II. Dosing: Adults (or children over age 12 years)
- Oral
- Hydromorphone 2 to 4 mg orally as needed every 4 to 6 hours
- SC or IM
- Hydromorphone 0.5 to 2 mg SC or IM as needed every 4 to 6 hours
- IV
- Hydromorphone 0.5 mg (0.2 to 0.3 mg in elderly) slow IV over 2 to 5 min every 15 to 30 min as needed for 3 doses or
- Hydromorphone 1 mg slow IV over 2 to 5 min every 2 hours as needed (limit to Opioid tolerant, younger adults)
III. Dosing: Children (under age 12 years, not FDA approved)
- Oral
- Hydromorphone 0.03 to 0.08 mg/kg up to 2 to 4 mg orally as needed every 4 to 6 hours
- IV
- Hydromorphone 0.015 mg/kg/dose up to 0.5 to 2 mg slow IV over 2 to 5 min as needed every 4 to 6 hours
IV. Safety
- Pregnancy Category C
- Unknown safety in Lactation
V. Adverse Effects
VI. Pharmacokinetics
- Onset 5 to 15 minutes
- Peaks 10 to 20 minutes
- Duration 2 to 4 hours
VII. Precautions
- Hydromorphone 1 mg IV is equivalent to 7 mg Morphine Sulfate IV
- Hydromorphone more easily crosses blood-brain barrier than other Opioids
- Risk of excessive sedation and respiratory depression
- Hydromorphone is renally excreted (clearance may be delayed 40 hours in Renal Failure)
- Dilaudid triggers greater euphoria than Fentanyl or Morphine (higher risk of drug seeking and abuse)
- Dilaudid is a high potency Opioid (1 mg is equivalent to up to 10 mg Morphine)
- Most iatrogenic Opioid Overdoses have occurred with Hydromorphone (Dilaudid)
VIII. Resources
- Hydromorphone Oral (DailyMed)
- Hydromorphone Injection (DailyMed)
IX. References
- Velasco and Kiel (2023) Crit Dec Emerg Med 37(1): 4-9
Images: Related links to external sites (from Bing)
Related Studies
| hydromorphone (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| HYDROMORPHONE 1 MG/ML SOLUTION | Generic | $0.25 per ml |
| HYDROMORPHONE 2 MG TABLET | Generic | $0.07 each |
| HYDROMORPHONE 4 MG TABLET | Generic | $0.09 each |
| HYDROMORPHONE 5 MG/5 ML SOLN | Generic | $0.25 per ml |
| HYDROMORPHONE 8 MG TABLET | Generic | $0.26 each |
| HYDROMORPHONE HCL ER 8 MG TAB | Generic | $3.27 each |
Ontology: Hydromorphone (C0012306)
| Definition (NCI) | The hydrogenated ketone of morphine, a semi-synthetic opioid with analgesic effects. Hydromorphone selectively binds the mu-opioid receptor which is linked through G-proteins. Binding stimulates the exchange of guanosine triphosphate (GTP) for guanosine diphosphate (GDP) on the G-protein complex and interacts with and inhibits adenylate cyclase located at the inner surface of the plasma membrane. This leads to a reduction in intracellular cyclic 3',5'-adenosine monophosphate (cAMP). Further, voltage-gated potassium channels are activated, thereby causing hyperpolarization and reducing neuronal excitability. In addition, the opening of voltage-gated calcium channels is inhibited, thereby leading to an inhibition of calcium entry and a reduction in the release of various neurotransmitters, including GABA, vasopressin, somatostatin, insulin and glucagons. |
| Definition (NCI_NCI-GLOSS) | A drug used to relieve pain. |
| Definition (MSH) | An opioid analgesic made from MORPHINE and used mainly as an analgesic. It has a shorter duration of action than morphine. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D004091 |
| SnomedCT | 387485001, 44508008, 414428000, 83929000 |
| LNC | LP16162-7, MTHU007189 |
| English | Dihydromorphinone, Hydromorphon, Hydromorphone, Morphinan-6-one, 4,5-epoxy-3-hydroxy-17-methyl-, (5alpha)-, hydromorphone (medication), Hydromorphone [Chemical/Ingredient], HYDROMORPHONE, HYDROmorphone, (-)-Hydromorphone, hydromorphone, Hydromorphone (substance), dihydromorphinone, hydromorphon, Hydromorphone (product) |
| Swedish | Hydromorfon |
| Spanish | dihidromorfinona, Hidromorfona, hidromorfona (sustancia), hidromorfona, hidromorfona (producto), Dihidromorfinona |
| Czech | dihydromorfinon |
| Finnish | Hydromorfoni |
| Russian | DIGIDROMORFINON, GIDROMORFON, LAUDAKON, ГИДРОМОРФОН, ДИГИДРОМОРФИНОН, ЛАУДАКОН |
| Japanese | ヒドロモルフォン, ラウダコン, ジヒドロモルフィノン, ヒドロモルホン |
| Italian | Diidromorfinone, Idromorfone |
| Polish | Hydromorfon, Dwuhydromorfinon, Dihydromorfinon, Dilavdit, Lavdacon |
| Portuguese | Di-Hidromorfinona, Hidromorfona |
| French | Dihydromorphinone |
| German | Dihydromorphinon, Hydromorphone, Hydromorphon |
Ontology: Dilaudid (C0728755)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D004091 |
| English | dilaudid, Dilaudid |
