Products
Hydromorphone is commercially available as sustained-release tablets, sustained-release capsules, capsules, solution for injection, solution for infusion, and drops (e.g., Palladon, Jurnista, Hydromorphoni HCl Streuli). It has been approved in many countries since 1996.
Structure and properties
Hydromorphone (C17H19NO3, Mr = 285.3 g/mol) is a semisynthetic, hydrogenated and oxidized morphine derivative. It is present in drugs as hydromorphone hydrochloride, a white crystalline powder that is readily soluble in water.
Effects
Hydromorphone (ATC N02AA03) has analgesic, depressant, antianxiety, and cough-irritant properties. The effects are due to binding to µ-opioid receptors. Hydromorphone has an effect about five times stronger than morphine and a shorter duration of action. It is a pure opioid agonist with no antagonistic properties.
Indications
For the treatment of moderate-to-severe acute and chronic pain.
Dosage
According to the professional information. Dose is adjusted on an individual basis. The sustained-release medications are usually administered every 12 hours, and the non-retarded medications are administered more frequently. Jurnista only needs to be taken once daily.
Abuse
Like other opioids, hydromorphone can be abused as a euphoric intoxicant.
Contraindications
- Hypersensitivity
- Severe respiratory depression
- Severe obstructive respiratory disease
- Acute abdomen
- Intestinal obstruction
- Acute liver disease
- Delayed gastric emptying
- Coma
- Traumatic brain injury
- Increased intracranial pressure
- Convulsions
- Delirium tremens
- Combination with MAO inhibitors
Full precautions can be found in the drug label.
Interactions
Hydromorphone is mainly conjugated and interacts poorly with CYP450, the main metabolite being hydromorphone-3-glucuronide. Central depressant drugs, alcohol, muscle relaxants, and anticholinergics may potentiate the effects and adverse effects of hydromorphone.
Adverse effects
The most common possible adverse effects include itching, sweating, dizziness, drowsiness, abdominal pain, constipation, dry mouth, nausea, vomiting, anxiety, confusion, insomnia, poor appetite, weakness, urinary retention, and low blood pressure. As with other opioids, the risk for dangerous respiratory depression must be considered.
