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 :321.8

%Protein binding :7.1

%Excreted unchanged in urine : 6

Volume of distribution (L/kg) :24.4 litres

half-life – normal/ESRD (hrs) :2.5/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Reduce dose – start with lowest dose and titrate according to response

<10 : Reduce dose – start with lowest dose and titrate according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :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

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Route

Oral

Rate of Administration

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Comments

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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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