Adult Dosing
Moderate to severe pain
- Start 1-2 mg IM/SC or slow IV (over 2-3 mins) q4-6 hrs; then individualize on the basis of baseline clinical status and pain severity
- 1.3-2 mg is equianalgesic to 10 mg of Morphine
Notes:
- Use high potency formulation only in patients who are already receiving large doses of opioids
- Similar doses should be used if therapy is changed from regular hydromorphone to high potency formulation
- Individualize dosage since adverse reactions may occur at any dosage; use lower starting dose in geriatric patients, patients with hepatic and renal impairment and non-opioid-tolerant patients
- Injection should be given slowly, over at least 2-3 minutes
- Experience with IV route is limited; avoid use. If IV administration is necessary, give slowly over at least 2-3 minutes
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Testicular Torsion [Non-FDA Approved]
- 0.015 mg/kg/dose IV q4-6 hrs PRN
Pain [Non-FDA Approved]
- Adolescent: 1-2 mg/dose IV PRN
- Child: 0.015 mg/kg/dose IV PRN
[Outline]
See Supplemental Patient Information
- Potent schedule II opioid agonist with highest abuse potential and risk of causing respiratory depression [US Black Box warning]
- Use high potency formulation (10 mg/mL) only in opioid tolerant patients; do not confuse with standard parenteral formulations of hydromorphone or other opioids [US Black Box warning]
- Use hydromorphone hydrochloride injection (high potency formulation) only if the amount of hydromorphone required can be delivered accurately with this formulation
- Overdosage may result in respiratory depression in geriatrics, debilitated and in those suffering from conditions accompanied by hypoxia or hypercapnia, moderate doses may decrease pulmonary ventilation which can be fatal
- Fatal life threatening respiratory depression may occur on concomitant use with alcohol, other opioids and central nervous system depressants (sedative-hypnotics)
- Assess patients for potential for opioid abuse prior to prescribing therapy. Monitor for signs of abuse, misuse, and addiction as such drugs are used by abusers and people with addiction disorders which may lead to criminal diversion. Consider this while prescribing or dispensing hydromorphone
- Patients with personal or family history of substance abuse or mental illness are more prone to opioid abuse, intensive monitoring is necessary of such patients
- Respiratory difficulties and withdrawal symptoms may be exhibited in infants born to mothers physically dependent on hydromorphone
- Presence of head injury, other intracranial lesions, or preexisting increase in intracranial pressure may result in exaggerated respiratory depressant effects with carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure
- Severe hypotension/orthostatic hypotension may occur with single use or concomitant use with drugs such as phenothiazines or general anesthetics
- Use cautiously and reduce initial dose in geriatrics, debilitated and in severe impairment of hepatic, pulmonary or renal function myxedema or hypothyroidism, adrenocortical insufficiency, CNS depression or coma, toxic psychoses, prostatic hypertrophy or urethral stricture, gall bladder disease, acute alcoholism, delirium tremens, kyphoscoliosis or following gastrointestinal surgery
- Initial dose should be estimated on relative potency of hydromorphone and the opioid previously used by the patient
- May aggravate pre-existing convulsions in patients with convulsive disorders, mild to severe seizures and myoclonus may occur in severely compromised patients, obscure the diagnosis or clinical course in patients with acute abdominal conditions
- May impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating machinery)
- Slowly taper to discontinue if at risk for physical dependence. Abrupt cessation can cause a withdrawal syndrome or precipitate seizures
Cautions: Use cautiously in
- Medications with anticholinergic activity (increase risk of urinary retention and severe constipation)
- Renal impairment
- Hepatic impairment
- Pre-existing respiratory depression
- Asthma
- COPD
- Cor pulmonale
- Hypoxia
- Hypercapnia
- Severe obesity
- Sleep apnea
- Adreno-cortical insufficiency
- Head trauma
- Thyroid disorder
- CNS depression
- Increased intracranial pressure
- Alcohol/drug abuse
- Coma
- Toxic psychoses
- Concurrent MAO inhibitors
- Delirium tremens
- Undiagnosed abdominal pain
- Prostatic hypertrophy
- Acute pancreatitis
- Myxedema
- Hypothyroidism
- Gallbladder disease
- Kyphoscoliosis
- Gastrointestinal surgery
- Geriatric population
- Note: For information on prevention, detect abuse or diversion of this product, healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority
Supplemental Patient Information
- Patients receiving hydromorphone or their caregivers should be given information on its effect, adverse effects, alcohol and other medication precautions, pregnancy implications, potential for abuse, taper of dosing and secure storage of the medication
Pregnancy Category:C
Breastfeeding: Probably safe; minimally excreted in breastmilk; newborn infants may be particularly sensitive to the effects of even small dosages, especially in the first week of life. Alternative non-narcotic analgesics may be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 October 2010). Manufacturer recommends discontinuation of nursing.
