Hydromorphone (Oral)

Overview

Patients who are known to tolerate opioid-containing medications have found relief with the immediate and extended-release drug known as hydromorphone. This drug is taken orally, either in tablet or capsule form, to alleviate moderate or severe pain in patients that require 24-hour pain relief for an extended period of time.

This prescription strength medication is not appropriate for use in short-term cases or in situations of mild pain levels. Patients who are recovering from surgery, or have other shorter term pain relief needs are not good candidates for hydromorphone. This medication is appropriate for acute pain cases and is not suitable for occasional pain relief. This drug depresses the central nervous system (CNS) and caution should be taken with the use of alcohol or medications that also affect the CNS as the effect of the drug can be magnified.

Because this is a narcotic drug, patients should be aware of the chance of addiction and dependence on hydromorphone, especially with its intended use over long periods of time. Physical dependence is of concern, but it is secondary to the effectiveness of the drug in relieving pain. Withdrawal symptoms are likely to occur if the patient stops using this medication quickly and without first receiving instructions from their prescribing physician. Do not stop taking this drug without first discussing any changes with your doctor. Gradually decreasing the amount of hydromorphone taken over a certain period of time is advisable.

There is a possibility of overdose when taking hydromorphone and patients and their caregivers should familiarize themselves with these signs and seek immediate emergency care if they occur.

A reaction known as anaphylaxis can occur in patients that are taking hydromorphone. This reaction can be severe and even life-threatening in some cases. Patients who experience any of the signs or symptoms of anaphylaxis should seek emergency treatment right away.

It is important to inform your doctor and healthcare team immediately if you have any changes in the way that you are taking any other medications or to your health and general well-being. This drug can be potentially harmful and it is advised that patients stay in close communication with their prescribing physician during their course of treatment.

Hydromorphone is available in the following dosage delivery methods:

  • Solution
  • Liquid
  • Tablet, Extended Release
  • Capsule, Extended Release
  • Tablet

Conditions Treated

  • Moderate to severe long-term pain

Type Of Medicine

  • Analgesic
  • Opioid

Side Effects

There are a number of unwanted side effects that can occur with the use of hydromorphone, some of which can be serious. If you are taking this medication or caring for someone who is, be sure to familiarize yourself with the various types of side effects as there are some that require immediate attention. Others are likely the result of your system adjusting to the medication and typically dissipate after a few days. Patients who experience any side effects that do not go away on their own or become worse are advised to seek further medical attention. Do not change the way in which you take hydromorphone without first discussing these alterations with your doctor.

Seek further medical attention should you experience any of the following side effects and symptoms as they may be a sign of a more serious problem:

Rare and unlikely chance of occurrence:

  • Agitation
  • Vomiting of material resembling coffee grounds
  • Mood or mental changes
  • Blurred vision
  • Difficulty breathing
  • Chest pain or discomfort
  • Sunken eyes
  • Decreased urination
  • Severe stomach pain, cramping, or burning
  • Fast, pounding, slow or irregular heartbeat
  • Rapid breathing
  • Lightheadedness, dizziness, or fainting
  • Stiff neck
  • Dry mouth
  • Suicidal thoughts
  • Convulsions
  • Unexplained tiredness
  • Changes in behavior
  • Wrinkled skin
  • Bloody, black, or tarry stools

Unknown likelihood of occurrence:

  • Bluish lips or skin
  • Headaches
  • Tightness in the chest
  • Cold, clammy skin
  • Pale or blue lips, fingernails, or skin
  • Coughing
  • Noisy breathing
  • Difficulty in passing urine
  • Irregular, fast or slow, or shallow breathing
  • Fast or weak pulse
  • Loss of appetite
  • Dizziness
  • Painful urination
  • A decrease in frequency of urination or urine amount
  • Sweating
  • Confusion
  • Difficulty sleeping
  • Change in the ability to see colors, especially blue or yellow

There is the possibility of an overdose while taking hydromorphone which increases the importance of taking the medication exactly as directed. Familiarize yourself with these signs of overdose and seek immediate emergency medical attention if they occur:

Overdose symptoms:

  • Cold, clammy skin
  • Slow heartbeat
  • Convulsions
  • Very slow or troubled breathing
  • Pinpoint pupils
  • Drowsiness that is so severe you are not able to answer when spoken to

There are also a number of side effects that can occur that will likely go away on their own after a few days. If you experience any of this group of symptoms and they do not dissipate in a few days, or if they become worse, it is advisable to contact your doctor for further medical advice.

More likely:

  • Muscle pain or stiffness
  • Joint pain
  • Nausea
  • Trouble with moving
  • Difficulty having a bowel movement

Less likely:

  • Acid or sour stomach
  • Trouble concentrating
  • Belching
  • Stomach discomfort, upset, or pain
  • Diarrhea
  • Muscle spasms
  • Feeling sad or empty
  • Irritability
  • Indigestion
  • Unexplained weight gain or loss
  • Loss of interest or pleasure
  • Heartburn
  • Pain in the arms or legs
  • Discouragement
  • Tingling of the hands or feet
  • Bloating or swelling of the face or extremities
  • Back pain

Rare and less likely to occur:

  • Forgetfulness
  • Sneezing
  • Clumsiness
  • Shivering
  • Crying
  • Seeing, hearing, or feeling things that are not there
  • Difficulty with swallowing
  • Rhythmic movement of muscles
  • Double vision
  • Muscle twitching or jerking
  • Feeling of constant movement of self or surroundings
  • Low body temperature
  • Increased appetite
  • Bleeding after defecation
  • Loss of balance
  • Joint pain, stiffness, or swelling
  • Muscle aches
  • Full feeling
  • Overactive reflexes
  • Excess air or gas in the stomach or intestines
  • A runny nose
  • Difficulty with walking
  • Sensation of spinning
  • Delusions of persecution, mistrust, suspiciousness, or combativeness
  • Slurred speech
  • Continued ringing or buzzing in the ears
  • Swelling of the feet or lower legs
  • Trouble with speaking
  • Loss of sexual ability, desire, drive, or performance

Unknown likelihood of occurrence:

  • Bad, unusual or unpleasant mouth taste
  • The feeling of warmth
  • Shaking
  • Chills
  • Redness of the face, neck, arms, and occasionally, upper chest
  • Deep or fast breathing with dizziness
  • Muscle stiffness or tightness
  • Dry mouth
  • Hives or welts
  • Fear or nervousness
  • Itching
  • False or unusual sense of well-being
  • Numbness of the feet, hands, and around the mouth
  • Drowsiness
  • Relaxed and calm feeling
  • Constricted, pinpoint, or small pupils (black part of the eye)
  • Uncontrolled eye movements
  • Burning, crawling, itching, numbness, prickling feeling in extremities
  • Upper stomach pain

There are other potential side effects that may occur that are not listed here. Confer with your doctor if you have any concerns regarding how you react to hydromorphone. Any symptoms that occur that are significant and do not go away on their own after a few days should be discussed with your doctor.

Dosage

The dosage guidelines that are outlined below reflect the typical amounts that are prescribed, yet your dosage may differ. It is important that the prescription instructions provided by your doctor are followed. Your dosage may vary due to your size, the severity of your condition, and the other medications that you are taking and any other medical conditions that you have.

Children who are prescribed this medication will be instructed by their doctor of the dosage that is appropriate for their condition and situation. All patients should follow the instructions provided by their prescribing physicians and not make any changes to how they take this medication without first seeking medical advice.

If you are utilizing the oral suspension (liquid) method of delivery, be sure to use a proper measuring device such as a medicine cup, clearly marked measuring spoon, or oral syringe. It is not recommended to use common household utensils for measuring your dosage of hydromorphone.

Patients taking tablets or capsules that are extended-release can take this medication with or without food, whichever is the patient's preference. Do not crush, chew, break or otherwise alter the medication as it is important that it is swallowed whole. Be sure to take each dose at the same time of day each day.

Hydromorphone should only be taken by patients who have taken other opioid medications and have tolerated them well. If you are unsure of your level of tolerance for opioid-based medications check with your doctor prior to starting your course of treatment. This medication is not appropriate for patients that are recovering from surgery or who have another short-term need for pain relief. Additionally, do not take hydromorphone if your pain is mild, as it is intended for use in patients who suffer from moderate to severe long-term pain.

There are significant differences between the extended and immediate-release formulations that can cause issues when taken, even at the same dosage amount, so do not make any changes to the type of medication that you are taking or how you take it without first consulting your doctor or another member of your healthcare team.

Patients are advised to thoroughly wash their hands with soap and water after touching these tablets, especially those that are crushed or broken.

Extended-release capsule oral dosage:

If the patient is switching from another narcotic medication:

Take the capsule one time each day. At the beginning of the course of treatment, the dosage amount will be determined by the amount of the previous medication that was taken. The prescribing doctor will make any necessary adjustments once the patient has transitioned to the use of hydromorphone.

Extended-release tablet oral dosage:

If the patient is switching from a different form of regular hydromorphone:

Take the tablet one time each day. The total amount of milligrams that are taken each day will be the same as that taken of the previous medication.

If the patient is switching from another narcotic medication:

Take the tablet one time each day. At the beginning of the course of treatment, the dosage amount will be determined by the amount of the previous medication that was taken. The prescribing doctor will make any necessary adjustments once the patient has transitioned to the use of hydromorphone.

Liquid oral dosage form:

At the start of the course of treatment, patients will take approximately a half teaspoon to two teaspoons or 2.5 to 10 milliliters every three to six hours as necessary.

Immediate-release tablet oral dosage:

At the start of treatment with hydromorphone, the patient will take between two to four milligrams of the medication every four to six hours as necessary.

If a scheduled dose of hydromorphone is inadvertently missed, it should be taken as soon as the oversight is noticed. However, if it is close to the time of the next scheduled dose it should be skipped entirely. Patients that are unsure what to do in an instance of a skipped dose should confer with their doctor or pharmacist for further advice. It is important that double doses of hydromorphone are never taken under any circumstances.

Major Drug Interactions:

Similar to many medications, there are certain drugs with which hydromorphone is contraindicated. If you are currently taking Naltrexone it is not recommended to also take hydromorphone although your doctor will make the final determination on a case by case basis. Do not change the way in which you take any of your medications while you are taking hydromorphone as it can have a negative effect on your system. Discuss any changes to your medications with your doctor prior to implementing them.

There are other medications that the prescribing doctor may wish to alter the way that you take them when prescribed with hydromorphone. It is important that patients inform their medical team of all of the medications that they are currently taking, the dosage of each, and how often they are taken. When disclosing the medications taken be sure to include both prescription and non-prescription drugs, any over the counter medications, as well as herbal remedies and any vitamin and mineral supplements.

  • Alfentanil
  • Zaleplon
  • Anileridine
  • Triazolam
  • Asenapine
  • Tramadol
  • Brofaromine
  • Tizanidine
  • Bromopride
  • Thioridazine
  • Buspirone
  • Temazepam
  • Butalbital
  • Suvorexant
  • Carbinoxamine
  • Sodium Oxybate
  • Carisoprodol
  • Selegiline
  • Chlordiazepoxide
  • Risperidone
  • Chlorzoxazone
  • Rasagiline
  • Clonazepam
  • Quetiapine
  • Clorgyline
  • Propoxyphene
  • Codeine
  • Promethazine
  • Dantrolene
  • Procarbazine
  • Dexmedetomidine
  • Pimozide
  • Diazepam
  • Phenobarbital
  • Diphenhydramine
  • Perphenazine
  • Doxylamine
  • Pentobarbital
  • Estazolam
  • Pargyline
  • Ethchlorvynol
  • Oxymorphone
  • Flibanserin
  • Oxazepam
  • Fluphenazine
  • Opium
  • Fospropofol
  • Nitrous Oxide
  • Halazepam
  • Nialamide
  • Halothane
  • Hydromorphone
  • Molindone
  • Iloperidone
  • Midazolam
  • Isocarboxazid
  • Methocarbamol
  • Ketamine
  • Metaxalone
  • Meclizine
  • Lazabemide
  • Meptazinol
  • Linezolid
  • Mephobarbital
  • Lormetazepam
  • Meperidine
  • Lurasidone
  • Morphine Sulfate Liposome
  • Medazepam
  • Mephenesin
  • Loxapine
  • Meprobamate
  • Lorazepam
  • Mesoridazine
  • Levorphanol
  • Methadone
  • Ketazolam
  • Methohexital
  • Isoflurane
  • Moclobemide
  • Iproniazid
  • Morphine
  • Hydroxyzine
  • Nalbuphine
  • Hydrocodone
  • Nitrazepam
  • Haloperidol
  • Olanzapine
  • Furazolidone
  • Orphenadrine
  • Flurazepam
  • Oxycodone
  • Flunitrazepam
  • Paliperidone
  • Fentanyl
  • Pentazocine
  • Eszopiclone
  • Periciazine
  • Enflurane
  • Phenelzine
  • Donepezil
  • Pimavanserin
  • Dihydrocodeine
  • Prazepam
  • Dezocine
  • Promazine
  • Desflurane
  • Propofol
  • Cyclobenzaprine
  • Quazepam
  • Clozapine
  • Ramelteon
  • Clorazepate
  • Remifentanil
  • Clobazam
  • Secobarbital
  • Chlorpromazine
  • Sevoflurane
  • Chloral Hydrate
  • Sufentanil
  • Cariprazine
  • Tapentadol
  • Butorphanol
  • Thiopental
  • Butabarbital
  • Thiothixene
  • Buprenorphine
  • Toloxatone
  • Bromazepam
  • Tranylcypromine
  • Baclofen
  • Trifluoperazine
  • Aripiprazole
  • Ziprasidone
  • Alprazolam
  • Zolpidem

The medical team should be aware of all allergies to medications, foods, cleaning supplies and other substances, and pets and animals. Lifestyle habits such as the use of tobacco products and drinking on a regular basis should also be disclosed as they can affect the way in which the body's system reacts to hydromorphone.

It is important to avoid the following while taking the drug hydromorphone:

  • Ethanol

Patients that currently suffer from and are being treated for any of the following conditions may have a different reaction when taking hydromorphone. Anyone who is prescribed this medication may experience more significant side effects or other negative reactions and the prescribing doctor should be informed of any side effects or negative reactions.

  • Addison disease
  • Seizures
  • Brain tumor
  • Hypotension
  • Chronic obstructive pulmonary disease (COPD)
  • Prostatic hypertrophy
  • Drug dependence, especially narcotic abuse or dependence
  • Nervous system depression
  • Head injury
  • Liver disease
  • Mental illness
  • Hypothyroidism
  • Obesity
  • Gallbladder disease
  • Weakened physical condition
  • Cor pulmonale or any other serious heart condition
  • Pancreatitis
  • Breathing or lung problems
  • Kidney disease
  • Alcohol abuse

Warnings

All scheduled appointments should be kept while taking this medication as your doctor will need to monitor the effectiveness of the medication and check for any unwanted side effects. It is advisable to undergo all diagnostic testing ordered by your physician while taking hydromorphone.

Hydromorphone depresses the CNS and other medications and substances that affect this system should be avoided while taking this medication. Be aware that the effect of alcohol may be heightened while you are taking hydromorphone and it is best avoided when you are taking this medication. Cold and allergy medications, muscle relaxants, sedatives, sleeping aids and similar drugs should also be used with caution.

Due to the habit-forming nature of this medication, patients should not increase the amount of hydromorphone that they are taking. If you do not believe that you are getting the necessary relief with your current dosage level discuss the situation with your medical team. It can be extremely dangerous to take more than the prescribed amount of any medication, especially one containing opioids. Consult with your doctor prior to making any changes to the way that you take this medicine.

The use of narcotic painkillers over an extended period of time may lead to constipation. It is recommended that patients increase the level of fluids that they drink and increase their fiber intake. If necessary, your doctor may advise that you use laxatives to relieve these symptoms. Chronic constipation can lead to more serious medical issues if it is not cleared up in a reasonable amount of time, speak with your doctor if these methods do not give you the relief that you need.

This medication has been reported to cause dizziness, extreme drowsiness, and confusion in some patients. Prior to driving, using heavy machinery, or partaking in any activity that requires full alertness, patients should be aware of how their bodies react to this medication. Do not engage in any activity that could potentially be dangerous if you are unsure of how your body will react when taking hydromorphone or if you regularly experience these symptoms.

There have been cases of anaphylaxis reported by patients that are using this medication; anaphylaxis is an allergic reaction that can become severe and requires immediate emergency treatment. Patients should familiarize themselves with the symptoms of this reaction which can be severe and even life-threatening in some cases. Inform your doctor of all of your allergies, including food, other medications, cleaning supplies and other substances, prior to starting your hydromorphone course of treatment as they may cause an increased risk of an anaphylaxis reaction. If you experience any of the symptoms of anaphylaxis listed below, immediate medical attention should be sought:

  • Rash
  • Itching
  • Hoarseness
  • Trouble breathing
  • Trouble swallowing
  • Swelling of your hands, face, or mouth

Patients who stop taking this medication in an abrupt manner may experience withdrawal symptoms that can be severe in some cases. If you need to end your course of treatment with this medication your doctor will work with you to formulate a gradual weaning from the drug which should help to minimize the symptoms of withdrawal that you experience. Do not stop taking hydromorphone or change the way that you take it without first checking with your prescribing physician.

Do not take too much of this medicine. This can be life-threatening. It is strongly advised that patients and their caretakers familiarize themselves with these symptoms of overdose:

  • Extreme dizziness or weakness
  • Trouble breathing
  • Cold, clammy skin
  • Slow heartbeat or breathing
  • Seizures

If you are pregnant your doctor may still keep you on hydromorphone to treat your long-term pain. In such cases, it is important to inform your doctor of any difficulties that you experience. This medication can cause serious issues in babies that are exposed to it in utero. Patients who take this medication while pregnant should look for withdrawal symptoms in their child. Notify your doctor right away if you observe any of the following symptoms in your newborn:

  • Failure to gain weight
  • Abnormal sleep patterns
  • Weight loss
  • High-pitched crying
  • Shakiness or tremors
  • Irritability
  • Vomiting
  • Diarrhea

Prior to taking any new medications, even those that are available over the counter and medications that are available without a prescription, it is important that such changes and the introduction of new drugs are discussed with the prescribing physician prior to beginning the course of treatment.

Storage

It is always best practice to store medications in the original packaging. Keep this medication in a low-moisture environment away from direct light and excessive heat and cold at room temperature. Do not allow hydromorphone to freeze.

Keep this and all medications out of the reach of both children and pets, especially as it is possible to overdose on this drug.

This drug must be disposed of in a safe and appropriate manner that your pharmacist can assist you with. Many communities offer give-back programs that allow patients to safely return any unused, expired, or excess medication that contains opioids. It is important that medication that is not being used not be stored in the home.

This medication must be stored in a secure location where it cannot be taken by someone else who may suffer from a narcotic addiction.

Summary

Patients that suffer from long-term pain that is moderate to severe may find relief when taking hydromorphone. This narcotic is appropriate for long-term pain management in patients that are opioid-tolerant. Patients that are currently being treated for other medical conditions may need to alter the way in which they take their medication concurrently with hydromorphone.

Due to the possibility of overdose, while taking hydromorphone, it is important that it is taken as directed. Do not alter the amount of the drug that you are taking without talking to your doctor first. There is a risk of both physical and psychological dependence when taking this medication and patients should not increase the amount of the drug that they are taking unless directed to do so by their doctor.

If you are going to stop taking this medication it is important that you follow the directions provided by your prescribing physician in order to minimize the possibility of experiencing withdrawal symptoms. Do not stop taking hydromorphone in an abrupt manner, and do not decrease the amount that you are taking without first consulting with your doctor.

Patients that are taking hydromorphone can expect to find relief from their long-term and moderate to severe pain.