• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), low thyroid function, or Addison's disease (low adrenal function). These conditions may require that your medicine dose, regimen, or timing be changed.

• If you have had abdominal pain or any disorder with slowed or blocked intestines, such as paralytic ileus. Hydromorphone can worsen this problem.

• If you have trouble urinating, narrow urethra, or if you have an enlarged prostate. Hydromorphone can make it harder to urinate.

• If you have ever had a seizure, head injury, or if you have had problems with pressure, infection, or a tumor in your head or brain. Hydromorphone can raise your risk of seizures.

• If you have low blood pressure. Hydromorphone can worsen this.

• If you have asthma, emphysema, chronic bronchitis, sleep apnea, or other breathing problem. Hydromorphone can make it worse.

• If you have gallstones, gallbladder disease, or pancreatitis. Hydromorphone can sometimes worsen these problems.

• If you drink alcohol or take any medicine that can affect your brain or nervous system. These may worsen the side effects of hydromorphone or cause other problems.

• If you have trouble with addiction, alcohol, or drug abuse now or have had one in the past. Hydromorphone can be habit forming, especially for those who have had problems before.

• If any family members have or have had an addiction or drug problem. Hydromorphone is sometimes stolen by or for those who have become addicted to it or similar drugs.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy, especially later in pregnancy.

• If you are breast-feeding. The drug passes into breast milk and can affect the baby.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs.

Medicines that slow down the brain or nervous system, such as other pain relievers, tranquilizers, sedatives, sleeping pills, antidepressants, muscle relaxers, antihistamines, phenothiazines, anesthetic medicines, and alcohol can cause worse side effects, such as slowed breathing, low blood pressure, extreme sleepiness, coma, or even death if taken with hydromorphone.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

The pill and liquid should be taken with a full glass of water, with or without food. You should shake the liquid before measuring the dose.

When taking a suppository, open the package and then dip the tip in water. If you are right-handed, lie down on your left side, bring your knees up near your chest, and slowly insert the suppository in your rectum about an inch. You should stay in this position for about 15 minutes, then get up and wash your hands well.

Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children, pets, and others. Take this drug exactly as directed by your doctor, or as specified by the drug label. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Be careful getting up, changing position, or walking. Get up slowly and hold onto something or someone to keep you steady. If you feel lightheaded or dizzy, it may help to lie down. It is best to have a responsible adult with you for the first day or two after starting the hydromorphone or after any increase in dose, until you know how you will respond to it.

Since hydromorphone affects the central nervous system, it is important not to take other drugs or substances that slow down the brain or nervous system such as alcohol, sedatives, muscle relaxers, and sleeping medicines unless your doctor tells you to do so.

Call your doctor right away if you have trouble breathing, get short of breath, dizzy, faint, confused, or very drowsy. These may be signs your dose is too high, or you could have gotten an accidental overdose of the medicine.

Tell your doctor or nurse right away if you have trouble passing your urine, trouble walking, or other problems.

If you are having any kind of surgery, be sure to tell the doctor or dentist in charge that you are using this medicine.

Most people on opioid pain medicines need to take a stool softener, bulk-forming agent, and a laxative to help keep bowel movements regular. Talk to your nurse or doctor about this when you first start this medicine. Drink plenty of fluids throughout the day, and try to eat foods high in fiber such as whole grains, bran, fruits, and vegetables. Call your doctor or nurse right away if you have not moved your bowels in 2 days.

Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

If you have chronic (long term) cancer pain, talk to your doctor about taking your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain comes back between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

Talk to your doctor or nurse about using the smallest effective dose to reduce side effects. Tolerance (larger doses needed to give the same effect) and physical dependence (body goes into withdrawal if drug is suddenly stopped) happen normally when strong (opioid) medicines are taken over several weeks to treat chronic pain. However, this is different from addiction, which is psychological dependence (when drug is taken for psychological effect, not for relief of pain). Tell your doctor or nurse if you still have pain despite taking the medicine as directed. Do not adjust your dose without talking to your doctor or nurse first.

Do not stop taking this medicine without talking to your doctor or nurse. When no longer needed, this medicine should be stopped gradually with the help of your doctor. If it is stopped suddenly, withdrawal symptoms may occur, such as restlessness, irritability, anxiety, runny nose, watering eyes, yawning, sweating, chills, gooseflesh, aches, nausea, vomiting, poor appetite, high blood pressure, fast heartbeat, and fast breathing.

Acetaminophen or aspirin may be taken along with hydromorphone to increase the pain relief action. It is important to know if any of your other medicines contain either of these drugs. They are in many other remedies and it is easy to accidentally get too much of them. Check with your doctor, nurse, or pharmacist to find out which of these drugs are included in your daily medicines.

If you think you or someone else may have taken an overdose of hydromorphone, get emergency help right away. Symptoms of hydromorphone overdose may include extreme drowsiness, slow heart beat, slow or irregular breathing, cold clammy skin, or coma. Hydromorphone overdose may cause the heart or breathing to stop.

• constipation*
• drowsiness*
• sedation*
• dizziness, lightheadedness*
• nausea
• dry mouth
• sweating

• mood changes
• euphoria (happiness)
• mental clouding
• slow or shallow breathing*
• vomiting
• slowed digestion
• low blood pressure when sitting up or standing*
• decreased heart rate
• itching

• small pupils in the eyes
• seizures
• trouble urinating*
• decreased sexual interest
• impotence
• bowel rupture due to constipation*

*See "Precautions" section for more detailed information.