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Pronunciation |
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(hye
droe MOR
fone) |
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U.S. Brand
Names |
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Dilaudid®; Dilaudid-5®;
Dilaudid-HP®; HydroStat
IR® |
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Generic
Available |
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Yes |
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Canadian Brand
Names |
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Hydromorph Contin®;
PMS-Hydromorphone |
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Synonyms |
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Dihydromorphinone; Hydromorphone Hydrochloride |
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Pharmacological Index |
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Analgesic, Narcotic |
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Use |
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Management of moderate to severe pain; antitussive at lower
doses |
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Restrictions |
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C-II |
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Pregnancy Risk
Factor |
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B/D (if used for prolonged periods or in high doses at
term) |
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Contraindications |
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Hypersensitivity to hydromorphone or any component or other phenanthrene
derivative |
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Warnings/Precautions |
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Tablet and cough syrup contain tartrazine which may cause allergic reactions;
hydromorphone shares toxic potential of opiate agonists, and precaution of
opiate agonist therapy should be observed; extreme caution should be taken to
avoid confusing the highly concentrated injection with the less concentrated
injectable product, injection contains benzyl alcohol; use with caution in
patients with hypersensitivity to other phenanthrene opiates, in patients with
respiratory disease, or severe liver or renal failure; tolerance or drug
dependence may result from extended use |
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Adverse
Reactions |
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Percentage unknown: Antidiuretic hormone release, biliary tract spasm,
urinary tract spasm, miosis, histamine release, physical and psychological
dependence, increased AST, ALT
>10%:
Cardiovascular: Palpitations, hypotension, peripheral vasodilation
Central nervous system: Dizziness, lightheadedness, drowsiness
Gastrointestinal: Anorexia
1% to 10%:
Cardiovascular: Tachycardia, bradycardia, flushing of face
Central nervous system: CNS depression, increased intracranial pressure,
fatigue, headache, nervousness, restlessness
Gastrointestinal: Nausea, vomiting, constipation, stomach cramps, xerostomia
Genitourinary: Decreased urination, ureteral spasm
Hepatic: Increased LFTs
Neuromuscular & skeletal: Trembling, weakness
Respiratory: Respiratory depression, dyspnea, shortness of breath
<1%: Hallucinations, mental depression, pruritus, rash, urticaria,
paralytic ileus |
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Overdosage/Toxicology |
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Symptoms of overdose include CNS depression, respiratory depression, miosis,
apnea, pulmonary edema, convulsions
Maintain airway, establish I.V. line; naloxone 2 mg I.V. (0.01 mg/kg for
children) with repeat administration as necessary up to a total of 10 mg.
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Drug
Interactions |
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Increased toxicity: CNS depressants, phenothiazines, tricyclic
antidepressants may potentiate the adverse effects of
hydromorphone |
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Stability |
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Protect tablets from light; do not store intact ampuls in refrigerator; a
slightly yellowish discoloration has not been associated with a loss of potency;
I.V. is incompatible when mixed with minocycline, prochlorperazine,
sodium bicarbonate, tetracycline, thiopental |
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Mechanism of
Action |
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Binds to opiate receptors in the CNS, causing inhibition of ascending pain
pathways, altering the perception of and response to pain; causes cough
supression by direct central action in the medulla; produces generalized CNS
depression |
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Pharmacodynamics/Kinetics |
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Onset of analgesic effect: Within 15-30 minutes
Peak effect: Within 0.5-1.5 hours
Duration: 4-5 hours
Metabolism: Primarily in the liver
Bioavailability: 62%
Half-life: 1-3 hours
Elimination: In urine, principally as glucuronide conjugates
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Usual Dosage |
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Doses should be titrated to appropriate analgesic effects; when changing
routes of administration, note that oral doses are less than half as effective
as parenteral doses (may be only one-fifth as effective)
Pain: Older Children and Adults:
Oral, I.M., I.V., S.C.: 1-4 mg/dose every 4-6 hours as needed; usual adult
dose: 2 mg/dose
Rectal: 3 mg every 6-8 hours
Antitussive: Oral:
Children 6-12 years: 0.5 mg every 3-4 hours as needed
Children >12 years and Adults: 1 mg every 3-4 hours as needed
Dosing adjustment in hepatic impairment: Should be considered
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Dietary
Considerations |
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Alcohol: Additive CNS effects, avoid or limit alcohol; watch for sedation
Food: Glucose may cause hyperglycemia; monitor blood glucose concentrations
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Administration |
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Can be given S.C. or I.M.; for IVP, must be given slowly over 2-3 minutes
(rapid IVP has been associated with an increase in side effects, especially
respiratory depression and hypotension) |
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Monitoring
Parameters |
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Pain relief, respiratory and mental status, blood
pressure |
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Mental Health: Effects
on Mental Status |
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Drowsiness and dizziness are common; may cause nervousness or restlessness;
may rarely cause hallucinations or depression |
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Mental Health:
Effects on Psychiatric
Treatment |
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Concurrent use with psychotropics may produce additive
sedation |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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Dry mouth and nausea in 10% of patients |
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Patient
Information |
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If self-administered, use exactly as directed (do not increase dose or
frequency); may cause physical and/or psychological dependence. While using this
medication, do not use alcohol and other prescription or OTC medications
(especially sedatives, tranquilizers, antihistamines, or pain medications)
without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids
unless instructed to restrict fluid intake). May cause dizziness, drowsiness,
impaired coordination, or blurred vision (use caution when driving, climbing
stairs, or changing position - rising from sitting or lying to standing, or when
engaging in tasks requiring alertness until response to drug is known); loss of
appetite, nausea, or vomiting (frequent mouth care, small frequent meals,
chewing gum, or sucking lozenges may help); constipation (increased exercise,
fluids, or dietary fruit and fiber may help - if constipation remains an
unresolved problem, consult prescriber about use of stool softeners). Report
chest pain, slow or rapid heartbeat, acute dizziness, or persistent headache;
swelling of extremities or unusual weight gain; changes in urinary elimination;
acute headache; back or flank pain or spasms; or other adverse reactions.
Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend
to be pregnant. Breast-feeding is not recommended. |
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Nursing
Implications |
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Observe patient for oversedation, respiratory depression, implement safety
measures |
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Dosage Forms |
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Injection, as hydrochloride:
Dilaudid®: 1 mg/mL (1 mL); 2 mg/mL (1 mL, 20 mL); 3
mg/mL (1 mL); 4 mg/mL (1 mL)
Dilaudid-HP®: 10 mg/mL (1 mL, 2 mL, 5 mL)
Liquid, as hydrochloride: 5 mg/5 mL (480 mL)
Powder for injection, as hydrochloride: (Dilaudid-HP®):
250 mg
Suppository, rectal, as hydrochloride: 3 mg (6s)
Tablet, as hydrochloride: 1 mg, 2 mg, 3 mg, 4 mg, 8 mg |
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References |
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"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.
Ferrell BA, "Pain Management in Elderly People," J Am Geriatr Soc,
1991, 39(1):64-73.
Honigberg IL, and Stewart JT,
"Radioimmunoassay of Hydromorphone and Hydrocodone in Human Plasma," J Pharm
Sci, 1980, 69(10):1171-3.
Inturrisi CE, "Narcotic Drugs," Med Clin North Am, 1982,
66(5):1061-71.
Kaiko RF, Wallenstein SL, Rogers AG, et al, "Narcotics in the Elderly,"
Med Clin North Am, 1982, 66(5):1079-89.
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