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
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