Hydromorphone
Mechanism :
Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression.
Indication :
- Pain management: Reserve for use in patients for whom alternative treatment options (e.g., non-opioid analgesics, opioid combination products) are ineffective.
Contraindications :
Hypersensitivity (e.g., anaphylaxis) to hydromorphone, hydromorphone salts, or any component of the formulation; significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment or ventilatory support; gastrointestinal obstruction, including paralytic ileus.
Dosing :
Oral:
Children:
0.03-0.08 mg/kg/dose PO every 4-6 hours, not to exceed 5 mg/dose.
Adolescents:
1-4 mg/dose PO every 4-6 hours.
Injectable:
Children:
0.015 mg/kg IV every 4-6 hours.
Adolescents:
1-2 mg/dose IV/IM/SC every 4-6 hours.
Adverse Effect :
Dry mouth, palpitation, tachycardia, urinary retention, angina pectoris, bradycardia, cardiac arrest, circulatory depression, myocardial infarction, QT-interval prolongation, severe cardiac arrhythmias, shock, ST-segment elevation, syncope, ventricular tachycardia, agitation, coma, dizziness, dysphoria, mental clouding or depression, euphoria, faintness, nervousness, restlessness, sedation, seizures, visual disturbances, weakness, constipation, nausea, vomiting, anorexia, abdominal distention, biliary tract spasm, decreased appetite, decreased intestinal motility, gastroesophageal reflux disease, paralytic ileus, respiratory depression, respiratory arrest, hypoxia, bronchospasm, dyspnea, rhinorrhea, flu-like symptoms, flushing, pruritus, sweating, urticaria, skin rash, hyperhidrosis, warmness of face/neck/upper thorax.
Interaction :
Alvimopan: Opioid Analgesics may enhance the adverse/toxic effect of Alvimopan.
Anticholinergic Agents: May enhance the adverse/toxic effect of Opioid Analgesics. Specifically, the risk for constipation and urinary retention may be increased with this combination.
Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine.
CNS Depressants: May enhance the CNS depressant effect of Opioid Analgesics.
Opioid Analgesics: CNS Depressants may enhance the CNS depressant effect of Opioid Analgesics.
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Reduce dose – start with lowest dose and titrate according to response |
| <10 | Reduce dose – start with lowest dose and titrate according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Moderate or severe hepatic impairment: A reduced initial dose because of increased systemic drug exposure.