Exalgo

Generic Name: hydromorphone (oral) (HYE droe MOR fone)
Brand Names: Dilaudid, Dilaudid-5, Exalgo

What is Exalgo?

Exalgo (hydromorphone) is a prescription opioid pain medication. An opioid is sometimes called a narcotic.

Exalgo is a strong opioid pain medicine. It is used in people who are opioid tolerant, to manage moderate to severe pain that continues around-the-clock and is expected to last for a long period of time.

Exalgo may also be used for purposes not listed in this medication guide.

Important information about Exalgo

Exalgo may be habit-forming and should be used only by the person for whom it was prescribed. Keep the medication in a secure place where others cannot get to it. Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine. Check your food and medicine labels to be sure these products do not contain alcohol.

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Never take Exalgo in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Exalgo may impair your thinking or reactions. Avoid driving or operating machinery until you know how Exalgo will affect you. Do not stop using Exalgo suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using hydromorphone.

Before using Exalgo

Do not use Exalgo if you have ever had an allergic reaction to a narcotic medicine (examples include codeine, methadone, morphine, Lortab, OxyContin, Percocet, Vicodin, and many others).

You should also not take Exalgo if you have:

• a bowel obstruction called paralytic ileus; or

• if you are having an asthma attack.

Do not take Exalgo if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

To make sure you can safely take Exalgo, tell your doctor if you have any of these other conditions:

• asthma, COPD, sleep apnea, or other breathing disorders;

• sulfite allergy;

• liver or kidney disease;

• underactive thyroid;

• curvature of the spine;

• a history of head injury or brain tumor;

• epilepsy or other seizure disorder;

• low blood pressure;

• gallbladder disease or pancreatitis;

• Addison's disease or other adrenal gland disorders;

• enlarged prostate, urination problems;

• mental illness;

• a history of alcoholism or drug addiction; or

• if you have recently used alcohol, sedatives, tranquilizers, or other narcotic medications.

Exalgo may be habit forming and should be used only by the person for whom it was prescribed. Never share Exalgo with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

You may not be able to take Exalgo unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Opioid medicines include fentanyl (Actiq, Duragesic), methadone (Methadose, Dolophine), morphine (Kadian, MS Contin, Oramorph), oxycodone (Oxycontin), oxymorphone (Opana), and many others. Talk with your doctor if you are not sure you are opioid-tolerant.

FDA pregnancy category C. It is not known whether Exalgo will harm an unborn baby. Exalgo may cause addiction or withdrawal symptoms in a newborn if the mother uses the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using Exalgo. Hydromorphone can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Exalgo. Serious side effects may be more likely in older adults and those who are ill or debilitated.

See also: Exalgo pregnancy and breastfeeding warnings (in more detail)

How should I use Exalgo?

Take Exalgo exactly as prescribed. Never take Exalgo in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Do not crush, chew, or break an extended-release Exalgo tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be may be released too fast and you may overdose.

Do not stop using Exalgo suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using Exalgo.

Store Exalgo at room temperature away from moisture, heat, and light.

Keep track of the amount of medicine used from each new bottle. Exalgo is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

After you have stopped using Exalgo, flush any unused tablets down the toilet. Disposal of medicines by flushing is recommended to reduce the danger of accidental overdose causing death. This advice only applies to a very small number of medicines. The FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal and presents the least risk to human safety.

What happens if I miss a dose?

Since Exalgo is used on an as needed basis, you are not likely to miss a dose. Do not use extra medicine to make up the missed dose.

Extended-release Exalgo is not for use on an as-needed basis for pain.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Exalgo can be fatal.

Overdose symptoms may include extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.

What should I avoid while using Exalgo?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine. Check your food and medicine labels to be sure these products do not contain alcohol. This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how Exalgo will affect you.

Exalgo side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Exalgo: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• weak or shallow breathing;

• pounding heartbeats or fluttering in your chest;

• wheezing, chest tightness, trouble breathing;

• seizure (convulsions);

• confusion, severe weakness or drowsiness; or

• feeling like you might pass out.

Less serious Exalgo side effects are more likely to occur, such as:

• blurred vision, double vision;

• flushing (warmth, redness, or tingly feeling);

• nausea, vomiting, constipation, diarrhea, stomach pain;

• dizziness, drowsiness;

• dry mouth;

• sweating;

• itching; or

• sleep problems (insomnia), or strange dreams.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Exalgo side effects (in more detail)

What other drugs will affect Exalgo?

Do not take Exalgo with other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Tell your doctor about all other medicines you use, especially:

• buprenorphine (Buprenex, Subutex);

• butorphanol (Stadol);

• nalbuphine (Nubain);

• pentazocine (Talwin);

• atropine (Atreza, Sal-Tropine), belladonna (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm Scop);

• bladder or urinary medicines such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

• bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

• irritable bowel medicines such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine); or

• ulcer medications such as glycopyrrolate (Robinul) or mepenzolate (Cantil).

This list is not complete and other drugs may interact with Exalgo. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about Exalgo.