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Hydromorphone

(hy-droh-mor-own)

Trade/other name(s): Dilaudid, Dilaudid HP, Exalgo

Why would this drug be used?

Hydromorphone is used to relieve moderate to severe pain.

How does this drug work?

Hydromorphone is an opioid pain reliever, similar to morphine. It binds to opioid receptors in the brain and central nervous system (CNS), reducing the perception of pain as well as the emotional response to pain.

Before taking this medicine

Tell your doctor…

  • 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 passing urine, 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 and even cause breathing to stop.
  • 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 you have serious mental illness or delirium tremens (severe alcohol withdrawal symptoms) you may have more problems on hydromorphone.
  • 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. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Buprenorphine (Subutex, Suboxone), butorphanol (Stadol), nalbuphine (Nubain), or pentazocine (Talwin, Talacen) may reduce the effectiveness of hydromorphone.

Medicines or substances that slow down the brain or nervous system, such as these, can cause worse side effects if taken with hydromorphone:

  • Anti-anxiety drugs (tranquilizers or sedatives)
  • Sleeping pills
  • Muscle relaxers
  • Barbiturates
  • Anti-seizure medicines
  • Other opioid drugs
  • Anesthetics
  • Antidepressants such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline
  • Anti-psychotic drugs
  • Certain anti-nausea medicines
  • Alcohol and drugs that contain alcohol

Some of these can cause 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.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem. Do not drink alcohol while taking this medicine.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Hydromorphone can be given by mouth as a pill, rectal suppository, or a liquid. It can also be given as an injection under the skin or in a vein as a short infusion or a continuous infusion with extra medicine that you can take when needed (patient controlled analgesia or PCA). Your doctor may start you on a low dose and slowly increase it over a few days or weeks. The dose will depend on how you respond to the drug, and how well the medicine controls your pain.

The pill and liquid should be taken with a full glass of water. You should shake the liquid before measuring the dose. If it upsets your stomach, take it with food.

If you are taking the extended-released pill (Exalgo), do not crush, chew, split, break, melt, dissolve. These pills contain enough medicine for the whole day. If they are chewed, dissolved, or crushed, the entire dose can be absorbed by the body all at once, causing overdose symptoms such as trouble breathing and even death.

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.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Store the medicine in a tightly closed container away from heat and moisture and safely away from children, pets, and others. Flush unused medicine down the toilet. Do not let others take your medicine.

Precautions

This medicine can cause drowsiness and lightheadedness. Do not drive, operate machinery, or perform other activities that require alertness until you know how you react to this medicine.

Hydromorphone can make you feel dizzy or faint, and increase your risk of falling. 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, do not 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, feel very drowsy, or start seeing or hearing things that aren't there. 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, vision problems, fainting, trouble swallowing, 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.

Constipation is a very common side effect of taking opioid pain medicines. While you're taking hydromorphone, you should take medicines such as stool softeners, bulk-forming agents, and/or laxatives as needed to have regular (daily) bowel movements. 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 and the development of tolerance and physical dependence. Tolerance means that larger doses needed to give the same pain relief. Physical dependence means that the body goes into withdrawal if drug is suddenly stopped. Both of these happen normally when strong (opioid) medicines are taken over several weeks to treat chronic pain. But this is different from addiction, which starts when the drug is taken for pleasure, not for pain relief. 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 too quickly or the dose reduced too much, you can have withdrawal symptoms 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.

This drug is a controlled substance, and may be habit forming. Do not allow others to take your medicine. A person who has taken hydromorphone for some time often needs large doses for pain relief, while the same amount could quickly kill someone else.

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.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Constipation*
  • Drowsiness*
  • Sedation*
  • Dizziness, lightheadedness*
  • Nausea
  • Dry mouth
  • Sweating

Less common

  • Mood changes
  • Euphoria (happiness)
  • Mental clouding
  • Slow or shallow breathing*
  • Vomiting
  • Slowed digestion
  • Low blood pressure (can cause you to be dizzy or faint when sitting or standing)*
  • Slow heart rate
  • Itching

Rare

  • Seizures
  • Trouble urinating*
  • Decreased sexual interest
  • Impotence
  • Bowel rupture due to constipation*
  • Death due to overdose, slow/shallow breathing, bowel rupture, or other*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1984.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 08/14/2012
Last Revised: 08/14/2012