Home Drug Guide Hydromorphone Hydrochloride

Drug Guide

Generic Name

Hydromorphone Hydrochloride

Brand Names Dilaudid-hp, Dilaudid, Palladone, Exalgo

Classification

Therapeutic: Analgesic, Opioid

Pharmacological: Opioid Receptor Agonist

FDA Approved Indications

Moderate to severe pain management

Mechanism of Action

Hydromorphone binds primarily to mu-opioid receptors in the central nervous system, altering the perception and response to pain.

Dosage and Administration

Adult: Typically, 2-4 mg orally every 4-6 hours as needed; IV dose varies based on clinical judgment.

Pediatric: Use is generally discouraged due to risk of respiratory depression.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Adjust dose considering reduced clearance; cautious use recommended.

Hepatic Impairment: Modify dose as hepatic metabolism is affected.

Pharmacokinetics

Absorption: Well absorbed orally; rapid onset when given parenterally.

Distribution: Widely distributed, crosses blood-brain barrier, crosses placenta.

Metabolism: Metabolized in the liver via conjugation to hydromorphone-3-glucuronide.

Excretion: Excreted primarily in urine.

Half Life: Approximately 2-3 hours.

Contraindications

Hypersensitivity to hydromorphone or any opioids.
Acute respiratory depression.
Severe asthma.

Precautions

Use with caution in patients with respiratory depression, head injury, increased intracranial pressure, multiple opioid use, or in elderly and patients with hepatic or renal impairment.
Pregnancy/Lactation: Use only if benefits outweigh risks; crosses placenta and is excreted in breast milk.

Adverse Reactions - Common

Drowsiness (Common)
Nausea (Common)
Constipation (Common)
Dizziness (Common)

Adverse Reactions - Serious

Respiratory depression (Serious)
Hypotension (Serious)
Addiction, overdose, death (Serious)

Drug-Drug Interactions

CNS depressants (benzodiazepines, alcohol)
MAO inhibitors
Other opioids

Drug-Food Interactions

Alcohol (increases sedation and respiratory depression)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess pain level and respiratory status before and during therapy.

Diagnoses:

Acute pain
Risk for respiratory depression

Implementation: Administer drug as prescribed; monitor for adverse effects; use the lowest effective dose.

Evaluation: Evaluate pain relief and monitor for signs of toxicity or adverse reactions.

Patient/Family Teaching

Take medication exactly as prescribed.
Avoid alcohol and other CNS depressants.
Report signs of respiratory depression, excessive sedation, or allergic reactions.
Use caution when driving or operating machinery.

Special Considerations

Black Box Warnings:

Addiction, abuse, and codevelopment of overdose leading to death.
Risks related to use during pregnancy and in breastfeeding.
Respiratory depression risk.

Genetic Factors: Genetic variations may affect metabolism and response.

Lab Test Interference: May cause increase in liver enzymes, but generally no significant interference.

Overdose Management

Signs/Symptoms: Respiratory depression, pinpoint pupils, unconsciousness, cold/clammy skin.

Treatment: Administer opioid antagonist (naloxone), support airway, breathing, and circulation; provide symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.