Select a medication above to begin.
Dilaudid
hydromorphone
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; ER form not indicated for prn analgesic use; proper dosing and titration essential to decr. resp. depression risk
Medication Error Risk
ensure accuracy when prescribing, dispensing, and administering hydromorphone oral solution; dosing errors due to confusion between mg and mL or different concentrations can result in accidental overdose and death; hydromorphone injection high potency formulation (10 mg per mL) for use in opioid-tolerant pts only; do not confuse w/ standard parenteral hydromorphone forms, overdose and death could result
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; instruct pts to swallow ER tabs whole; crushing, chewing, or dissolving hydromorphone ER tabs can cause rapid release and absorption of potentially fatal doses
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal hydromorphone overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
Adult Dosing .
Dosage forms: TAB: 2 mg, 4 mg, 8 mg; SOL: 1 mg per mL; INJ (pre-filled syringe): 0.5 mg per 0.5 mL, 1 mg per mL, 2 mg per mL, 4 mg per mL
Dosage Forms Discontinued in US
- [3 mg supp not avail. as brand; see generic]
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-severe
- [PO route, tablet]
- Dose: individualize dose PO q3-6h prn; Start: 2-4 mg PO q4-6h prn; Info: in pts converting from other opioids, consider starting 1-2 mg PO q4-6h prn; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use
- [PO route, oral solution]
- Dose: individualize dose PO q3-6h prn; Start: 2.5-10 mg PO q3-6h prn; Info: in pts converting from other opioids, consider starting 1.25-5 mg PO q3-6h prn; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use
- [parenteral route]
- Dose: individualize dose IV/SC/IM q2-3h prn; Start: 0.2-1 mg IV q2-3h prn; 1-2 mg SC/IM q2-3h prn; Info: IV preferred to SC/IM; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper dose by 25-50% q2-4 days to D/C if prolonged or long-term use
- [rectal route]
- Dose: 3 mg PR q6-8h prn; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [PCA route (off-label)]
- Dose: 0.05-0.4 mg IV q6-20min prn; Start: 0.1-0.5 mg IV x1; Info: basal rate for opioid-experienced pts is up to 0.5 mg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
renal dosing
- [PO route]
- CrCl <80: decr. usual start dose by 50-75%
- HD: start 0.5-1 mg q6h prn; no supplement after dialysis; PD: start 0.5-1 mg q6h prn; no supplement
- [parenteral route]
- CrCl <80: decr. usual start dose by 50-75%
- HD: decr. usual start dose, amount not defined; no supplement after dialysis; PD: decr. usual start dose, amount not defined; no supplement
- [rectal route]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [PO route]
- Child-Pugh Class B: decr. usual start dose by 50-75%; Child-Pugh Class C: decr. usual start dose, amount not defined, titrate slowly
- [parenteral route]
- Child-Pugh Class B: decr. usual start dose by 50-75%; Child-Pugh Class C: decr. usual start dose, amount not defined, titrate slowly
- [rectal route]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 2 mg, 4 mg, 8 mg; SOL: 1 mg per mL; INJ (pre-filled syringe): 0.5 mg per 0.5 mL, 1 mg per mL, 2 mg per mL, 4 mg per mL
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-severe (off-label)
- [PO route, 6 mo and older, <50 kg]
- Dose: individualize dose PO q3-4h prn; Start: 30-80 mcg/kg/dose PO q3-4h prn; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [PO route, 6 mo and older, >50 kg]
- Dose: individualize dose PO q3-4h prn; Start: 1-2 mg PO q3-4h prn; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [parenteral route, 6 mo and older, <50 kg]
- Dose: individualize dose IV q2-6h prn; Start: 15-20 mcg/kg/dose IV q2-6h prn; Alt: 6 mcg/kg/h IV; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [parenteral route, 6 mo and older, >50 kg]
- Dose: individualize dose IV/SC/IM q2-6h prn; Start: 0.2-0.6 mg IV q2-4h prn; 0.8-1 mg SC/IM q4-6h prn; Alt: 0.3 mg/h IV; Info: IV preferred to SC/IM; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [PCA route, <50 kg]
- Dose: 2-5 mcg/kg/dose IV q6-20min prn; Start: 8 mcg/kg/dose IV x1; Max: 20 mcg/kg/h; Info: basal rate for opioid-experienced pts is up to 3 mcg/kg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [PCA route, >50 kg]
- Dose: 0.05-0.4 mg IV q6-20min prn; Start: 0.1-0.5 mg IV x1; Info: basal rate for opioid-experienced pts is up to 0.5 mg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
renal dosing
- [see below]
- renal impairment: decr. usual dose, amount not defined
- HD/PD: not defined, caution advised
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance