Analgesic

Hydromorphone

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Hydromorphone, Dilaudid

  • See Also
  1. Opioid
  • Dosing
  • Adults (or children over age 12 years)
  1. Oral
    1. Hydromorphone 2 to 4 mg orally as needed every 4 to 6 hours
  2. SC or IM
    1. Hydromorphone 0.5 to 2 mg SC or IM as needed every 4 to 6 hours
  3. IV
    1. Hydromorphone 0.5 mg (0.2 to 0.3 mg in elderly) slow IV over 2 to 5 min every 15 to 30 min as needed for 3 doses or
    2. Hydromorphone 1 mg slow IV over 2 to 5 min every 2 hours as needed (limit to Opioid tolerant, younger adults)
  • Dosing
  • Children (under age 12 years, not FDA approved)
  1. Oral
    1. Hydromorphone 0.03 to 0.08 mg/kg up to 2 to 4 mg orally as needed every 4 to 6 hours
  2. IV
    1. Hydromorphone 0.015 mg/kg/dose up to 0.5 to 2 mg slow IV over 2 to 5 min as needed every 4 to 6 hours
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Adverse Effects
  1. See Opioid Adverse Effect
  • Pharmacokinetics
  1. Onset 5 to 15 minutes
  2. Peaks 10 to 20 minutes
  3. Duration 2 to 4 hours
  • Precautions
  1. Hydromorphone 1 mg IV is equivalent to 7 mg Morphine Sulfate IV
  2. Hydromorphone more easily crosses blood-brain barrier than other Opioids
    1. Risk of excessive sedation and respiratory depression
  3. Hydromorphone is renally excreted (clearance may be delayed 40 hours in Renal Failure)
  4. Dilaudid triggers greater euphoria than Fentanyl or Morphine (higher risk of drug seeking and abuse)
  5. Dilaudid is a high potency Opioid (1 mg is equivalent to up to 10 mg Morphine)
    1. Most iatrogenic Opioid Overdoses have occurred with Hydromorphone (Dilaudid)
  • Resources
  1. Hydromorphone Oral (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cc574063-6ede-4da7-82c4-7450c92b229b
  2. Hydromorphone Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f9ca2ef5-46d8-475a-a26e-f7c8becd6db7
  • References
  1. Velasco and Kiel (2023) Crit Dec Emerg Med 37(1): 4-9