II. Dosing: Adults (or children over age 12 years)

  1. Oral
    1. Hydromorphone 2-4 mg orally as needed every 4-6 hours
  2. Parenteral: SC or IM
    1. Hydromorphone 0.5 to 2 mg SC or IM as needed every 4-6 hours
  3. Parenteral: IV
    1. Hydromorphone 0.5 mg slow IV over 2-5 min every 15 min as needed for 3 doses or
    2. Hydromorphone 1 mg slow IV over 2-5 min every 2 hours as needed

III. Dosing: Children (under age 12 years)

  1. Oral
    1. Hydromorphone 0.03 to 0.08 mg/kg up to 2-4 mg orally as needed every 4-6 hours
  2. Parenteral: IV
    1. Hydromorphone 0.015 mg/kg/dose up to 0.5 to 2 mg slow IV over 2-5 min as needed every 4-6 hours

IV. Adverse Effects

V. Precautions

  1. Hydromorphone 1 mg IV is equivalent to 7 mg Morphine Sulfate IV
  2. Hydromorphone more easily crosses blood-brain barrier than other Opioids
    1. Risk of excessive Sedation and respiratory depression
  3. Hydromorphone is renally excreted (clearance may be delayed 40 hours in Renal Failure)

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Cost: Medications

hydromorphone (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
HYDROMORPHONE 1 MG/ML SOLUTION Generic $0.30 per ml
HYDROMORPHONE 2 MG TABLET Generic $0.08 each
HYDROMORPHONE 2 MG/ML VIAL Generic $1.05 per ml
HYDROMORPHONE 3 MG SUPPOS Generic $9.58 each
HYDROMORPHONE 4 MG TABLET Generic $0.09 each
HYDROMORPHONE 5 MG/5 ML SOLN Generic $0.30 per ml
HYDROMORPHONE 8 MG TABLET Generic $0.31 each
HYDROMORPHONE HCL ER 12 MG TAB Generic $10.73 each
HYDROMORPHONE HCL ER 16 MG TAB Generic $18.78 each
HYDROMORPHONE HCL ER 32 MG TAB Generic $40.10 each
HYDROMORPHONE HCL ER 8 MG TAB Generic $8.40 each
dilaudid (on 5/15/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DILAUDID 5 MG/5 ML ORAL LIQUID Generic $0.30 per ml

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