO, SC, IM, IV, PR, PCA
• Common Trade Names: Dilaudid, Exalgo

Adult Dosing

Severe Pain

• Oral: 2-4mg PO q4-6h PRN
• IV: 0.2-1mg IV q2-3h PRN
• IM: 1-2mg IM q2-3h PRN (not recommended secondary to variable absorption)

Pediatric Dosing

Severe Pain

• > 6 months, > 50 kg: 0.5 - 2mg PO/SC/IM/IV q3-6h.
• Alternatively: 15-20 mcg/kg q3-6h.

Special Populations

• Pregnancy Rating: C
• Lactation Risk Categories: probably safe
• Renal Dosing
  • Adult: mod-severe impairment: decrease start dose, amount not defined
  • Pediatric: mod-severe impairment: decrease start dose, amount not defined
• Hepatic Dosing
  • Adult: Child-pugh class B: decrease start dose 50-75%
  • Pediatric: Child-pugh class B:decrease start dose 50-75%

Contraindications

• Allergy to class/drug
• Respiratory depression
• CNS depression
• MAO inhibitor use in prior 2 weeks
• GI obstruction or ileus

Adverse Reactions

Serious

• Respiratory Depression
• Apnea
• Hypotension
• Syncope
• Bradycardia
• Urinary retention
• Seizures
• Anaphylaxis

Common

• Nausea
• Rash
• Headache
• Fatigue
• xerostomia
• constipation
• Tremor
• urinary retention

Pharmacology

• Half-life: 2.3 hour
• Metabolism: Liver
• Excretion: urine
• Mechanism of Action:binds to various opioid receptors

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

	Indication	Dose	Context	Route	Population
Acute pain management#Hydromorphone Step 3 - Severe pain (opioid) Adult	Acute pain management	0.015 mg/kg IV or 1-2 mg IM; titrate 0.5-1.0 mg IV increments	Step 3 - Severe pain (opioid)	IV/IM	Adult