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DILAUDID (hydromorphone hydrochloride), a hydrogenated ketone of morphine, is an opioid analgesic. The chemical name of DILAUDID (hydromorphone hydrochloride) is 4,5α-epoxy-3-hydroxy-17-methylmorphinan-6-one hydrochloride.

DILAUDID INJECTION is available in ampules for parenteral administration. Each 1 mL of sterile solution contains 1 mg, 2 mg, or 4 mg hydromorphone hydrochloride with 0.2% sodium citrate and 0.2% citric acid solution. DILAUDID INJECTION ampules are sterile. HIGH POTENCY DILAUDID (DILAUDID-HP) is available in AMBER ampules or single dose vials for intravenous (IV), subcutaneous (SC), or intramuscular (IM) administration. Each 1 mL of sterile solution contains 10 mg hydromorphone hydrochloride with 0.2% sodium citrate and 0.2% citric acid solution. It is also available as lyophilized DILAUDID-HP for intravenous (IV), subcutaneous (SC), or intramuscular (IM) administration. Each single dose vial contains 250 mg sterile, lyophilized hydromorphone HCl to be reconstituted with 25 mL of Sterile Water for Injection USP to provide a solution containing 10 mg/ml.

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Dosage and Administration
Immediate release oral hydromorphone: o Prescribe 4 hourly regularly and use the same dose as required for breakthrough pain.
• Modified release (long acting) oral hydromorphone (Palladone SR): o Prescribe 12 hourly, with a 1/6th of the 24 hour dose as immediate release oral hydromorphone for breakthrough pain. o Palladone SR capsules can be opened (if difficulty when swallowing the SR capsules) and the contents sprinkled on cold soft food, but the granules should NOT be broken, chewed, dissolved or crushed. Seek pharmacy advice if the patient has a feeding tube

Uses

Hydromorphone injection: o Continuous subcutaneous infusion in a syringe pump over 24 hours. o In addition, prescribe 1/6th of the 24 hour infusion dose subcutaneously, 1-2 hourly as required for breakthrough pain (max. 6 doses in 24 hours) o Diluent: water for injection. o Stability and compatibility: reported to be physically stable with the following medicines over 24 hours: haloperidol, hyoscine hydrobromide, levomepromazine, metoclopramide and midazolam1. Sodium Chloride 0.9% can also be used as a diluent. Seek specialist palliative care/pharmacy advice. Used to treat moderate-to-severe pain, including pain after surgery.

Side Effects

-Hyperglycemia
-Dizziness
-Drowsiness
-Altered LOC
-Hallucinations
-Euphoria
-Mental Impairment
-Lightheadedness
-Bradycardia
-Tachycardia
-Hypotension
-CNS Depression
-Respiratory
-Depression
-Transient

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The major hazards of DILAUDID INJECTION and DILAUDID-HP include respiratory depression and apnea. To a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred. The most frequently observed adverse effects are lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain.

Opioid side effects similar to morphine/oxycodone-monitor for opioid toxicity.

  • Prescribe a laxative to be taken regularly and antiemetic as needed (e.g. metoclopramide).
  • Hydromorphone may cause drowsiness, impairing mental and/or physical ability. If affected do not drive or operate machinery. Avoid alcoholic drink.

Contraindications:
-Hypovolemia
-Hypotension
-Hypersensitivity
-Head injury with altered mental status
-Patients with status asthmaticus

Warnings

DILAUDID-HP (high potency, 10 mg/mL ampules and vials) is a more concentrated solution of hydromorphone than DILAUDID INJECTION, and is intended for use only in opioid-tolerant patients. Do not confuse DILAUDID-HP with standard parenteral formulations of DILAUDID or other opioids, as overdose and death could result. Wiki

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