hydromorphone; dihydromorphinone (Dilaudid, Palladone)
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Introduction
Tradenames: Dilaudid, Palladone[5]. DEA-controlled substance: class 2.
Indications
- management of moderate to severe pain[11]
- useful in patients with renal failure[13]
- cough, antitussive agent at lower doses
Dosage
- 1-2 mg IV/IM/SC every 4-6 hours (7x as potent as morphine)
- 2 mg PO* every 4-6 hours.
- 3 mg PR every 6-8 hours.
- extended-release* (Palladone) QD dosing
Tabs: 1, 2, 3, 4 mg.
* Palladone (extended-release)[4]
Suppositories: 3 mg.
* Oral doses 20% to 50% as potent as parenteral administration. marketing & sales suspended due to alcohol interactions[7]
Pharmacokinetics
- bioavailability 62%
- metabolized in the liver
- elimination in the urine as glucuronides
- cleared by hemodialysis
- elimination 1/2 life of 3-4 hours
elimination via liver
1/2life = 1.5-4 hours
protein binding = 14 %
Adverse effects
- common (> 10%)
- less common (1-10%)
- shortness of breath, troubled breathing, tachycardia, weakness, tiredness, bradycardia, flushing of the face, trembling, decreased urination, dry mouth, stomach cramps,headache, nausea/vomiting, nervousness, restlessness, ureteral spasm
- uncommon (< 1%)
- skin rash, hives, hallucinations, mental depression, paralytic ileus
- other
- increased all-cause mortality after 180 days of exposure[10]
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
Drug interactions
- CNS depressants
- phenothiazines
- tricyclic antidepressants (TCA)
- alcohol in combination
- increased CNS depression
- increased release of Palladone resulting in high serum & tissue levels leading to overdose (marketing & sales suspended)[5]
- drug interaction(s) of benzodiazepine with opiates
- drug interaction(s) of Z-drugs with opiates
- drug interaction(s) of alcoholic beverage with opiates
- drug interaction(s) of pregabalin with opiates
- drug interaction(s) of gabapentin with opiates
Laboratory
- methods: GC-MS, GLC, RIA, EIA
- labs with Loincs
- hydromorphone in specimen
- hydromorphone in hair
- hydromorphone in gastric fluid
- hydromorphone in meconium
- hydromorphone in saliva
- hydromorphone in serum/plasma
- hydromorphone in urine
- hydromorphone free in blood
- hydromorphone free in serum/plasma
- hydromorphone free in stool
- hydromorphone free in urine
- hydromorphone free in vitreous fluid
Mechanism of action
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ 4.0 4.1 Prescriber's Letter 12(3): 2005 Palladone (Hydromorphone Extended-release Capsules) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210308&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 5.2 FDA Medwatch http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ 7.0 7.1 Prescriber's Letter 13(2): 2006 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220215&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
- ↑ Chang AK et al, Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: A randomized clinical trial. Ann Emerg Med 2006, 48:164 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16857467
- ↑ 10.0 10.1 Solomon DH et al. The comparative safety of opioids for nonmalignant pain in older adults. Arch Intern Med 2010 Dec 13/27; 170:1979. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149754
Becker WC, O'Connor PG. The safety of opioid analgesics in the elderly: New data raise new concerns: Comment on "The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults". Arch Intern Med 2010; 170(22):1986-1988. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21149755
Papaleontiou M, Henderson CR, Turner BJ, et al. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2010; 58(7):1353-1369. Epub 2010 Jun 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20533971 - ↑ 11.0 11.1 Chang AK et al. Randomized clinical trial of efficacy and safety of a single 2-mg intravenous dose of hydromorphone versus usual care in the management of acute pain. Acad Emerg Med 2013 Feb; 20:185 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23406078
- ↑ Pfizer and Acura Announce FDA Approval of Oxectatm (Oxycodone HCL, USP) CII http://www.pfizer.com/news/press_releases/pfizer_press_releases.jsp#guid=20110620005857en&source=RSS_2011&page=1
- ↑ 13.0 13.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2021