Hydromorphone (Injection)

Overview

Available only by prescription and under a doctor's supervision, hydromorphone is used to manage the most severe pain, for example, from a traumatic accident. Since this can be a habit-forming drug if used regularly, it is prescribed only for situations where there is acute pain to be managed. Milder pains and those that are chronic in nature are better served by some other non-habit-forming medications.

When this medication is used to manage pain over a longer period of time, such as in the recovery period after a severe accident, there is a chance that it will become habit-forming. In these situations, any attempt to stop treatment with hydromorphone suddenly may result in pronounced withdrawal symptoms for the patient. This can be avoided by gradually lessening the dosage over a long period of time, so as to allow the body time to acclimate itself to the reduced amount of medicine.

Delivery to a patient is done via injection, either under the skin or directly into a vein or muscle. An initial dosage will be administered by a qualified medical professional, and if treatment is to continue in the home setting, the patient will be required to learn the proper technique for self-administration, as well as how to properly dispose of all associated materials after usage. Before using this medicine at home, it will be important to check the solution for discoloration or for any particles which may be inside. If either of these conditions are met, the medicine should be discarded and not used, since this could trigger an adverse medical condition if injected.

Hydromorphone works best when it is administered at the first signs of oncoming pain, and if it is administered at any time after that, it is likely that the medication will not be quite as effective as it should be. However, you should never increase the dosage in order to manage the pain better, since a greater amount will not improve effectiveness if delivered after the onset of severe pain.

Condition Treated

  • Severe pain

Type Of Medicine

  • Narcotic analgesics

Side Effects

There are some side effects that you should be aware of, which may be a consequence of using hydromorphone. Many patients will not experience any side effects at all, or they may be very mild in nature. However, other patients may experience several side effects and they may be moderate or even severe in nature. If you should experience side effects to the point where they become very uncomfortable for you, contact your doctor at the earliest opportunity, inform them of whatever it is you are experiencing and be prepared to discuss the severity of side effects.

The first side effect that you should be aware of that is possible from using this medication is an allergic reaction, and this could be a serious issue because the symptoms from an allergic reaction have the potential to become life-threatening in a worst-case scenario. The symptoms to look for in an allergic reaction are as follows:

  • Dizziness or disorientation, with the sensation that you may be about to faint
  • Tightness in the chest, often accompanied by extreme difficulty with breathing
  • Hives or rashes appearing on skin surfaces
  • Extreme itchiness at various sites around the body
  • Pronounced puffiness or swelling in the area around the face, especially in the eyelids, lips, throat and tongue

Some of the most common side effects reported by patients using hydromorphone include those listed below:

  • Drowsiness or unexplained weakness
  • Lightheadedness or dizziness
  • Dry mouth
  • Flushing on the skin
  • Nausea and vomiting
  • Profuse sweating
  • Constipation
  • Pain, swelling, or redness at the injection site or nearby
  • Stomach or abdominal pain
  • Cramping in the abdomen or stomach
  • Fainting
  • Mood changes such as agitation or nervousness
  • Hallucinations
  • Seizures or convulsions
  • Difficulty with urinating
  • Loss of appetite
  • Weight loss
  • Unusual tiredness
  • Difficulty waking up
  • Irregular breathing which may be slow and or shallow
  • Fast or irregular heartbeat

To avoid the constipation that may be attendant upon using this medication, it is advisable to maintain a diet rich in fiber, while also exercising frequently and drinking plenty of water. It may also be necessary to at least occasionally use a laxative or stool softener. To reduce the possibility of fainting or the effects of lightheadedness, you may have to get into the habit of rising slowly from a lying or sitting position, rather than standing up quickly.

Dosage

Each time this medication is injected, it should be at a different site on the body, and your doctor or other trained medical professional will instruct you as to which locations on the body are acceptable for injection. However, it will always be either into a major muscle, into one of your veins or under the skin, and if you are going to be self-medicating at home, you will be thoroughly trained in the delivery method for injections.

It is extremely important, though, that you understand all instructions you are given regarding self-administration, because mistakes are always possible and they would, at the very least, diminish the effectiveness of the medication. You should always use a new needle and syringe whenever you are self-administering at home, and you should only use the brand name of the medication that a doctor has prescribed, because other brands may work in slightly different ways.

Dosages of this medication will be different for every patient, because the specific medical condition being treated is likely to be different. In addition, dosages will depend on the strength of the medication itself, your body's tolerance to the medication, the elapsed time between dosages and the total duration of time that your medical condition is being treated for.

For subcutaneous or intramuscular injection treating moderate to severe pain, adults should receive a dosage of 1 to 2 mg, which is to be injected into a major muscle or under the skin every two or three hours as needed to manage pain. Your doctor will probably adjust this dosage based on its effectiveness and your body's tolerance to it.

Pediatric patients being treated with this medication have no standard dosage, but will have a dosage determined by a doctor, based on their specific circumstances.

For patients who currently are taking some other opioid medication, an adult's dosage will be based on the base dosage of whatever other narcotic you're being treated with. Pediatric patients must have a specific dosage determined by a doctor, based on their medical circumstances.

If you should happen to miss a scheduled dosage of hydromorphone and your pain level is still severe, you should contact your doctor about what to do, because any course of action will be determined under specific medical condition and circumstances.

Interactions

Whenever you take a new medication, there is a potential for it to interact with some other drugs which you may concurrently be taking. The form that these kinds of interactions can take include either triggering adverse side effects or decreasing the effectiveness of one or other of the drugs. Since neither of these are desirable conditions, everything possible should be done to avoid interactions between drugs.

As a patient, you can help this process by preparing a list of all the medications you are currently taking, including all vitamins, herbal supplements, over the counter drugs and other prescription medications, as well as each of the dosages. Your doctor can review this medication list and make a determination on whether or not there is potential for any two drugs on this list to interact with each other or with hydromorphone.

If there is a potential for interaction, your doctor will likely recommend that you discontinue one of the drugs or that a decreased dosage be used during the period you will be treated with hydromorphone. This list will also be useful if you have a need to go to an emergency room for emergency care or if you are visiting any other healthcare facility where your primary care doctor is not in residence.

A doctor who reviews this medication list can make the same determination as your primary care doctor in avoiding drug interactions by consulting this list. You should never start, stop or change the dosage of any medication that you are currently using unless you are advised to do so by your doctor. Some of the drugs most commonly checked for potential interaction with hydromorphone are listed below:

  • Cimetidine
  • Benztropine
  • Oxybutynin
  • Belladonna alkaloids
  • Pentazocine
  • Nalbuphine
  • Naltrexone
  • Butorphanol
  • Codeine
  • Hydrocodone
  • Alcohol
  • Marijuana
  • Lorazepam
  • Zolpidem
  • Alprazolam
  • Cetirizine
  • Cyclobenzaprine
  • Carisoprodol
  • Diphenhydramine

It's also a good idea to get into the habit of checking labels on any medications you buy over the counter at pharmacies, for instance coughs and cold medications or allergy medications, since there is potential for these to cause drowsiness, and that may exacerbate some of the side effects triggered by hydromorphone.

It's also possible for hydromorphone to have an impact on specific laboratory testing results, for instance those testing for amylase or lipase. When you're taking hydromorphone, it can cause false results to be obtained in these kinds of laboratory tests, so whenever you have that kind of testing, you should alert laboratory personnel to the fact that you are currently taking hydromorphone.

Warnings

There are quite a few precautions that you should observe when taking hydromorphone, which is understandable because it is a narcotic and can have some serious impacts on your body. Because it operates on your brain and central nervous system, it's very important that your doctor checks on your progress during the period you are being treated with this medication. This will allow your doctor to determine whether the medication is being effective and how well your body is tolerating it. For this reason, you should never miss any scheduled appointments with your doctor.

Hydromorphone will significantly compound the effects of alcohol and any other depressant kinds of medications that you take, making you drowsy and much less alert. Some specific medications in this category include antihistamines and cold or allergy medications, tranquilizers, sedatives, sleeping pills, any other pain medications that are narcotics, muscle relaxants, medications for seizures, barbiturates, anesthetics and alcohol.

This medication is also known to be habit-forming, so you should never use more than the dosage prescribed by your doctor, because that can increase your dependence on the medication over time.

You should be aware that it is possible to experience dizziness or lightheadedness when you rise quickly from a lying or sitting position. This danger can be avoided by rising slowly or by laying down for a while when you do feel a bit lightheaded.

It's also possible for hydromorphone to make you feel confused and drowsy, so you should never operate a motor vehicle or any kind of machinery after taking this drug, since you could become a danger to yourself and to others.

There is a known potential when using any kind of narcotic over a longer time to develop persistent constipation. If you should notice this development in your own case, it's a good idea to to take steps to relieve the constipation by drinking plenty of water, taking an occasional laxative or stool softener and significantly increasing the amount of fiber you consume in your diet.

There is the potential for hydromorphone to trigger a serious allergic reaction in a patient, including anaphylaxis, which is a life-threatening situation that requires immediate medical attention. The onset of anaphylaxis can be recognized through symptoms such as extreme difficulty with swallowing or breathing, sudden hoarseness, the sudden appearance of rashes or hives and a very pronounced swelling of the eyelids, face, hands or mouth.

When you have been using hydromorphone for a period of time, for example, several weeks or longer, you should not abruptly discontinue using the drug without first consulting your doctor. In most cases, your doctor will want to gradually decrease your dosage level so that your body can become accustomed to the reduced amount of hydromorphone being injected. This will avoid potentially unpleasant withdrawal symptoms that you would otherwise experience, including extreme cramping of the abdomen or stomach, severe anxiety and agitation, fevers, nausea and vomiting, runny nose or congestion, difficulty was sleeping, profuse sweating, shaking and trembling.

In some cases, babies born to mothers who have become physically dependent on hydromorphone will themselves become physically dependent on the drug and will have to be medically weaned off it. This will likely cause some breathing problems for the infant, as well as some symptoms of withdrawal. This can be a very dangerous situation for the infant and will require constant medical attention to avoid a life-threatening situation.

If you should observe any of the following symptoms with your baby, you should seek immediate medical attention:

  • Excessive crying
  • Nausea and vomiting
  • Fevers
  • Unusual irritability
  • Extreme shortness of breath
  • Tremors
  • Difficulty with breathing

Hydromorphone is known to be passed through breastmilk to a nursing infant and is likely to cause undesirable side effects in the infant. This makes it highly inadvisable for a mother taking hydromorphone to breastfeed, so either the medication must be discontinued or the nursing mother should discontinue breastfeeding the infant.

Before taking this medication, you and your doctor should thoroughly review of your medical history, because there are certain medical conditions that can be heavily impacted by your use of hydromorphone. The specific medical conditions that you should make a point of telling your doctor about from your past history include the following:

  • Any kind of stomach or intestinal problems, such as diarrhea or constipation
  • Brain injuries
  • Tumors
  • Intracranial pressure
  • Seizures or convulsions
  • Emphysema
  • Asthma
  • Chronic bronchitis
  • Sleep apnea
  • Heart failure
  • Low blood pressure
  • Irregular heartbeat
  • Pancreatitis
  • Depression
  • Psychosis
  • Gallbladder disease
  • Drug addiction
  • Alcohol addiction
  • Liver disease
  • Kidney disease
  • Addison's disease
  • Difficulty with urination
  • Hypothyroidism.

If you have any kind of surgery scheduled, including dental surgery, you should notify your doctor or dentist that you are currently taking hydromorphone, as well as telling them about any other prescription medications or over the counter drugs you are taking. This may influence the doctor or dentist's usage of anesthetics during surgery.

There's a potential for geriatric patients to be impacted to a higher degree than younger patients by this drug, which would cause their side effects to be significantly exacerbated, especially dizziness, confusion, shallow breathing and extreme drowsiness.

Storage

If you are self-administering hydromorphone at home, it can be stored at room temperature in a location that is away from any kind of extremes of temperature - it should never be frozen. Excess humidity is also to be avoided, which is why hydromorphone should not be stored in the bathroom medicine cabinet, since that room is frequently subject to excessive heat and humidity.

It is extremely important that this medication be kept out of the reach of pets and small children in the household, because it is a narcotic drug that can of have severe impacts on a young person. If you are suspicious that a child in your household has ingested hydromorphone, you should seek medical attention immediately for the child, and you should be prepared to advise medical personnel about how much of the drug you believe the child has taken.

Any unused amounts of hydromorphone that you have or any medication that has expired should not be administered as a treatment dosage, but should instead be discarded. Proper disposal methods should always be observed when discarding this drug, rather than simply flushing it down the toilet or a sink where it might cause potential harm for others.

You can find out about proper disposal methods from your doctor or pharmacist, and, failing these sources of information, you can also find what you need at the FDA website for the safe disposal of medicines. Make sure that this medication is not exposed to direct lighting in the room where it is stored, and if you should observe that it has become discolored or that it has particles floating in it, you should discard the medication according to appropriate disposal methods.

Summary

Hydromorphone is a prescription injectable drug that can be very effective at pain management by acting on the brain and central nervous system. Since it is a narcotic, it can be habit-forming if used over a period of time, and, when discontinuing usage, no sudden stoppage should be undertaken, or symptoms of withdrawal may occur.

This drug will be initially administered in a hospital setting or doctor's office, after which it can be administered at home. Any patients administering this drug at home need to be well-versed in the allowable locations for injection, the actual procedures for injection, the proper usage and disposal of needles and syringes and the proper disposal of any unused medication.