Narcotic analgesics:

Indications for Hydromorphone HCl Injection (HPF):

Management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate in opioid-tolerant patients who require higher doses.

Limitations of Use:

Reserve for use in patients for whom alternative treatment options have not been tolerated or not provided adequate analgesia.

Adult Dosage:

Use in opioid-tolerant patients only. Individualize; base starting dose on prior Dilaudid inj or prior dose of alternate opioid: see full labeling.

Children Dosage:

Not established.

Hydromorphone HCl Injection (HPF) Contraindications:

Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus. Hydromorphone-HPF: opioid non-tolerant.

Boxed Warning:

Addiction, abuse, and misuse. Life-threatening respiratory depression. Neonatal opioid withdrawal syndrome. Risks from concomitant use with benzodiazepines and other CNS depressants.

Hydromorphone HCl Injection (HPF) Warnings/Precautions:

Abuse potential (monitor). Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery: not recommended. Nursing mothers: monitor infants.

See Also:

Hydromorphone HCl Injection (HPF) Classification:

Opioid agonist.

Hydromorphone HCl Injection (HPF) Interactions:

Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. During or within 14 days of MAOIs: not recommended. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics.

Adverse Reactions:

Lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, pruritus; respiratory depression, severe hypotension, syncope.

How Supplied:

Prefilled syringes—10, 24; HPF Injection—contact supplier