DRUG | SUPPLIED | DOSE | COMMENTS |
---|---|---|---|
HYDROMORPHONE (Paeds) (Dilaudid) Mechanism of action: Opioid analgesic Ref: 44, 389 Last update: 2024-02-22 |
injection: 2 mg/mL; 10 mg/mL 20 mg/100 mL PCA bag Immediate release tablet: 1 mg, 4 mg, liquid: 1 mg/mL Standard concentrations for IV infusions: 40 mcg/mL (pts up to 6 kg) 80 mcg/mL (pts 6-30 kg) 200 mcg/mL (pts > 30 kg) controlled release capsules: 3 mg, 6 mg, 12 mg, 24 mg 30 mg |
Analgesia: titrate to effect. Intermittent Dosing: Oral:Children <= 50 kg: 0.04-0.08 mg/kg/dose PO every 3-4 hr PRN IV: 15 mcg/kg/dose IV every 2-4 hr PRN Continuous IV Infusion: 1-8 mcg/kg/hr continuous IV infusion. Higher doses may be required, especially in opioid tolerant patients. Children >50 kg: Oral: 1-2 mg PO every 3-4 hr PRN IV: 0.2-0.5 mg IV every 2-4 hr PRNUsual Adult dose: 2-4 mg PO every 3-4 hr Epidural Infusion (with ropivacaine) 0.3-1.5 mcg/kg/hour |
CAUTION: Hydromorphone is 5x more potent than morphine (eg. Hydromorphone 2 mg IV ≈ morphine 10 mg IV). Should not be used in patients with a true allergic reaction to morphine. Antidote for opioid overdose is naloxone. Peak analgesic effect: 10-20 min. after IV and immediate release oral doses. Duration of analgesia: 3-4 hr. See also Opioid Administration Guidelines (white pages of print copy). Opioid tolerant patients may require higher doses Hydromorphone considered safer for use in renal impairment. Use extreme caution when converting from one opioid to another. Consult with APS/Palliative Care when converting opioids. Cross-tolerance at the opioid receptor may not occur and equianalgesic opioid dosing tables may overestimate opioid requirements. Controlled release capsules are NOT suitable for PRN dosing. Daily hydromorphone requirements should be established using immediate release formulations before converting to long acting formulations. Controlled release formulations are usually dosed Q12H. Controlled release tablets should generally be swallowed whole. Consult individual product monograph prior to manipulating the formulation. Standard Prescription: hydromorphone__mcg IV{PO} Q__H PRN pain ( __ mcg/kg/dose) hydromorphone controlled release__mg PO Q__H hydromorphone__mcg/kg/hr continuous IV infusion Note: continuous infusion to be ordered by APS only. |