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