Other Names/Brands

Jurnista, Dilaudid, Hydromorph Contin, Dilaudid-HP, Exalgo, and Palladone

Mechanism of Action

Hydromorphone is a powerful analgesic drug belonging to the opioid class. It works by binding to opioid receptors in the brain and spinal cord, particularly the mu (µ) receptors, which play a role in regulating pain.

When hydromorphone binds to these receptors, it inhibits the transmission of pain signals in the central nervous system, thereby reducing the perception of pain. In addition to reducing pain, hydromorphone can also cause sedation and euphoria, and in high doses, respiratory depression.

Indications

Hydromorphone is indicated for the treatment of moderate to severe pain that cannot be controlled with non-opioid analgesics or weaker opioids. This medication is often used in patients with acute postoperative pain, cancer pain, or severe chronic pain that requires long-term opioid management.

Due to its potent action and effects, hydromorphone is usually prescribed when patients require more intensive pain control and is only used under close medical supervision to prevent the risk of abuse, dependence, and serious side effects.

Contraindications

Hydromorphone is contraindicated in patients with hypersensitivity to hydromorphone or other opioids, as well as in those experiencing severe respiratory depression without ventilatory support.

This medication should also not be administered to patients with airway obstruction, such as in acute asthma, or severe gastrointestinal disorders such as paralytic ileus. Furthermore, hydromorphone should be avoided in patients with head trauma, increased intracranial pressure, or severe liver or kidney dysfunction, as it may worsen these conditions.

Administration to pregnant or breastfeeding women should also be considered with extreme caution due to the risk to the fetus or infant

Side Effects

Hydromorphone can cause a variety of side effects, both mild and serious. Common side effects include nausea, vomiting, constipation, dizziness, drowsiness, and headache. Because of its potent opioid properties, hydromorphone can also cause respiratory depression, especially at high doses or with prolonged use.

Other possible effects include hypotension, confusion, euphoria, or allergic reactions. Long-term use can lead to tolerance, physical dependence, and the risk of addiction. Therefore, close monitoring is essential during use of this medication, especially in patients with a history of respiratory disorders or drug abuse.

Preparations

Hydromorphone is available in various dosage forms to suit patients' clinical needs. Common dosage forms include oral tablets (both immediate-release and extended-release), oral solution, injection (intravenous, intramuscular, or subcutaneous), and rectal suppositories.

Immediate-release tablets are used to treat acute pain requiring rapid pain relief.

Extended-release tablets are intended for patients with chronic pain who require long-term pain control.

Injectables are typically used in hospitals for the treatment of severe pain that cannot be controlled orally. The choice of dosage form should be tailored to the patient's clinical condition, pain level, and ability to take the medication orally.

Dosage

The dosage of hydromorphone depends largely on the severity of pain, the route of administration (oral, injection, or rectal), the patient's opioid tolerance, and kidney or liver condition.

• For opioid-naive adult patients, the initial oral dose is approximately 2–4 mg every 4–6 hours as needed.
• For parenteral routes (intravenous, intramuscular, or subcutaneous), the initial dose is 0.5–2 mg every 4–6 hours as needed, with IV administration usually administered slowly over 2–5 minutes.
• For long-term use and for patients who are already opioid-tolerant, an extended-release preparation is available, administered once daily, with the dose adjusted based on the patient's previous total daily opioid dose.

Safety of Drugs

Hydromorphone is classified as pregnancy category C by the FDA, meaning animal studies have shown adverse effects on the fetus, but there are no controlled studies in humans. Therefore, hydromorphone should only be used during pregnancy if the expected benefit outweighs the potential risk to the fetus.

Hydromorphone can pass into breast milk and may cause excessive sedation or respiratory depression in nursing infants. Therefore, its use in nursing mothers should be considered carefully and should be undertaken under medical supervision.

Drug Interactions

Hydromorphone can interact with various other medications that affect the central nervous system, increasing the risk of excessive sedation, respiratory depression, or other serious side effects. Medications such as benzodiazepines (e.g., diazepam), tranquilizers, antipsychotics, general anesthetics, sedative antihistamines, and alcohol can potentiate the depressant effects of hydromorphone.

Concurrent use with monoamine oxidase inhibitors (MAOIs) can cause dangerous interactions and should be avoided. Medications that affect liver enzymes, such as CYP450 inducers or inhibitors, can also affect hydromorphone metabolism, altering its effectiveness or increasing its toxicity.

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