Hydromorphone

Hydromorphone Brand Names

Dilaudid | Dilaudid-HP | Exalgo | Palladone | Simplist Dilaudid

What is Hydromorphone

Hydromorphone is an opioid agonist of the phenanthrene class; hydromorphone is a hydrogenated ketone, semisynthetic analog of morphine.

Hydromorphone, which is available in multiple dosage forms, is used to relieve moderate to severe pain.

Hydromorphone may be useful in elderly patients and patients with renal dysfunction as opposed to morphine, which has an active metabolite that is renally excreted.

Hydromorphone has a more rapid onset of analgesia than morphine, but its duration of action is usually shorter and may limit its use in patients with chronic pain.

Hydromorphone was initially marketed before 1962.

In March 2010, the FDA approved an extended-release tablet formulation of hydromorphone (Exalgo).

Indications

1. moderate pain
2. sedation maintenance
3. severe pain

Side Effects

1. abdominal pain
2. adrenocortical insufficiency
3. agitation
4. amenorrhea
5. anaphylactoid reactions
6. anorexia
7. anxiety
8. apnea
9. appetite stimulation
10. arthralgia
11. asthenia
12. back pain
13. bezoar
14. biliary obstruction
15. blurred vision
16. bradycardia
17. bronchospasm
18. cardiac arrest
19. chest pain (unspecified)
20. chills
21. confusion
22. constipation
23. dehydration
24. depression
25. diaphoresis
26. diarrhea
27. diplopia
28. dizziness
29. drowsiness
30. dysarthria
31. dysgeusia
32. dyskinesia
33. dyspepsia
34. dysphagia
35. dysphoria
36. dyspnea
37. dysuria
38. elevated hepatic enzymes
39. encephalopathy
40. eructation
41. erythema
42. esophagitis
43. euphoria
44. fatigue
45. fever
46. flushing
47. gastroesophageal reflux
48. GI obstruction
49. GI perforation
50. gonadal suppression
51. hallucinations
52. headache
53. hemorrhoids
54. hyperalgesia
55. hyperamylasemia
56. hyperesthesia
57. hyperhidrosis
58. hyperreflexia
59. hypertension
60. hyperuricemia
61. hypoesthesia
62. hypokalemia
63. hyponatremia
64. hypotension
65. hypothermia
66. ileus
67. impaired cognition
68. impotence (erectile dysfunction)
69. increased intracranial pressure
70. increased urinary frequency
71. infertility
72. injection site reaction
73. insomnia
74. laryngospasm
75. lethargy
76. libido decrease
77. malaise
78. memory impairment
79. miosis
80. myalgia
81. myoclonia
82. nausea
83. neonatal opioid withdrawal syndrome
84. nystagmus
85. orthostatic hypotension
86. palpitations
87. pancreatitis
88. paranoia
89. paresthesias
90. peripheral edema
91. physiological dependence
92. pruritus
93. psychological dependence
94. rash
95. respiratory arrest
96. respiratory depression
97. restlessness
98. seizures
99. serotonin syndrome
100. SIADH
101. sinus tachycardia
102. suicidal ideation
103. syncope
104. tinnitus
105. tolerance
106. tremor
107. urinary retention
108. urticaria
109. vertigo
110. visual impairment
111. vomiting
112. weakness
113. weight loss
114. withdrawal
115. xerophthalmia
116. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• accidental exposure
• acute abdomen
• adrenal insufficiency
• alcoholism
• angina
• asthma
• biliary tract disease
• bladder obstruction
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• coadministration with other CNS depressants
• coma
• constipation
• cor pulmonale
• depression
• diarrhea
• driving or operating machinery
• emphysema
• epidural administration
• ethanol ingestion
• ethanol intoxication
• gallbladder disease
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypotension
• hypothyroidism
• hypovolemia
• hypoxemia
• ileus
• increased intracranial pressure
• infants
• inflammatory bowel disease
• intracranial mass
• intravenous administration
• labor
• lactase deficiency
• latex hypersensitivity
• myxedema
• neonatal opioid withdrawal syndrome
• neonates
• obesity
• obstetric delivery
• oliguria
• opiate agonist hypersensitivity
• opioid-naive patients
• orthostatic hypotension
• pancreatitis
• paraben hypersensitivity
• potential for overdose or poisoning
• pregnancy
• prostatic hypertrophy
• pulmonary disease
• renal disease
• renal impairment
• requires an experienced clinician
• respiratory depression
• respiratory insufficiency
• scoliosis
• seizure disorder
• seizures
• shock
• sleep apnea
• status asthmaticus
• substance abuse
• sulfite hypersensitivity
• surgery
• ulcerative colitis
• urethral stricture
• urinary retention

Interactions

• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Alfentanil
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alosetron
• Alprazolam
• Alvimopan
• Amide local anesthetics
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamines
• Anticholinergics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atenolol; Chlorthalidone
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Baclofen
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzonatate
• Benzphetamine
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brexpiprazole
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bumetanide
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Clemastine
• Clobazam
• Clomipramine
• Clonazepam
• Clonidine
• Clopidogrel
• Clorazepate
• Clozapine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dantrolene
• Darifenacin
• Delavirdine
• Desflurane
• Desipramine
• Desmopressin
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexpanthenol
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Promethazine
• Diazepam
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dolasetron
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Droperidol
• Eletriptan
• Eltrombopag
• Eluxadoline
• Enalapril; Hydrochlorothiazide, HCTZ
• Eprosartan; Hydrochlorothiazide, HCTZ
• Escitalopram
• Esketamine
• Estazolam
• Eszopiclone
• Ethacrynic Acid
• Ethanol
• Ethotoin
• Fenfluramine
• Fentanyl
• Fesoterodine
• Flibanserin
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Frovatriptan
• Furosemide
• Gabapentin
• General anesthetics
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanabenz
• Guanfacine
• Haloperidol
• Homatropine; Hydrocodone
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydroxyzine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
• Imipramine
• Indapamide
• Isocarboxazid
• Lasmiditan
• Lemborexant
• Levobupivacaine
• Levocetirizine
• Levomilnacipran
• Levorphanol
• Lidocaine
• Lidocaine; Prilocaine
• Lincosamides
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofexidine
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lorazepam
• Lorcaserin
• Loxapine
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Melatonin
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methyclothiazide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metoclopramide
• Metolazone
• Metyrapone
• Metyrosine
• Midazolam
• Milnacipran
• Minocycline
• Mirtazapine
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nalbuphine
• Naloxone
• Naltrexone
• Naproxen; Sumatriptan
• Naratriptan
• Nefazodone
• Nesiritide, BNP
• Nitroglycerin
• Nortriptyline
• Octreotide
• Olanzapine
• Ondansetron
• Orphenadrine
• Oxazepam
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Papaverine
• Paroxetine
• Pegvisomant
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pramipexole
• Pramlintide
• Prasugrel
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Primidone
• Procaine
• Procarbazine
• Prochlorperazine
• Promethazine
• Propoxyphene
• Protriptyline
• Quazepam
• Quetiapine
• Ramelteon
• Rasagiline
• Remifentanil
• Risperidone
• Rizatriptan
• Ropinirole
• Ropivacaine
• Rotigotine
• Safinamide
• Secobarbital
• Selegiline
• Serotonin-Receptor Agonists
• Serotonin-Receptor Antagonists
• Sertraline
• Sibutramine
• Sildenafil
• Skeletal Muscle Relaxants
• Sodium Oxybate
• Solifenacin
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sumatriptan
• Suvorexant
• Tapentadol
• Tasimelteon
• Tedizolid
• Temazepam
• Tetrabenazine
• Tetracaine
• Thalidomide
• Thiazide diuretics
• Thiopental
• Thioridazine
• Thiothixene
• Ticagrelor
• Tizanidine
• Tolterodine
• Torsemide
• Tramadol
• Tranylcypromine
• Trazodone
• Triamterene
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Venlafaxine
• Vigabatrin
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolmitriptan
• Zolpidem