Hydromorphone*

• Hydromorphone

Other Names:

• Dilaudid

Classification:

• Narcotic analgesic

Mechanism of Action:

• Hydromorphone is a hydrogenated ketone derivative of morphine that acts as a narcotic analgesic. It has a shorter duration of action than morphine. Hydromorphone is approximately 8 times more potent on a milligram basis than morphine. In addition, hydromorphone is better absorbed orally than is morphine.
• Exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Binds to opioid receptors (mu and delta) in the CNS producing analgesia and euphoria.
• Multiple actions but works primarily on the CNS and organs containing smooth muscle.

Indications:

• Moderate to severe pain (first line drug or when switching medications due to opioid neurotoxicity)

Contraindications:

• Hypersensitivity
• Status asthmaticus
• Severe CNS depression (relative contraindication in palliative care)
• Severe respiratory depression (relative contraindication in palliative care)

Precautions:

• At high doses, as given for malignant cancer pain control, it can be associated with seizures
• Withdrawal symptoms can occur if discontinued abruptly
  

Adverse Effects:

• Opioid neurotoxicity
• Constipation or diarrhea
  
• Nausea/Vomiting
• Drowsiness
  

Dose:

• 1 tube (15 g) orally/buccal PRN

Adult:

• 1.0 – 2.0 mg SQ

Pediatric:

• 0.01 – 0.02 mg/kg SQ

• SQ

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2nd Edition