Dilaudid (Hydromorphone)

Dilaudid (Hydromorphone)

Q) What is Dilaudid?

A) Dilaudid is an analgesic narcotic with an addiction liability similar to that of morphine. It is apparent within 15 minutes and remains in effect for more than 5 hours. Dilaudid is approximately 8 times more potent on a milligram basis than morphine. Often called "drug store heroin" on the streets. DILAUDID (hydromorphone hydrochloride) (WARNING: May be habit forming), a hydrogenated ketone of morphine, is a narcotic analgesic.

Q) How is Dilaudid available?

A) Dilaudid is available in: ampules (sterile solution) , intravenously, oral liquid, tablets, and suppositories.

Q) What are the side effects of Dilaudid?

A) It inhibits ascending pain pathways in Central Nervous System. Dilaudid increases the pain threshold and alters pain perception.

… nausea

… vomiting

… dizziness

… somnolence

… anorexia

… constipation

… pain at the injection site

… local tissue irritation

… Hallucinations

… itching or skin rash

… increased sweating,

… agitation

Q) What are the symptoms of overdose?

… respiratory depression

… stupor

… coma

… skeletal muscle flaccidity

… cold and clammy skin

… hypertension

… circulatory collapse

… cardiac arrest

Q) What is Dilaudid addiction?

A) Prescription pill addiction is common place in today's society and can happen to anyone. The addict will start out with a legitimate ailment and become dependent on the drug prescribed. When addicted users are unable to get legitimate prescriptions they resort to what is called doctor shopping. The addict will see many doctors and pretend to be sick to obtain their drug of choice. Sometimes addicts get addicted by someone turning them onto a prescription drug and they end up liking it. Some pills are psychologically dependent and some physically. Drug enforcement officers seize street pills like valium, xanax, percocet, darvocet, which are popular depressants. Stimulants like fastin, ritalin, dexedrine are also obtained for illicit use. The elderly are targets for prescription theft. Health care workers or family members might obtain pills by this method. Prescription pill sales on the street are more expensive than other illicit drugs. Pills depending on their type can sell for $2 to $10 a piece. Pills like Dilaudid are very expensive selling for $50 to $60 dollars a piece on the street.

Addiction is a major risk with prolonged use (over 2-3 weeks) of narcotics. Even moderate doses of some narcotics can result in a fatal overdose. When increasing doses of narcotics, the person may first feel restless and nauseous and then progress to loss of consciousness and abnormal breathing. Other risks include withdrawal symptoms that may last for months.

Hydromorphone hydrochloride
Hydromorphone hydrochloride (Dilaudid)
Hydromorphone hydrochloride
(hy-droh-MOR-fohn)
Pregnancy Category: C

Classification: Narcotic analgesic, morphine type

Action/Kinetics: Hydromorphone is 7-10 times more analgesic than morphine, with a shorter duration of action. It manifests less sedation, less vomiting, and less nausea than morphine, although it induces pronounced respiratory depression. Onset: 15-30 min. Peak effect: 30-60 min. Duration: 4-5 hr. t1/2: 2-3 hr. Give rectally for prolonged activity.

Uses: Analgesia for moderate to severe pain (e.g., surgery, cancer, biliary colic, burns, renal colic, MI, bone trauma). Dilaudid-HP is a concentrated solution intended for those tolerant to narcotics.

Additional Contraindications: Migraine headaches. Use in children or during labor. Status asthmaticus, obstetrics, respiratory depression in absence of resuscitative equipment. Lactation.

Special Concerns: Do not confuse Dilaudid-HP with standard parenteral solutions of Dilaudid or with other narcotics as overdose and death can result. Use Dilaudid-HP with caution in clients with circulatory shock.

Additional Side Effects: Nystagmus.

Additional Drug Interactions: CNS and respiratory depression when used with protease inhibitors.

How Supplied: Injection: 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL; Liquid, Oral: 1 mg/mL; Powder for injection, lyophilized: 250 mg/vial; Suppository; 3 mg; Tablet: 1 mg, 2 mg, 3 mg, 4 mg, 8 mg

Dosage
ïLiquid Analgesia.
Adults: 2.5-10 mg q 4-6 hr as necessary.
ïSuppositories Analgesia.
Adults: 3 mg q 6-8 hr or as directed by physician.
ïTablets Analgesia.
Adults: 2-4 mg q 4-6 hr; for more severe pain, 4 or more mg q 4-6 hr.
ïSC, IM, IV Analgesia.
Adults: 1-2 mg IM or SC q 4-6 hr. For severe pain, 3-4 mg q 4-6 hr. May be given by slow IV over 2-3 min.

Hydromorphone (Dilaudid)

ADVERSE REACTIONS

Central Nervous System: Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, dizziness, psychic dependence, mood changes.

Gastrointestinal System: Nausea and vomiting occur infrequently; they are more frequent in ambulatory than in recumbent patients. The antiemetic phenothiazines are useful in suppressing these effects; however, some phenothiazine derivatives seem to be antianalgesic and to increase the amount of narcotic required to produce pain relief, while other phenothiazines reduce the amount of narcotic required to produce a given level of analgesia. Prolonged administration of DILAUDID may produce constipation. Opiate agonist- induced increase in intra-luminal pressure may endanger surgical anastomosis.

Cardiovascular System: Circulatory depression, peripheral circulatory collapse and cardiac arrest have occurred after rapid intravenous injection. Orthostatic hypotension and fainting may occur if a patient stands up suddenly after receiving an injection of DILAUDID.

Genitourinary System: Ureteral spasm, spasm of vesical sphincters and urinary retention have been reported.

Respiratory Depression: DILAUDID produces dose-related respiratory depression by acting directly on brain stem respiratory centers. DILAUDID also affects centers that control respiratory rhythm, and may produce irregular and periodic breathing. If significant respiratory depression occurs, it may be antagonized by the use of naloxone hydrochloride. The usual adult dose of 0.4 to 0.8 mg given intramuscularly or intravenously, promptly reverses the effects of morphine-like opioid agonists such as DILAUDID. In patients who are physically dependent, small doses of naloxone may be sufficient not only to antagonize respiratory depression, but also to precipitate withdrawal phenomena. The dose of naloxone should therefore be adjusted accordingly in such patients Since the duration of action of DILAUDID may exceed that of the antagonist, the patient should be kept under continued surveillance; repeated doses of the antagonist may be required to maintain adequate respiration. Apply other supportive measures when indicated.

DRUG ABUSE AND DEPENDENCE

DILAUDID is a Schedule II narcotic. Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of narcotics; therefore, DILAUDID should be prescribed and administered with caution. However, psychic dependence is unlikely to develop when DILAUDID is used for a short time for the treatment of pain. Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, usually assumes clinically significant proportions only after several weeks of continued narcotic use, although some mild degree of physical dependence may develop after a few days of narcotic therapy. Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia. is manifested initially by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. The rate of development of tolerance varies among patients.

DRUG INTERACTIONS

Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepressants or other CNS depressants (including alcohol) concomitantly with DILAUDID may exhibit an additive CNS depression. When such combined therapy is contemplated, the dose of one or both agents should be reduced.

WARNINGS

Head Injury and Increased Intracranial Pressure: The respiratory depressant effects of narcotics and their capacity to elevate cerebra-spinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure. Furthermore, narcotics produce effects which may obscure the clinical course of patients with head injuries.

Acute Abdominal Conditions: The administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.

PRECAUTIONS

Special Risk Patients: DILAUDID should be used with caution in elderly or debilitated patients and those with impaired renal or hepatic function, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture. As with any narcotic analgesic agent, the usual precautions should be observed and the possibility of respiratory depression should be kept in mind.

Cough Reflex: DILAUDID suppresses the cough reflex; as with all narcotics, caution should be exercised when DILAUDID is used postoperatively and in patients with pulmonary disease.

Usage in Ambulatory Patients: Narcotics may impair the mental and or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery; patients should be cautioned accordingly.

Drug Interactions: Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepressants or other CNS depressants (including alcohol) concomitantly with DILAUDID may exhibit an additive CNS depression. When such combined therapy is contemplated, the dose of one or both agents should be reduced.

Parenteral Administration: The parenteral form of DILAUDID may be given intravenously, but the injection should be given very slowly. Rapid intravenous injection of narcotic analgesics increases the possibility of side effects such as hypotension and respiratory depression.

Pregnancy: Pregnancy Category C. DILAUDID has been shown to be teratogenic in hamsters when given in doses 600 times the human dose. There are no adequate and well-controlled studies in pregnant women. DILAUDID should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent. The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexea, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever. The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose. There is no consensus on the best method of managing withdrawal. Chlorpromazine 0.7 to 1.0 mg/kg q.h. phenobarbital 2 mg/kg q.h. and paregoric 2 to 4 drops/kg q4h, have been used to treat withdrawal symptoms in infants. The duration ot therapy is 4 to 28 days, with the dosages decreased as tolerated.

Labor and Delivery: As with all narcotics, administration of DILAUDID to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used.

Nursing Mothers: it is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from DILAUDID, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use: Safety and effectiveness in children have not been established.