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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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