Dilaudid-HP

Generic Name: hydromorphone (Injection route)

hye-droe-MOR-fone hye-droe-KLOR-ide

Injection route(Solution;Powder for Solution)

Hydromorphone is a potent Schedule II opioid agonist which has the highest potential for abuse and risk of producing respiratory depression. Alcohol, other opioids and central nervous system depressants (sedative-hypnotics) potentiate the respiratory depressant effects of hydromorphone, increasing the risk of respiratory depression that might result in death. Dilaudid-HP(R) is a highly concentrated solution of hydromorphone intended for use in opioid-tolerant patients. Do not confuse Dilaudid-HP(R) with standard parenteral formulations of hydromorphone or other opioids as overdose and death could result .

Commonly used brand name(s)

In the U.S.

  • Dilaudid
  • Dilaudid-HP

Available Dosage Forms:

  • Solution
  • Powder for Solution

Therapeutic Class: Analgesic

Chemical Class: Hydromorphone

Uses For Dilaudid-HP

Hydromorphone belongs to the group of medicines called narcotic analgesics, which are medicines used to relieve pain. Dilaudid® is used to relieve pain in patients who require a narcotic pain medication. Dilaudid-HP® is used to relieve moderate-to-severe pain in patients who are opioid-tolerant and who require higher doses of opioid medicine.

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Hydromorphone acts on the central nervous system (CNS) to relieve pain. Some of the side effects are also caused by actions in the CNS. When hydromorphone is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only with your doctor's prescription.

Before Using Dilaudid-HP

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of hydromorphone injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of hydromorphone injection in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving hydromorphone injection.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Naltrexone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Perampanel

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Addison's disease (adrenal gland problem) or
  • Alcohol abuse, acute or
  • Asthma, severe, history of or
  • Breathing problems, severe (e.g., hypercapnia, hypoxia) or
  • Chronic obstructive pulmonary disease (COPD) or
  • Cor pulmonale (serious heart condition) or
  • Drug dependence, especially narcotic abuse or dependence, or history of or
  • Enlarged prostate (BPH, prostatic hypertrophy) or
  • Gallbladder disease or gallstones or
  • Head injuries or
  • Hypothyroidism (an underactive thyroid) or
  • Kyphoscoliosis (curvature of the spine with breathing problems) or
  • Mental illness, history of or
  • Problems with passing urine—Use with caution. May increase risk for more serious side effects.
  • Allergy to medicines containing sulfites or
  • Asthma, acute or severe or
  • Bowel blockage or
  • Paralytic ileus (bowels stop working and may be blocked) or
  • Respiratory depression (very slow breathing)—Dilaudid® and Dilaudid-HP® should not be used in patients with these conditions.
  • Hypotension (low blood pressure) or
  • Pancreatitis (inflammation of the pancreas) or
  • Seizures, history of—Use with caution. May make these conditions worse.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of hydromorphone

This section provides information on the proper use of a number of products that contain hydromorphone. It may not be specific to Dilaudid-HP. Please read with care.

Dilaudid-HP® injection should only be used by patients who have already been taking narcotic pain medicines, also called opioids. These patients are called opioid-tolerant. If you are uncertain whether or not you are opioid-tolerant, check with your doctor before using this medicine.

A nurse or other trained health professional will give you this medicine in a hospital. This medicine may be given as a shot under the skin, as a shot into one of your muscles, or through a needle placed in one of your veins.

Hydromorphone injection may sometimes be given at home to patients who do not need to be in the hospital. If you are using this medicine at home, your doctor will teach you how to prepare and inject the medicine. Be sure that you understand exactly how the medicine is prepared and injected.

You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.

Use a new needle and syringe each time you inject your medicine.

If the medicine in the vial or ampule has changed color, or if you see particles in it, do not use it.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection (intramuscular or subcutaneous) dosage forms:
    • For moderate to severe pain:
      • For patients who are not taking opioid medicines (not opioid-tolerant):
        • Adults—At first, 1 to 2 milligrams (mg) injected under your skin or into one of your muscles every 2 to 3 hours as needed. Your doctor may adjust your dose as needed and tolerated.
        • Children—Use and dose must be determined by your doctor.
      • For patients who are already taking opioid medicines (opioid-tolerant):
        • Adults—Your dose is the same as your dose of Dilaudid® or your doctor will determine your dose based on the narcotic pain medicine you are already receiving.
        • Children—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

If you store this medicine at home, keep it at room temperature, away from heat and direct light.

Flush all leftover medicine down the toilet after you have finished your treatment. Also, flush old medicine after the expiration date has passed. This medicine is one of only a few medicines that should be disposed of this way.

Precautions While Using Dilaudid-HP

It is very important that your doctor check your progress while you are receiving this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert) and may cause serious side effects. Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before drinking alcohol or taking any of the medicines listed above while you are using this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

This medicine may make you dizzy, drowsy, confused, or disoriented. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are receiving this medicine.

If you have been using this medicine regularly for several weeks or longer, do not suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Some babies who are born to mothers physically dependent on this medicine will also be physically dependent and may have breathing problems and withdrawal symptoms. This could be life-threatening and requires immediate medical attention. Check with your doctor right away if your child has the following withdrawal symptoms: difficulty with breathing, shortness of breath, excessive crying, irritability, fever, vomiting, or tremors.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Dilaudid-HP Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Incidence not known
  • Abdominal or stomach pain
  • blurred vision
  • change in the ability to see colors, especially blue or yellow
  • chest pain or discomfort
  • cold, clammy skin
  • confusion
  • cough
  • difficult or troubled breathing
  • dizziness
  • fast, pounding, or irregular heartbeat or pulse
  • fast or weak pulse
  • headache
  • irregular, fast, slow, or shallow breathing
  • lightheadedness, dizziness, or fainting
  • loss of appetite
  • low blood pressure
  • noisy breathing
  • pale or blue lips, fingernails, or skin
  • severe constipation
  • severe vomiting
  • shortness of breath
  • sleeplessness
  • slow or irregular heartbeat
  • sweating
  • tightness in the chest
  • trouble with sleeping
  • unable to sleep
  • unconscious
  • unusual tiredness
  • very slow breathing
  • very slow heartbeat or pulse
  • vomiting
  • wheezing

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Bigger, dilated, or enlarged pupils (black part of the eye)
  • decreased awareness or responsiveness
  • increased sensitivity of the eyes to light
  • no muscle tone or movement
  • sleepiness or unusual drowsiness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known
  • Anxiety
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • bad, unusual, or unpleasant (after) taste
  • change in taste
  • chills
  • constricted, pinpoint, or small pupils (black part of the eye)
  • decrease in the frequency of urination
  • decrease in urine volume
  • diarrhea
  • difficulty having a bowel movement (stool)
  • difficulty in passing urine (dribbling)
  • double vision
  • dry mouth
  • false or unusual sense of well-being
  • feeling of warmth
  • hives or welts
  • hyperventilation
  • irritability
  • loss of appetite
  • muscle stiffness or tightness
  • nausea
  • painful urination
  • redness, pain, or swelling at the injection site
  • redness of the face, neck, arms, and occasionally, upper chest
  • relaxed and calm
  • seeing, hearing, or feeling things that are not there
  • seeing double
  • shaking
  • skin itching
  • sleepiness
  • uncontrolled eye movements
  • upper abdominal or stomach pain
  • weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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