Hydromorphone dosing

Hydromorphone should not be combined with other pain medications. This includes over-the-counter medications that are commonly used to treat pain, such as Nuprin or Tylenol. If the prescribed dose of hydromorphone does not sufficiently alleviate the pain, then the treating doctor can adjust the dose. The patient should not make adjustments of hydromorphone dose on his or her own or add pain medications to the regimen. 

Severe 7-1 0/1 0 Switch to a high-potency opioid regular scheduled dosing Morphine 10 mg every 4 hours Hydromorphone 4 mg every 4 hours ... 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Epidural analgesia is frequently used for lower extremity procedures and pain (e.g., knee surgery, labor pain, and some abdominal procedures). Intermittent bolus or continuous infusion of preservative-free opioids (morphine, hydromorphone, or fentanyl) and local anesthetics (bupivacaine) may be used for epidural analgesia. Opiates given by this route may cause pruritus that is relieved by naloxone. Adverse effects including respiratory depression, hypotension, and urinary retention may occur. When epidural routes are used in narcotic-dependent patients, systemic analgesics must also be used to prevent withdrawal since the opioid is not absorbed and remains in the epidural space. Doses of opioids used in epidural analgesia are 10 times less than intravenous doses, and intrathecal doses are 10 times less than epidural doses (i.e., 10 mg of IV morphine is equivalent to 1 mg epidural morphine and 0.1 mg of intrathecally administered morphine).45... 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

Morphine 0.1 -0.1 5 mg/kg per dose every 3-4 hours for children 5-10 mg/dose for adults Continuous infusion 0.04-0.05 mg/kg per hour titrate to effect Hydromorphone 0.015 mg/kg per dose every 3 1 hours for children 1.5-2 mg/dose for adults Continuous infusion 0.004 mg/kg per hour titrate to effect Intravenous anti-inflammatory agents ... 

Patients who are considered opioid-tolerant are those who have been taking, for a week or longer, morphine 60 mg/day or more, or oral oxycodone 30 mg/day or more, or oral hydromorphone 8 mg/day or more, or an equianalgesic dose of another opioid. 

Because of its high concentration, the delivery of precise doses of HP hydromorphone may be difficult if low doses of hydromorphone are required. Therefore, use HP hydromorphone only if the amount of hydromorphone required can be delivered accurately with this ormulation. 

Hydromorphone (Dilaudid) [C-ll] [Narcotic Analgesic] Uses Pain Action Narcotic analgesic Dose 1-4 mg IV (onset w/in 10 min duration about 3 h) Caution [B (D if prolonged use or high doses near term), ] t resp depression and CNS t effects CNS depressants, phenothiazines, TCA Contra Component sensitivity Disp Tabs 2, 4 mg, 8 mg Liq 5 mg/5 mL or 1 mg/mL inj... 

Hydromorphone is eight times as potent as morphine but has less bioavailability following oral administration. Its side effects do not differ from those of morphine but are more intense. Hydromorphone is indicated for use in severe pain and in high doses for relief of pain in opioid-addicted patients. 

The effects of these active metabolites should be considered in patients with renal impairment before the administration of morphine or hydromorphone, especially when given at high doses. 

Parenteral (generic, Sublimaze) 50 mcg/mL for injection Fentanyl Transdermal System (Duragesic) 12.5, 25, 50, 75, 100 mcg/h delivery Fentanyl Buccal 100, 200, 400, 600, 800 meg oral lozenge Fentanyl Actiq 200, 400, 600, 800, 1200, 1600 meg lozenge on a stick Patient Controlled Transdermal Iontophoretic Fentanyl System 40 meg per dose for delivery Hydromorphone (generic, Dilaudid)... 

Dosages and routes of administration Hydromorphone is used in doses of 1-2 mg by subcutaneous, intramuscular, slow intravenous or rectal administration, and in oral doses between 2-4 mg. The doses for cough inhibition are 1 mg, given as a syrup. 

Hydromorphone (Dilaudid) [C—II] [Narcotic Analgesic] Uses Mod/severe pain Action Narcotic analgesic Dose 1-4 mg PO, IM, IV, or PR... 

Depending on the country where the drug is manufactured, a number of different time-release preparations are available. Palladone , a controlled-release preparation consisting of hydromorphone HC1 pellets, was withdrawn from the U.S. market in 2005. When taken with alcohol the pellets rapidly released their contents leading to dangerously elevated peak plasma concentrations.60 Interaction with ethanol and dose dumping is not the only concern. Any CNS depressant may enhance the depressant effects of hydromorphone. 

Persons with a history of drug abuse of any kind should not receive hydromorphone unless absolutely necessary because of the great potential for addiction. Hydromorphone can become addictive for anyone who has received doses higher than those prescribed by a doctor and in those who use the drug for recreational purposes. In addition, those who receive the drug at prescribed levels for a lengthy period are at a relatively slight increased risk of addiction. 

SCHEDULE II Certain barbiturates, cocaine, codeine, codeine + acetaminophen (depends on dose and formulation), fentanyl (depends on dose), hydrocodone, hydromorphone, meperidine, methadone, morphine (depends on combination with other pain relievers), oxycodone, propoxyphene... 

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