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What is hydromorphone?

Hydromorphone is an opioid pain medication. An opioid is sometimes called a narcotic.
Hydromorphone, also known as dihydromorphinone, and sold under the brand name
Dilaudid, among others, is a centrally acting pain medication of the opioid class,  It is made
from morphine.
Hydromorphone is used to treat moderate to severe pain. Dilaudid and other versions of
hydromorphone are stronger drugs than oxycodone. These drugs are often used for
serious pain caused by surgery, broken bones, or cancer. The third step would be potent
opioids such as oxycodone and hydromorphone.

The extended-release form of this medicine is for around-the-clock treatment of moderate
to severe pain. This form of hydromorphone is not for use on an as-needed basis for pain.
Side effects
Hormone imbalance
As with other opioids, hydromorphone (particularly during heavy chronic use) often causes temporary hypogonadism or hormone imbalance.
What is Dilaudid
Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid, among others, is a centrally acting pain medication of the opioid class.[3] It is made from morphine. Comparatively, hydromorphone is to morphine as hydrocodone is to codeine - it is a hydrogenated ketone thereof. In medical terms, it is an opioid analgesic, and in legal terms, a narcotic. Hydromorphone is commonly used in the hospital setting, mostly intravenously (IV) because its bioavailability is very low orally, rectally, and intranasally. Sublingual administration (under the tongue) is usually superior to swallowing for bioavailability and effects; however, hydromorphone is bitter and hydrophilic like most opiates, not lipophilic, so it is absorbed poorly and slowly through mouth membranes.

Hydromorphone is much more soluble in water than morphine and, therefore, hydromorphone solutions can be produced to deliver the drug in a smaller volume of water. The hydrochloride salt is soluble in three parts of water, whereas a gram of morphine hydrochloride dissolves in 16 ml of water; for all common purposes, the pure powder for hospital use can be used to produce solutions of virtually arbitrary concentration. When the powder has appeared on the street, this very small volume of powder needed for a dose means that overdoses are likely for those who mistake it for heroin or other powdered narcotics, especially those that have been cut (diluted) prior to consumption.

Very small quantities of hydromorphone are detected in assays of opium on rare occasions; it appears to be produced by the plant under circumstances and by processes which are not understood at this time. A similar process or other metabolic processes in the plant may very well be responsible for the very low quantities of hydrocodone also found on rare occasions in opium and alkaloid mixtures derived from opium. Dihydrocodeine, oxymorphol, oxycodone, oxymorphone, metopon, and possibly other derivatives of morphine and hydromorphone also are found in trace amounts in opium.
Formulations
Hydromorphone is available in parenteral, rectal, subcutaneous, and oral formulations. It can also be administered via epidural or intrathecal injection.Hydromorphone has also been administered via nebulization to treat shortness of breath, but it is not used as a route for pain control due to low bioavailability.

Concentrated aqueous solutions of hydromorphone hydrochloride have a visibly different refractive index from pure water, isotonic 9 (09 per cent) saline and the like and especially when stored in clear ampoules and phials can acquire a slight clear amber discolouration upon exposure to light; this reportedly has no effect on the potency of the solution, but 14-dihydromorphinones such as hydromorphone, oxymorphone and relatives come with instructions to protect from light.Ampoules of solution which have developed a precipitate should be discarded.
Battery-powered intrathecal drug delivery systems are implanted for chronic pain when other options are ruled out, such as surgery and traditional pharmacotherapy, provided that the patient is considered a suitable fit in terms of any contraindications, both physiological and psychological.
An extended-release (once-daily) version of hydromorphone is available in the United States. Previously, an extended-release version of hydromorphone, Palladone, was available before being voluntarily withdrawn from the market after a July 2005 FDA advisory warned of a high overdose potential when taken with alcohol. As of March 2010, it is still available in the United Kingdom under the brand name Palladone SR, Nepal under the brand name Opidol, and in most other European countries.
Adverse effects of hydromorphone are similar to those of other potent opioid analgesics, such as morphine and heroin. The major hazards of hydromorphone include dose-related respiratory depression, urinary retention, bronchospasm and sometimes circulatory depression.More common side effects include lightheadedness, dizziness, sedation, itching, constipation, nausea, vomiting, headache, perspiration, and hallucinations. These symptoms are common in ambulatory patients and in those not experiencing severe pain.

Simultaneous use of hydromorphone with other opioids, muscle relaxants, tranquilizers, sedatives, and general anesthetics can cause a significant increase in respiratory depression, progressing to coma or death. Taking benzodiazepines (such as diazepam) in conjunction with hydromorphone may increase side effects such as dizziness and difficulty concentrating. If simultaneous use of these drugs is required, dose adjustment can be done.

A particular problem that may occur with hydromorphone is accidental administration in place of morphine due to a mix-up between the similar names, either at the time the prescription is written or when the drug is dispensed. This has led to several deaths and calls for hydromorphone to be distributed in distinctly different packaging from morphine to avoid confusion.

Massive overdoses are rarely observed in opioid-tolerant individuals, but when they occur, they may lead to circulatory system collapse. Symptoms of overdose include respiratory depression, drowsiness leading to coma and sometimes to death, drooping of skeletal muscles, low heart rate and decreasing blood pressure. At the hospital, individuals with hydromorphone overdose are provided supportive care such as assisted ventilation to provide oxygen, gut decontamination using activated charcoal through a nasogastric tube. Opioid antagonist such as naloxone can also be administered concurrent with oxygen supplementation. Naloxone works by reversing the effects of hydromorphone. It is only administered in the presence of significant respiratory depression and circulatory depression.

The effects of overdose can be exacerbated by dose dumping if the medication is taken with alcohol.

Sugar cravings associated with hydromorphone use are the result of a glucose crash after transient hyperglycemia following injection or a less profound lowering of blood sugar over a period of hours, in common with morphine, heroin, codeine, and other opiates.
Neurotoxicity
In the setting of prolonged use, high dosage, and/or kidney dysfunction, hydromorphone has been associated with neuroexcitatory symptoms such as tremor, myoclonus, agitation, and cognitive dysfunction.This toxicity is less than that associated with other classes of opioids such as the pethidine class of synthetics in particular.
Withdrawal
Users of hydromorphone can experience painful symptoms if the drug is suspended.Some people cannot tolerate the symptoms which result in continuous drug use.Symptoms of opioid withdrawal are not easy to decipher. There are differences between drug-seeking behaviors and true withdrawal effects. Symptoms associated with hydromorphone withdrawal include:
Abdominal pain
Anxiety/panic attacks
Depression
Goose bump skin
Inability to enjoy daily activities
Muscle and joint pain
Nausea
Runny nose and excessive secretion of tears
Sweating
Vomiting
In the clinical setting excessive secretion of tears, yawning and dilation of pupils are helpful presentations in diagnosing opioid withdrawal.Hydromorphone is a rapid acting pain killer, however some formulations can last up to several hours; patients who stop taking this drug abruptly might experience withdrawal symptoms.These can start within hours of taking the last dose of hydromorphone and can last up to several weeks.Withdrawal symptoms in people who stopped taking the opioid can be managed by using opioids or non-opioid adjuncts.Methadone is an opioid commonly used for this kind of therapy. However, the selection of therapy should be tailored to each specific person. Methadone is also used for detoxification in people who have opioid addiction such as heroin or drugs similar to morphine. It can be given orally or intramuscularly. There is controversy regarding the use of opioids for people experiencing withdrawal symptoms since these agents can themselves cause relapse on patients when they suspend therapy.Clonidine is a non-opioid adjunct that can be used in situations where opioid use is not desired, such as in patients with high blood pressure.
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