Hydromorphone

FDA label

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Renal Start at 1/4 to 1/2 usual starting dose per degree of impairment

Hepatic Start at 1/4 to 1/2 usual starting dose per degree of impairment; severe impairment not studied

When converting from another opioid, start at ~half the usual dose

Instructions

• Use lowest effective dose for shortest duration
• Supplemental dose 5-15% of total daily dose q2h PRN
• Do not stop abruptly in physically dependent patients; taper ~10-25% every 2-4 weeks
• Ensure access to an opioid overdose reversal agent (naloxone/nalmefene)

Contraindications

• Significant respiratory depression
• Acute or severe bronchial asthma (unmonitored / no resuscitative equipment)
• Known or suspected GI obstruction, including paralytic ileus
• Known sulfite hypersensitivity

Cautions

• Opioid-induced hyperalgesia/allodynia
• Respiratory depression in COPD, elderly, cachectic, or debilitated patients
• Adrenal insufficiency
• Severe hypotension; avoid in circulatory shock
• Avoid with increased ICP, brain tumor, head injury, or impaired consciousness
• Serotonin syndrome with serotonergic drugs
• Seizures

Adverse reactions

• Lightheadedness, dizziness, sedation
• Nausea, vomiting
• Sweating, flushing
• Dysphoria/euphoria, dry mouth
• Pruritus
• Constipation

Pregnancy No human data; prolonged use may cause neonatal opioid withdrawal syndrome; not recommended during labor

Lactation Low levels in human milk; monitor infant for sedation and respiratory depression