HYDROMORPHONE
(Dilaudid)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.
hydromorphone controlled release__mg PO Q__H
hydromorphone__mcg/kg/hr continuous IV infusion
Note: continuous infusion to be ordered by APS only.
Dosages
Analgesia: titrate to effect.
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
Usual Adult dose:
2-4 mg PO every 3-4 hr
Intermittent Dosing:
Children <= 50 kg:
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/hourMechanism of Action
Opioid analgesic
Forms Supplied
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
Comments
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.
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.
Controlled release tablets should generally be swallowed whole. Consult individual product monograph prior to manipulating the formulation.
References
44, 389
Last Edited
2024-02-22 07:18:43