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HYDROmorphone

Classification

high alert medication

Controlled and targeted substance

Opioid analgesic

Indications

⚠️ PCP: Requires completion of scope expansion education. Analgesia in palliative care settings

ACP: Analgesia in palliative care and interfacility transfer settings

CCP: Sedation and ongoing analgesia in patients undergoing mechanical ventilation

Contraindications

Allergy or known hypersensitivity to HYDROmorphone

Adult dosages

PCP: Pain management in palliative or end-of-life patients

⚠️ Requires completion of PCP scope expansion education and licensing endorsement
CliniCall (or palliative care team) consultation required prior to selecting a dosing strategy
2-4 mg PO q 4-6 hours
- May repeat every 10-30 minutes as required based on blood pressure (> 100 mmHg) or as per CliniCall/palliative care team plan

0.2-1.0 mg IV q 2-3 hours
1 mg SC q 4 hours

ACP: Pain management during interfacility transports

As per sending facility direction. Contact CliniCall for additional support during transport as required.

CCP: Sedation and analgesia

0.5-3.0 mg/hr IV

Pediatric Considerations And Dosing

For patients 10-50 kg: Follow weight-based dosing

ACP: Pain management in palliative or end-of-life patients

Requires specific training and license endorsement
CliniCall (or palliative care team) consultation required prior to selecting a dosing strategy.
0.03 mg/kg PO q 4 hours
0.01 mg/kg IV q 3-6 hours

CCP: Sedation and analgesia

0.003 to 0.005 mg/kg/hr IV (max 0.2 mg/hr)

Mechanism Of Action

Binds to opiate receptors in the CNS causing inhibition of ascending pain pathways and altering the perception of and response to pain; produces generalized CNS depression

Pharmacokinetics

IV:
- Onset - 5 minutes
- Peak - 10-20 minutes
- Duration - 3-4 hours
Oral:
- Onset - 15-30 minutes
- Peak - 30-60 minutes
- Duration - 3-4 hours (13 hours for extended-release)

Adverse Effects

Lightheadedness, dizziness, sedation, agitation, fear, delirium, hallucinations, drowsiness, disorientation
Respiratory depression and apnea
Profound hypotension, reflex tachycardia, bradycardia, palpitations, chest wall rigidity
Nausea and vomiting

Overdose

Provide airway management and ventilatory support. Consider the use of naloxone to reverse opioid intoxication. Naloxone should be used judiciously in patients on long-term opioid therapy to avoid precipitating acute withdrawal syndrome.

See J12: Opioids for additional information.

Warning And Precautions

Causes respiratory depression; accumulation of carbon dioxide secondary to respiratory depression can potentiate the CNS depressant effects seen
Can cause or exacerbate hypotension
Can cause constipation
Use with caution in patients with other opioid sensitivity
Dosing should be adjusted for patients with hepatic disease; consult medical oversight or pharmacy for direction
Extended-release formulations will have extended duration of action

Drug Interactions

Depressant effects are potentiated by the presence of other CNS depressants such as alcohol, sedatives, antihistamines, neuroleptics, or psychotropic drugs