Author: Charles Frank

Dilaudid Hydromorphone Injection Side Effects, Interactions, Uses, Dosage, Warnings

See also How to Use section for more information about addiction and how to properly measure the dose of the liquid. The pharmacokinetics of hydromorphone are affected by hepatic impairment. Due to increased exposure of hydromorphone, patients with moderate hepatic impairment should be started at one-fourth to one-half the recommended starting dose depending on the degree of hepatic dysfunction and closely monitored during dose titration. A further increase in Cmax and AUC of hydromorphone in this group is expected and should be taken into consideration when selecting a starting dose [see CLINICAL PHARMACOLOGY]. Opioid-Induced Hyperalgesia (OIH) occurs when an opioid analgesic paradoxically causes an increase in pain, or an increase in sensitivity to pain.

As mentioned, the extended-release forms of these drugs can cause severe constipation, which can be dangerous. This is one reason why extended-release forms are reserved for people who have taken the drug long term, and who need an increased dose. Oxycodone dosing depends on the needs of the patient, as well as whether the drug is in liquid form or as a tablet designed for immediate or extended release.

No malformations were noted at 4 or 40.5 times the HDD in pregnant rats or rabbits, respectively [see Data]. Based on animal data, advise pregnant women of the potential risk to a fetus. If the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic, prescribe the lowest effective dosages and minimum durations of concomitant use.

Drug Interactions for Dilaudid

DILAUDID INJECTION is indicated for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate. DILAUDID Tablets are supplied in 2 mg, 4 mg, and 8 mg tablets for oral administration. The tablet strengths describe the amount of hydromorphone hydrochloride in each tablet. Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it. Take this medication by mouth as directed by your doctor.

Hydromorphone oral tablet can cause drowsiness and dizziness. These effects may be more likely in the first few hours after you take it. This means this drug has a risk of misuse and may cause dependence.

You may not be able to take Dilaudid if you are NOT already being treated with a similar opioid (narcotic) pain medicine and are tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant. You’ll soon start receiving the latest Mayo Clinic health information you requested in your inbox. You should be aware if anyone is using it improperly or without a prescription. Hydromorphone can pass into breast milk and may cause drowsiness or breathing problems in a nursing baby. Hydromorphone may also be used for purposes not listed in this medication guide.

Opioids have been shown to have a variety of effects on components of the immune system in in vitro and animal models. Overall, the effects of opioids appear to be modestly immunosuppressive. The precise mechanism of the analgesic action is unknown. However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug.

Drugs & Supplements

Hydromorphone may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of hydromorphone that works, and take it for the shortest possible time. Also, if you are taking the liquid form of this medication, follow the instructions carefully from your doctor or pharmacist to measure out the proper dose. This will help to decrease the risk of serious side effects.

1. Adverse effects of hydromorphone are similar to those of other potent opioid analgesics, such as morphine and heroin.
2. Avoid driving or operating machinery until you know how Dilaudid will affect you.
3. Babies born dependent on habit-forming medicine may need medical treatment for several weeks.
4. Your doctor can help you taper off the medication slowly, which reduces the risk of withdrawal.
5. Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see WARNINGS AND PRECAUTIONS].

Do not increase your dose, take the medication more often, or take it for a longer time than prescribed. Dilaudid may cause life-threatening addiction and withdrawal symptoms in a newborn if the mother has taken this medicine during pregnancy. Dilaudid can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use Dilaudid in larger amounts, or for longer than prescribed.

Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression). The potential for these risks should not, however, prevent the proper management of pain in any given patient. Use of opioid analgesics for an extended period of time during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Inform patients that opioids could cause a rare but potentially life-threatening condition called serotonin syndrome resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop after discharge from hospital. Instruct patients to inform their healthcare providers if they are taking, or plan to take serotonergic medications [see DRUG INTERACTIONS].

Maternal toxicity was noted in the two highest dose groups (reduced food consumption and body weights). Monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. Inform patients that the use of DILAUDID INJECTION, even when taken as recommended, can result in addiction, abuse, and misuse, which can lead to overdose and death [see WARNINGS AND PRECAUTIONS]. Start patients with renal impairment on one-fourth to one-half the usual DILAUDID INJECTION starting dose depending on the degree of impairment [see CLINICAL PHARMACOLOGY]. If you have ongoing pain (such as due to cancer), your doctor may direct you to also take long-acting opioid medications.

The principal therapeutic action of hydromorphone is analgesia. Like all full opioid agonists, there is no ceiling effect for analgesia with morphine. Clinically, dosage is titrated to provide adequate analgesia and may be limited by adverse reactions, including respiratory and CNS depression. Inform patients of the risk of life-threatening respiratory depression, including information that the risk is greatest when starting DILAUDID INJECTION or when the dosage is increased, and that it can occur even at recommended dosages. “Drug-seeking” behavior is very common in persons with substance use disorders.

Never crush or break a tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of hydromorphone and similar prescription drugs. Some medicines can interact with hydromorphone and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications. Your doctor will decide what kind of pain relief you need and will probably start you on a short-acting drug first.

DILAUDID INJECTION is contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus. Opioids may also obscure the clinical course in a patient with a head injury. Avoid the use of DILAUDID INJECTION in patients with impaired consciousness or coma. Tolerance is a physiological state characterized by a reduced response to a drug after repeated administration (i.e., a higher dose of a drug is required to produce the same effect that was once obtained at a lower dose). Both tolerance and physical dependence can develop during use of opioid therapy. Each 5 mL (1 teaspoon) of DILAUDID Oral Solution contains 5 mg of hydromorphone hydrochloride.

Dilaudid (Hydromorphone (Injection))

“Doctor shopping” (visiting multiple prescribers to obtain additional prescriptions) is common among people who abuse drugs and people with substance use disorder. Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with inadequate pain control. DILAUDID Oral Solution and DILAUDID Tablets expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing DILAUDID Oral Solution or DILAUDID Tablets, and monitor all patients regularly for the development of these behaviors and conditions [see WARNINGS AND PRECAUTIONS]. Though it helps many people, this medication may sometimes cause addiction.

Access to drugs with a potential for abuse such as DILAUDID INJECTION presents an occupational hazard for addiction in the health care industry. Routine procedures for handling controlled substances developed to protect the public may not be adequate to protect health care workers. Divide the new total amount by the number of doses permitted based on dosing interval (e.g., 8 doses for every-three-hour dosing).

In that case, this medication might be used for sudden (breakthrough) pain only as needed. Other pain relievers (such as acetaminophen, ibuprofen) may also be prescribed. Ask your doctor or pharmacist about using hydromorphone safely with other drugs. Ask your pharmacist where to locate a drug take-back disposal program.