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

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

Authors

Babak Missaghi, Ross Donaldson, Colin Hoff, Daniel Ostermayer, Neil Young