hydromorphone hydrochloride

CLINICAL USE


Relief of severe cancer pain

DOSE IN NORMAL RENAL FUNCTION

1.3 mg 4 hourly, increasing dose as requiredSR: 4 mg 12 hourly, increasing dose as required

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :321.8
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :7.1
  • %Excreted unchanged in urine &nbsp &nbsp : 6

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :24.4 litres

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2.5/–

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Reduce dose – start with lowest dose and titrate according to response
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Reduce dose – start with lowest dose and titrate according to response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Alcohol: can cause dose dumping with sustained release preparations
  • Antidepressants: possible CNS excitation or depression with MAOIs – avoid concomitant use and for 2 weeks after stopping MAOI; possible CNS excitation or depression with moclobemide; increased sedative effects with tricyclics
  • Antivirals: concentration possibly increased by ritonavirSodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    1.3 mg of hydromorphone is equivalent to 10 mg oral morphineMetabolised to mainly hydromorphone- 3-glucuronide and some hydromorphone-6-glucuronide, which also have opioid activity, and which accumulate in renal failure. May cause neuroexcitation and cognitive impairment
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