hydromorphone hydrochloride (Dilaudid, Dilaudid-5, Dilaudid-HP)

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GENERIC NAME: hydromorphone hydrochloride

BRAND NAME: Dilaudid, Dilaudid-5, Dilaudid-HP

DRUG CLASS AND MECHANISM: Hydromorphone is an opioid narcotic pain-reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. Hydromorphone, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain (increasing the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). The FDA approved hydromorphone in January 1984.



PREPARATIONS: Hydromorphone is available as immediate-release and extended-release tablets, injection, rectal suppository, and oral liquid forms.

  • Dilaudid (immediate release tablets): Available in 2 mg, 4 mg, and 8 mg strengths.
  • Exalgo (extended-release tablets): Available in 8 mg, 12 mg, 16 mg
  • Dilaudid (injection solutions): Available in 1mg/ml, 2 mg/ml, and 4 mg/ml strengths.
  • Dilaudid-HP (high potency injections): Available in two strengths: 250 mg powder for solution and 10 mg/ml injection solution.
  • Dilaudid-5 (oral solution): Available in 1 mg/ml strength in 473 ml bottle.
  • Dilaudid (rectal suppository): Available in 3 mg strength.

STORAGE: Hydromorphone tablets are stored at room temperature between 20 C to 25 C (68 F to 77 F). Hydromorphone oral liquid and injections are stored between 15 C to 30 C (59 F to 86 F). Hydromorphone suppositories are stored in a refrigerator, protected from light.

PRESCRIBED FOR: Hydromorphone is used for management of acute and moderate-to-severe chronic pain in patients when use of an opioid is appropriate.


  • Immediate-release tablets: Take 2 to 4 mg tablets by mouth every 4 to 6 hours as needed. Increase to 8 mg after careful observation and if needed to control pain.
  • Extended-release tablets: Start after discontinuation of all other opioid extended-release tablets. Dosed once-daily, individualized based on prior opioid therapy.
  • Injections: Give 1 to 2 mg intramuscularly or subcutaneously every 2 to 3 hours as needed. Give 0.2 to 1 mg intravenously over 2 to 3 minutes every 2 to 3 hours as needed.
  • Oral solution: Give 2.5 to 10 mg every 3 to 6 hours as needed.
  • Rectal suppository: Insert one 3 mg suppository rectally every 6 to 8 hours OR3 to 6 mg rectally every 3 to 4 hours, when appropriate.

Safe and effective use of hydromorphone in children has not been established.

DRUG INTERACTIONS: Hydromorphone should be used very cautiously with medications that depress the central nervous system (for example, hypnotics, anesthetics, tranquilizers, phenothiazines, and alcohol).

Hydromorphone should be used with caution with mixed agonist/antagonist opioid analgesics (for example, pentazocine, nalbuphine, butorphanol, and buprenorphine) because it may take away the analgesic effect of hydromorphone.

PREGNANCY: There are no adequate studies of hydromorphone to determine safe and effective use in pregnant women.

NURSING MOTHERS: Low levels of opioid medications may be excreted in breast milk; therefore, it should not be used in nursing mothers.

SIDE EFFECTS: Side effects of hydromorphone are lightheadedness, dizziness, sedation, nausea and vomiting, constipation, sweating, flushing, itching, and dry mouth. Serious side effects of the medications are respiratory depression and trouble breathing.

Since hydromorphone is a controlled narcotic, it carries a box warning of respiratory depression and abuse potential. Use with alcohol or other medications affecting central nervous system can worsen respiratory depression and may lead to death.

REFERENCE: Dilaudid, Dilaudid-5, Dilaudid-HP Prescribing Information.

Medically Reviewed by a Doctor on 5/19/2014

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