Hydromorphone: Side Effects, Dosage, Uses, and Warnings

Highlights for hydromorphone

Oral tablet formulations of hydromorphone are offered in both their generic and brand-name forms. Brand name: Dilaudid.

In addition to being formulated into a liquid that can be taken orally, hydromorphone is also accessible in the form of a solution that may be administered intravenously by a trained medical expert.

Hydromorphone is a type of opioid that is prescribed to patients when other treatments are ineffective in managing their acute pain.

What exactly is the drug hydromorphone?

Oral tablets of hydromorphone are sold under the brand name Dilaudid. This medication is available only with a doctor’s prescription (immediate release). These tablets are also sold under their generic names in some pharmacies. The cost of generic medications is typically lower. It is possible that they do not come in the same dosage strengths or forms as their branded counterparts in some circumstances.

In addition to these, hydromorphone can also be found in the following forms:

oral liquid solution injectable solution

solution for injection that is extremely strong

Only licenced medical professionals are allowed to administer the injectable solutions.

The oral tablet form of hydromorphone is categorised as a restricted substance. This indicates that there is a potential for the substance to be abused, and it may also lead to dependence.

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Why it’s put to use

A tablet form of hydromorphone is taken orally for the treatment of severe pain that cannot be managed by any other method. People who require medication for their pain 24 hours a day, seven days a week will benefit from using the extended-release tablet.

It is possible to use this medication in conjunction with other treatments. Because of this, it is possible that you will need to combine it with other medications.

The workings of it

The hydromorphone oral tablet is classified as an opioid analgesic medication, which is a class of medications. A group of different pharmaceuticals that share a common mode of action is referred to as a class of drugs. These medications are frequently prescribed to address illnesses that are analogous to one another.

It is not quite clear how exactly this medication relieves pain in the body. It does this by activating specific opioid receptors in the brain and spinal cord, both of which are part of your central nervous system. This may result in a reduction of pain.

The oral tablet form of hydromorphone might lead to feelings of tiredness and lightheadedness. In the first few hours after taking it, the likelihood of experiencing these symptoms may be higher. There may be more adverse effects associated with this medication.

Hydromorphone’s adverse effects on the body

Hydromorphone may result in adverse consequences ranging from minor to severe. The list that follows provides examples of some of the most common adverse reactions that could take place as a result of ingesting hydromorphone. This list does not contain all of the potentially adverse effects.

Talk to your healthcare provider or pharmacist if you would like further information about the potential adverse effects of hydromorphone or advice on how to cope with an adverse event that causes you concern.

More common side effects

The following are some of the more prevalent adverse effects that may be caused by this medication:

lightheadedness

dizziness \sdrowsiness

nausea

vomiting

symptoms such as perspiration, flushing, skin reddening and warmth, euphoria, or a general feeling of well-being

Itchiness caused by dry mouth

In the event that these side effects are not severe, it is possible that they will disappear in a matter of days or weeks. Talk to your primary care physician or your pharmacist if they become more severe or if they do not go away.

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Serious adverse effects may result.

If you are experiencing major adverse effects, you should contact your physician as soon as possible. If your symptoms appear to be life-threatening or if you believe you may be experiencing a medical emergency, you should call 911 or the emergency services in your area immediately.

The following is a list of potentially serious side effects and the symptoms they cause:

Problems with the heart There is a possibility that symptoms will include a very fast or extremely slow heart rate.

faster pulse

chest pain

Alterations to the eye or the vision Having difficulty seeing or having fuzzy vision are two possible symptoms.

double vision

tiny pupils that look like pinpoints

Stomach issues. Constipation is one of the possible symptoms.

stomach discomfort

intestinal obstruction, which can lead to the following:

nausea

vomiting inability to pass gas or stool

issues affecting both the nervous system and the muscles. Headaches, tremors, and other involuntary muscular movements are some of the possible symptoms.

Eye movements that are peculiar or involuntary, a tingling or prickling feeling on your skin, and/or a strange smell coming from your nose.

Alterations in mood or behaviour take place. Anxiety and agitation are two of the possible symptoms.

anxiety \sdepression

hallucinations are defined as the experience of seeing or hearing something that isn’t actually present.

disorientation

problem sleeping

bizarre dreams

Blood pressure changes. Flushing, high or low blood pressure and irregular heartbeat are all possible symptoms.

Insufficiency of the adrenal glands. Some of the symptoms include persistent feelings of exhaustion.

a lack of muscle strength

a discomfort in your stomach

Androgen deficiency. Symptoms may include things like fatigue.

problem sleeping

decreased amount of energy

Extreme drowsiness

Having difficulty breathing or feeling short of breath

Instructions for administering hydromorphone

The dosage of hydromorphone that your physician recommends for you will be based on a number of different factors. These may include the following:

the kind and severity of the problem you are trying to treat with hydromorphone, as well as your age and the specific formulation of hydromorphone that you are using, as well as any other preexisting medical issues that you may have.

In most cases, your physician will begin treatment with a low dosage and gradually increase it until they reach the level that is appropriate for you. In the end, they will prescribe the lowest possible dosage that still achieves the desired effect.

When prescribing, dispensing, and administering this medication, be sure to ensure that all of the details are correct. Accidental overdose and death can occur as a result of dosing errors brought on by confusion between the “mg” and “mL” units of measurement.

The material that follows provides a description of dosages that are typically employed or suggested. However, make sure to take the dosage that was prescribed for you by your medical professional. Your physician will calculate the correct dosage for you based on your individual requirements.

Structures and capabilities

Abbreviated Form: Hydromorphone Hydrochloride

Tablets to be taken orally.

Strengths: 2 milligrammes (mg), 4 mg, 8 mg

Extended-release tablets that are taken orally (24-hour abuse deterrent)

Strengths: 8 mg, 12 mg, 16 mg, 32 mg

Brand: Dilaudid

Tablets to be taken orally.

Strengths: 2 mg, 4 mg, 8 mg

Extended-release tablets that are taken orally

Strengths: 8 mg, 12 mg, 16 mg, 32 mg

Dosage for extreme pain

Adult dosage (ages 18–64 years)

Tablets to be taken by mouth: The recommended initial dosage range is 2–4 mg, taken once every 4–6 hours.

Extended-release oral tablet: Only for use in patients who have developed a tolerance to opioids.

People are said to have developed tolerance to opioids if they have been getting the following for at least one week:

60 milligrammes (mg) of morphine taken orally every day 25 micrograms (mcg) of fentanyl administered transdermally every hour

30 milligrammes of oxycodone orally once daily, 8 milligrammes of hydromorphone orally once daily, 25 milligrammes of oxymorphone orally once daily, 60 milligrammes of hydrocodone orally once daily, or an equivalent analgesic dose of another opioid

Your physician will advise you on the appropriate amount of hydromorphone to take for your condition. If necessary, they could bump up your dosage by four to eight milligrammes every three to four days.

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Child dose (ages 0–17 years)

Children have not been the focus of any studies regarding this medicine. Individuals who are younger than 18 years old should not be given it.

Senior dosage (ages 65 years and older)

It’s possible that kidney function declines with age, particularly in elderly persons. This may result in a decreased rate of medication elimination from your body. As a consequence of this, a greater quantity of medicine is retained in your body for a longer period of time. This increases the likelihood that you will experience side effects.

Your primary care physician can decide to start you on a reduced dose or a different schedule. This can help prevent dangerously high quantities of this substance from developing inside of your body in the first place.

Special considerations

Patients suffering from the renal disease: It’s possible that your doctor will start you off on a dose that’s anywhere from 25 percent to 50 percent lower than the average starting dose.

Patients who have liver illness may have their initial dose reduced by anywhere from 25 to 50 percent compared to the normal starting dose. If you have serious problems with your liver, your doctor may decide to use different medication to treat your pain rather than the extended-release tablet, or they may reduce the dosage of one of the other forms of this medication that they prescribe to you.

Take as directed

The oral tablet form of hydromorphone is typically only taken for a brief period of time. If you don’t take this medication exactly as directed, you put yourself at considerable risk.

If you suddenly stop taking the medication or if you don’t take it at all, the likelihood is that your pain will not improve.

If you skip doses or don’t take the prescription according to the prescribed schedule, the effects of your medication may be diminished or they may even stop working entirely. In order for this medication to perform properly, there must always be a specific quantity present in the body.

If you take an excessive amount of the medicine, you run the risk of having unsafe quantities of it in your body. The following are some of the symptoms that may accompany an overdose of this drug:

considerable difficulties with breathing

extreme drowsiness

a temporary lapse in consciousness

the sluggish beating of the heart

a lowering in the blood pressure

Confusion between milligrammes and millilitres can lead to dosing errors, which can lead to unintentional overdose and even death.

Call your physician immediately if you believe that you have taken an unsafe amount of this medication, or consult the American Association of Poison Control Centers at 800-222-1222 or use the resource that they provide on their website. If your symptoms are severe, however, you should immediately contact 911 or the emergency medical services in your area, or go to the emergency room that is located closest to you.

In the event that you forget to take a dose, you should take it as soon as you realise it. If you only remember a few hours before your next scheduled dose, then you should only take that dose. Under no circumstances should you attempt to catch up by taking two doses at once. Because of this, potentially harmful consequences could arise.

How to tell if the medicine is having the desired effect: It’s possible that your discomfort will be better controlled.

Warnings regarding hydromorphone

This medication comes with a number of precautions.

Boxed warnings have been issued by the FDA in relation to this medication. The Food and Drug Administration’s most serious warning is called a boxed warning (FDA). It serves to warn both medical professionals and patients about potential adverse pharmacological effects.

Serious difficulties with breathing Taking this medication may put you at an increased risk for developing breathing difficulties that could prove fatal. People of advanced age, those who have respiratory conditions, and those who have many health conditions may be at a greater risk.

The potential for errors in medication: When prescribing, distributing, and administering this medication, precision is of the utmost importance. It is possible for a person to accidentally overdose and die as a result of dosing errors brought on by confusion between milligrammes and millilitres.

Warning for the use of alcohol, narcotic medications, and other sedative-hypnotic drugs: Using this medication in conjunction with alcohol, opioid drugs, or other sedative-hypnotic drugs may result in serious breathing issues. These could prove to be lethal (cause death).

Addiction, abuse, and improper use of substances a word of caution: the use of hydromorphone puts patients and other users at risk for developing an addiction to opioids, as well as abusing or misusing them, which can result in overdose and death.

Because of the potential for misuse and addiction associated with this medication, the Food and Drug Administration (FDA) mandates that the drug’s producer implement a risk evaluation and mitigation strategy (REMS) programme. Your healthcare professional is required to participate in educational sessions developed by the pharmaceutical company because of the requirements of this REMS programme. These programmes must cover the appropriate and efficient use of opioids.

Accidental ingestion warning: Even if only one dose of hydromorphone is accidentally ingested, this might result in a deadly overdose of hydromorphone if it is taken by someone who is not used to taking it.

Opioid withdrawal in newborn newborns is a potential risk if the mother consumes the drug for an extended period of time while pregnant. This increases the likelihood that the baby will develop opioid withdrawal syndrome. This presents a significant risk to the infant’s survival. Irritability, hyperactivity, and an atypical sleep pattern might be symptoms of withdrawal. Other symptoms include high-pitched cries, tremors, vomiting, diarrhoea, and an inability to gain weight.

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Warning signs of low blood pressure

It is possible that this medication will induce a sudden reduction in blood pressure. This could lead to lightheadedness, vertigo, or even fainting in some people.

If you have a low blood volume and have problems maintaining healthy blood pressure, then your risk may be significantly increased. If you take certain medications, there is a possibility that your risk will be increased. Phenothiazines and general anaesthetics are two examples of these types of medications.

Caution: allergens present

This medication has the potential to trigger a severe allergic reaction. Symptoms may include the following:

a rash itching all over difficulty breathing swelling in your throat or tongue hives

In the event that you have an allergic reaction, you should contact either your physician or the local poison control center as soon as possible. If you are experiencing severe symptoms, you should phone 911 or your local emergency medical services, or go to the emergency room that is located closest to you.

If you have ever experienced an adverse reaction to this medication, you should never take it again. Taking it once again could be your last tragic mistake (cause death).

Caution regarding alcohol and drug interactions

Consuming alcohol while taking this medication may increase the likelihood that you will have adverse effects. Problems with breathing, low blood pressure, excessive lethargy, and even coma can be among these side effects. Talk to your healthcare provider if you are an alcoholic.

Warnings for individuals who have the following health conditions:

People who have had head trauma and have higher than normal head pressure: This medication has the potential to raise the pressure inside the skull (blood pressure in your brain). This could perhaps make your problem even more severe. Inquire with your primary care physician regarding the possible risks associated with using this medication.

For patients who have the liver disease: If you have a history of liver disease or if you now suffer from liver disease, it is possible that you will not be able to process this medication well. Because of this, the drug’s concentration in your body may rise, which could result in an increased risk of adverse effects. In the event that you have significant liver problems, your physician may prescribe a lesser dosage for you.

For those who have kidney issues: If you have kidney issues or a history of kidney disease, it is possible that you will not be able to flush this medication out of your system as well as others. This may cause the levels of it found in your body to increase, which may result in greater adverse consequences.

Cautionary notes for members of other groups

Talk to your healthcare provider if you are pregnant or if you are considering becoming pregnant if you are reading this. This medication should only be taken during pregnancy if there is a possibility that the potential benefits will outweigh any possible risks to the unborn child. It is possible for a child to be born with opioid withdrawal syndrome if the mother uses this substance for an extended period of time while they are pregnant. This presents a significant risk to the infant’s survival. If you become pregnant while using this medication, you should contact your healthcare provider as soon as possible.

For mothers who are nursing their children, please be aware that this medication has the potential to enter the breast milk and have adverse effects on children who are nursed. If you are breastfeeding your child, you should discuss this with your physician. It is possible that you will need to make a choice between discontinuing nursing and terminating treatment with this medicine.

Those who are senior citizens may find that their kidneys may not function as well as they did in their younger years. This may result in a decreased rate of medication elimination from your body. As a consequence of this, a greater quantity of medicine is retained in your body for a longer period of time. This increases the likelihood that you will experience side effects.

Regarding children, it is important to note that this medicine has not been tested on children. Individuals who are younger than 18 years old should not be given it. It is possible for a youngster to mistakenly consume this medication, which can result in an overdose. This can result in death (cause death).

There is a possibility that hydromorphone will interact with other drugs.

It’s possible that the hydromorphone oral tablet you take could interact with any medicines, vitamins, or herbs you’re already taking. When one substance alters the functioning of another, this is known as an interaction. This may result in adverse effects or reduce the efficacy of the medication.

Your physician ought to properly manage all of your prescriptions for you in order to help you avoid interactions. It is imperative that you discuss any drugs, supplements, or herbs that you are currently taking with your primary care physician. Talk to your healthcare provider or pharmacist if you have any questions about how this medication might interact with other medications that you are currently taking.

The following is a list of examples of medications that may induce adverse reactions when used with hydromorphone:

Interactions that raise the possibility of you experiencing adverse effects

Enhanced manifestations of hydromorphone’s adverse effects including: When used with certain drugs, hydromorphone increases the likelihood that you will experience adverse effects. Some examples of these medications are as follows:

Benzodiazepines, including lorazepam, clonazepam, and diazepam: Combining hydromorphone with any of these sedatives may result in difficulty breathing, a reduction in blood pressure, and excessive sleepiness. It is also capable of causing comas and even death.

When used with hydromorphone, general anaesthetics including propofol, midazolam, and etomidate can produce breathing difficulties, a reduction in blood pressure, as well as significant drowsiness. It is also possible for it to produce a coma.

When used with hydromorphone, the side effects of the medications prochlorperazine, promethazine, and chlorpromazine include difficulty breathing, a drop in blood pressure, and excessive sleepiness. It is also possible for it to produce a coma.

MAOIs, also known as monoamine oxidase inhibitors, include phenelzine, tranylcypromine, isocarboxazid, and selegiline. Taking MAOIs can significantly raise the risk of hydromorphone poisoning (having dangerous levels of the drug in your body). If you are currently being treated with an MAOI or are within 14 days of having finished treatment with an MAOI, you should not use hydromorphone.

When used with hydromorphone, anticholinergic medicines such as diphenhydramine, solifenacin, tolterodine, and benztropine might result in urinary retention (difficulty passing urine), severe constipation, and intestinal blockage.

An increase in the adverse effects caused by other drugs: Combining hydromorphone with some other medications increases the likelihood that you will experience adverse reactions to other medications. Some examples of these medications are as follows:

Antidepressant medications that are classified as serotonergic include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Combining hydromorphone with several other medicines may result in serotonin syndrome, which is a potentially lethal condition. Symptoms may include the following:

agitation

clammy skin twitching muscles disorientation

Interactions between your medications can make them less effective.

It is possible that the therapeutic effects of hydromorphone will be diminished when used with other medications in the treatment of your illness. This is because there is a possibility that the amount of hydromorphone present in your body will decrease. Some examples of these medications are as follows:

Pentazocine, nalbuphine, butorphanol, and buprenorphine are examples of medicines that, when combined with hydromorphone, have the potential to trigger withdrawal symptoms associated with opioids. If you have been abusing hydromorphone for an extended period of time, this is especially true.

Important things to think about before starting this medication

If your healthcare provider recommends an oral tablet form of hydromorphone for you, keep the following things in mind.

General

Take this medication while you are eating. It’s possible that this will ease the discomfort in your stomach.

Take this medication exactly as directed by your healthcare provider. This medication is not available at all pharmacies. Be sure to give your pharmacy a call ahead of time when you need your prescription filled.

The immediate-release pill can be sliced, crushed, or broken into many pieces. It is important that the extended-release pill not be sliced or crushed in any way.

Storage

This medication should be kept at room temperature, which is between 59 and 86 degrees Fahrenheit (15 and 30 degrees Celsius).

Keep this medication in a dark, secure location.

Do not store this medication in the bathroom or any other place that has a high humidity level.

Refills

An already filled prescription for this drug cannot be altered in any way. If you or your pharmacist need a new prescription for this medication, you will need to get in touch with your physician to make the necessary arrangements.

 

Travel

If you are going to travel with your medication, you should:

Always ensure that you have your medication on you. When flying, you should under never circumstances put it in a checked bag. Keep it in the carry-on bag you’re using.

Do not be concerned about being screened by X-ray equipment at the airport. They are unable to affect the medication you are taking.

It’s possible that airport employees will ask to see the pharmacy label for the medication you’re carrying with you. Always make sure you have the original container with the prescription label on it.

Do not store this medication in the glove compartment of your vehicle, nor should you leave it in the vehicle unattended. Make it a point to steer clear of doing this when the temperature is either hot or extremely cold.

Clinical monitoring

During the course of your therapy, your physician may monitor many aspects of your health. While you are taking this medication, this can assist ensure that you remain safe. These concerns include the following:

The function of the Kidneys: If your doctor is concerned about how well your kidneys are functioning, he or she may order blood tests. Your dosage of this medication may need to be adjusted if your kidneys aren’t functioning as they should be.

The function of the liver: Your physician may order blood tests to evaluate how well your liver is working. If your liver isn’t functioning properly, your doctor may reduce your dosage or recommend that you stop using this medication altogether.

Your doctor will keep an eye on both your heart rate and blood pressure to make sure everything is in order. If your blood pressure drops to an unsafe level, your physician may reduce your dosage or discontinue treatment with this medication altogether.

Your doctor will keep an eye on your respiratory rate as he or she examines you. If you experience difficulty breathing while taking this medication, your physician may reduce your dosage or recommend that you stop using it altogether.

Authorization in advance

This medication must first obtain prior authorization from the majority of insurance carriers. That means your doctor will need to gain clearance from your insurance company before your insurance company will pay for the medication.

Are there any other options available?

There are additional medications that can be used to treat your illness. It’s possible that some will work better for you than others. Talk to your healthcare provider about the possibility of trying out other medications to see if any of them help.