Hydromorphone HCl

A to Z Drug Facts

Hydromorphone HCl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(HIGH-droe-moRE-phone HIGH-droe-KLOR-ide)

Dilaudid, Dilaudid-HP, Dilaudid-HP Plus, Dilaudid Sterile Powder, Dilaudid-XP, Hydromorph Contin, PMS-Hydromorphone

Class: Narcotic/Analgesic

Action Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, inhibition of cough reflex, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting, and increased bladder tone.

Indications Relief of moderate to severe pain; control of persistent nonproductive cough.

Contraindications Hypersensitivity to similar compounds, depressed ventilatory function; acute asthma; diarrhea due to poisoning or toxins; patients not already receiving large amounts of parenteral narcotics; patients with respiratory depression without access to resuscitative equipment; labor.

Route/Dosage

ADULTS: PO/Tablet 2 mg q 4 to 6 hr prn; ³ 4 mg q 4 to 6 hr for more severe pain. PO/Liquid 2.5 to 10 mg q 4 to 6 hr. SC/IM 1 to 2 mg q 4 to 6 hr prn; 3 to 4 mg q 4 to 6 hr for more severe pain. IV May give slowly over 2 to 5 min. Use high potency (10 mg/ml) only for patients tolerant to other opiates. PR 3 mg q 6 to 8 hr. Antitussive: PO 1 mg q 3 to 4 hr prn.

Interactions

CNS depressants (eg, tranquilizers, sedatives, alcohol): Additive CNS depression. Barbiturate anesthetics: May have additive effects.

Lab Test Interferences Increased amylase and lipase may occur up to 24 hr after dose.

Adverse Reactions

CV: Hypotension; orthostatic hypotension; bradycardia; tachycardia. CNS: Lightheadedness; dizziness; sedation; disorientation; incoordination; lethargy; anxiety. DERM: Sweating; pruritus; urticaria. GI: Nausea; vomiting; constipation; abdominal pain. GU: Urinary retention or hesitancy. RESP: Respiratory depression; laryngospasm; depression of cough reflex. OTHER: Tolerance; psychological and physical dependence with chronic use.

Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Special risk patients: Use with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume or circulatory shock. Drug dependence: Hydromorphone has abuse potential. Hepatic or renal impairment: May need to reduce dose.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer before pain becomes severe.
Give medication with food.
If vomiting occurs, administer with antiemetic.
Store at room temperature and protect from light.

Assessment/Interventions

Obtain complete patient history, including drug history and any known allergies.
Assess vital signs before and periodically after administration. If hypotension, bradycardia, bradypnea, or difficulty in breathing occurs, notify health care provider.
Monitor I & O and check for urinary retention.
Monitor for orthostatic hypotension and supervise ambulation.
Encourage coughing and deep breathing in patients with pulmonary problems.
Monitor bowel function. If decreased bowel sounds or abdominal distention occur, notify health care provider.
Check for reduced dosage in patients with impaired renal and liver function.

OVERDOSAGE: SIGNS & SYMPTOMS
	Miosis, respiratory and CNS depression, apnea, bradycardia, hypotension, circulatory collapse, seizures, cardiopulmonary arrest, death

Patient/Family Education

Instruct patient to take medication before pain becomes severe.
Advise patient to take medication with food or milk to decrease stomach upset.
Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
Advise patient to eat high-fiber diet and to maintain adequate fluid intake. A stool softener or bulk laxative may be recommended to prevent constipation.
Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
Instruct patient to discontinue drug and notify health care provider if difficulty in breathing or persistent nausea, vomiting or constipation occurs.
When medication is used for acute pain, caution patient about potential for addiction and explain that medication should be for short-term use only.