hydromorphone

Action and Spectrum

Actions and Spectrum: 

A strong opioid analgesic used to alleviate severe pain is hydromorphone. It works by attaching to the mu-opioid receptors in the spinal cord and brain, which lessens the perception of pain. 

The main part of hydromorphone’s spectrum of action is analgesic, which means it effectively lessens pain. Acute or chronic pain brought on by cancer, surgery, accident, or other medical disorders is frequently treated with it. 

Drug Interaction

Adverse Reaction

Frequency not defined  

Anticholinergic: tachycardia, urinary retention, 

dry mouth, palpitation 

Cardiovascular: QT-interval prolongation, severe cardiac arrhythmias, Angina pectoris, bradycardia, syncope, ventricular tachycardia, cardiac arrest, circulatory depression, myocardial infarction, shock, ST-segment elevation 

Gastrointestinal (GI): vomiting, decreased intestinal motility, gastroesophageal reflux disease, paralytic ileus, anorexia, abdominal distention, biliary tract spasm, decreased appetite, Constipation, nausea 

Central nervous system (CNS): mental clouding or depression, euphoria, faintness, visual disturbances, weakness, nervousness, Agitation, coma, dizziness, dysphoria, restlessness, sedation, seizures 

Respiratory: Respiratory depression, dyspnea, rhinorrhea, flu-like symptoms, respiratory arrest, hypoxia, bronchospasm 

Post marketing Reports 

serotonin syndrome, adrenal insufficiency, anaphylaxis, androgen deficiency, confusional state, convulsions, drowsiness, hypersensitivity reaction, lethargy, myoclonus, oropharyngeal swelling, peripheral edema, and somnolence, dyskinesia, erectile dysfunction, fatigue, hepatic enzymes increased, hyperalgesia 

Black Box Warning

Black Box Warning 

The possible dangers of respiratory depression and addiction linked with the use of hydromorphone are highlighted in the black box warning for the drug. 

According to the black box warning, hydromorphone has a significant risk of respiratory depression, which can result in respiratory arrest and mortality, particularly in elderly and debilitated patients, as well as patients with respiratory disorders. 

The black box warning states that hydromorphone should only be administered for the shortest amount of time and in individuals for whom other therapies are ineffective.

In order to prevent withdrawal symptoms, the medication should be provided at the lowest possible dosage and should not be suddenly stopped in patients who have been using it for a long time. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• allergy or hypersensitivity to hydromorphone or any of its ingredients, 
• hypercarbia, acute bronchial asthma, or respiratory depression 
• ileus paralyticus 
• known or suspected gastrointestinal blockage, such as toxic megacolon, ileus, or bowel obstruction, 

Caution 

• history of addiction or substance abuse 
• Increased intracranial pressure or head trauma 
• severe damage of the liver or kidneys 
• shock or hypotension 
• adrenal underactivity 
• abnormalities of the seizure or a history of convulsions 
• ailing or elderly patients 
• pregnant ladies and nursing mothers

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were lack of studies on pregnant women and no evidence of risk to the foetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology 

A strong opioid analgesic with a strong potential for the mu-opioid receptor in the central nervous system is hydromorphone. In terms of pharmacology, it binds to the mu-opioid receptor and has a variety of effects. 

Among hydromorphone’s pharmacological effects include analgesia, drowsiness, respiratory depression, euphoria, and gastrointestinal side effects. 

Pharmacodynamics 

The pharmacodynamics of hydromorphone in the central nervous system are complex and include several receptor systems. Its strong analgesic effects make it a key pain management drug, but because to its misuse and addiction risk, it must be used with caution. 

Pharmacokinetics 

Absorption   

hydromorphone is offered in several forms, including as oral tablets, an injectable solution, and rectal suppositories. Oral hydromorphone has a 30% oral bioavailability and is only partially absorbed from the gastrointestinal system. After injection, the injectable form of hydromorphone is quickly absorbed, resulting in a quicker beginning of effect 

Distribution 

Because of its high lipophilicity, hydromorphone can pass across the blood-brain barrier and spread all through central nervous system. With a distribution volume of around 3.3 L/kg, the medication is widely dispersed throughout the body. 

Metabolism   

hydromorphone is largely metabolised in the liver through the processes of glucuronidation, N-demethylation, and to a lesser extent, hydroxylation. The main inactive metabolite is hydromorphone-3-glucuronide. Nevertheless, in patients with renal impairment, build-up of this molecule might result in toxicity. 

Elimination and excretion 

Most of the oral dosage of hydromorphone and its metabolites are excreted in the urine, 24% of which are eliminated unaltered and the remaining as metabolites. In healthy people, the clearance half-life of hydromorphone is about 2 to 3 hours, however it might be prolonged in patients with renal or hepatic impairment.

Adminstartion

Administration 

There are several ways to deliver hydromorphone, including intravenously, intramuscularly, orally, subcutaneously, and rectal. The state of the patient, the level of discomfort, and the desired time for action all play a role in the choice of administration route. 

The patient’s age, weight, and general health, as well as the level of pain and the method of administration selected, all influence the dosage and frequency of hydromorphone administration. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: hydromorphone 

Why do we use hydromorphone? 

A strong opioid analgesic, hydromorphone is generally used to treat moderate to severe pain. Among the specialized uses for hydromorphone are pain management, acute pain, palliative care, sedation and chronic pain.