HYDROMORPHONE HYDROCHLORIDE
(hye-droe-mor'fone)
Dilaudid, Dilaudid-HP
Classifications: central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Prototype: Morphine
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

1 mg, 2 mg, 3 mg, 4 mg, 8 mg tablets; 12 mg, 16 mg, 24 mg, 32 mg extended-release capsules; 5 mg/5 mL oral liquid; 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL injection; 3 mg suppositories

Actions

Semisynthetic derivative structurally similar to morphine but with 8–10 times more potent analgesic effect. Has more rapid onset and shorter duration of action than morphine and is reported to have less hypnotic action and less tendency to produce nausea and vomiting.

Therapeutic Effects

Is a narcotic analgesic which controls mild to moderate pain. Has antitussive properties.

Uses

Relief of moderate to severe pain and control of persistent nonproductive cough.

Contraindications

Intolerance to opiate agonists; pregnancy (category C), acute bronchial asthma, COPD, upper airway obstruction, decreased respiratory reserve, severe respiratory depression, opiate-naïve patients.

Cautious Use

Abrupt discontinuation, alcoholism; angina; biliary tract disease; older adults; epidural administration; GI disease, GI obstruction; head trauma; heart failure; hepatic disease; hypotension, hypovolemia, oliguria, prostatic hypertrophy; pulmonary disease; renal disease, renal impairment; paralytic ileus; increased intracranial pressure; inflammatory bowel disease; labor; latex hypersensitivity; obstetric delivery; bladder obstruction; cardiac arrhythmias, cardiac disease; respiratory depression; seizure disorder, seizures; substance abuse; surgery; ulcerative colitis; urethral stricture, urinary retention; lactation, neonates, and infants <6 mo.

Route & Dosage

Moderate to Severe Pain
Adult: PO/SC/IM/IV 1–4 mg q4–6h prn. Extended release 12–32 mg q24h (see prescribing information for conversion from other opioid analgesics) Rectal 3 mg q4–6h
Child: PO 0.03–0.08 mg/kg q4–6h (max: 5 mg/dose) IV 0.015 mg/kg q4–6h

Antitussive
Adult: PO 1 mg q3–4h prn
Child: PO 6–12 y, 0.5 mg q3–4h prn

Administration

Note: A fixed schedule when narcotic therapy is initiated provides more effective management than a prn schedule.

Intravenous

IV administration to infants, children: Verify correct IV concentration and rate of infusion with physician.

PREPARE: Direct: Dilute each dose in at least 5 mL of sterile water or NS. IV Infusion: Using Dilaudid-HP, reconstitute 250 mg dry powder vial immediately prior to use with 25 mL sterile water for injection to yield 10 mg/mL. Final dilution of Dilaudid-HP 250 and HP 500 (supplied 500 mg/50 mL) must be ordered by physician.

ADMINISTER: Direct: Give 2 mg or fraction thereof over 3–5 min. IV Infusion: Both final volume and rate of infusion must be ordered by physician.

INCOMPATIBILITIES Solution/additive: Prochlorperazine, sodium bicarbonate, thiopental. Y-site: Minocycline, prochlorperazine, tetracycline.

A slight discoloration in ampules or multidose vials causes no loss of potency.
Store in tight, light-resistant containers at 15°–30° C (59°–86° F).

Adverse Effects (1%)

GI: Nausea, vomiting, constipation. CNS: Euphoria, dizziness, sedation, drowsiness. CV: Hypotension, bradycardia or tachycardia. Respiratory: Respiratory depression. Special Senses: Blurred vision.

Interactions

Drug: Alcohol and other cns depressants compound sedation and CNS depression. Herbal: St. John's wort may increase sedation.

Pharmacokinetics

Absorption: 60% absorbed from GI tract. Onset: 15 min IV, 30 min PO/rectal. Peak: 30–90 min. Duration: 3–4 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: Excreted in urine. Half-life: 2–3 h; 18 h extended release.

Nursing Implications

Assessment & Drug Effects

Note baseline respiratory rate, rhythm, and depth and size of pupils before administration. Respirations of 12/min or less and mitosis are signs of toxicity. Withhold drug and promptly notify physician.
Monitor vital signs at regular intervals. Drug-induced respiratory depression may occur even with small doses and increases progressively with higher doses.
Assess effectiveness of pain relief 30 min after medication administration.
Monitor drug effects carefully in older adult or debilitated patients and those with impaired renal and hepatic function.
Assess effectiveness of cough. Drug depresses cough and sigh reflexes and may induce atelectasis, especially in postoperative patients and those with pulmonary disease.
Note: Nausea and orthostatic hypotension most often occur in ambulatory patients or when a supine patient assumes the head-up position.
Monitor I&O ratio and pattern. Assess lower abdomen for bladder distension. Report oliguria or urinary retention.
Monitor bowel pattern; drug-induced constipation may require treatment.

Patient & Family Education

Request medication at the onset of pain and do not wait until pain is severe.
Use caution with activities requiring alertness; drug may cause drowsiness, dizziness, and blurred vision.
Avoid alcohol and other CNS depressants while taking this drug.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug