Hydromorphone

DEA Class; Rx

Common Brand Names; Dilaudid, Dilaudid-HP, Exalgo

Semisynthetic, phenanthrene opioid agonist
Immediate-release for moderate to severe pain; extended-release for continuous therapy for chronic severe pain in opioid-tolerant patients
More rapid onset compared to morphine

Indicated for moderate-to-severe pain

Hypersensitivity

Anticholinergic: Dry mouth, palpitation, tachycardia, urinary retention

Cardiovascular: Angina pectoris, bradycardia, cardiac arrest, circulatory depression, myocardial infarction, QT-interval prolongation, severe cardiac arrhythmias, shock, ST-segment elevation, syncope, ventricular tachycardia

Central nervous system (CNS): Agitation, coma, dizziness, dysphoria, mental clouding or depression, euphoria, faintness, nervousness, restlessness, sedation, seizures, visual disturbances, weakness

Gastrointestinal (GI): Constipation, nausea, vomiting, anorexia, abdominal distention, bilieary tract spasm, decreased appetite, decreased intestinal motility, gastroesophageal reflux disease, paralytic ileus,

Respiratory: Respiratory depression, respiratory arrest, hypoxia, bronchospasm, dyspnea, rhinorrhea, flu-like symptoms (Exalgo)

Other: Flushing, pruritus, sweating, urticaria, skin rash, hyperhidrosis, warmness of face/neck/upper thorax

Dosing errors can result in accidental overdose and death; ensure dose is communicated clearly and dispensed accurately; a household teaspoon or tablespoon is not an adequate measuring device; given inexactitude of household spoon measure and possibility of using a tablespoon instead of a teaspoon, which could lead to overdosage, the enclosed measuring device should be used or a calibrated measuring device obtained from the pharmacist; health care providers should recommend a calibrated device that can measure and deliver the prescribed dose accurately, and instruct caregivers to use extreme caution in measuring the dosage

Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper

The oral solution or tablets are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus; may cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms

Pregnancy category: C

Lactation: Drug excreted in breast milk; use not recommended