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
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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 |