Dilaudid ( Hydromorphone ) 8mg is a centrally acting pain medication of the opioid class.It is made from morphine. In medical terms, it is an opioid analgesic, and in legal terms, a narcotic. Dilaudid( Hydromorphone ) 8mg is commonly used in the hospital setting, mostly intravenously (IV) because its bioavailability is very low orally, rectally, and intranasally. Sublingual administration (under the tongue) is usually superior to swallowing for bioavailability and effects; however,Dilaudid is bitter and hydrophilic like most opiates, not lipophilic, so it is absorbed poorly and slowly through mouth membranes.
Adverse effects of Dilaudid ( Hydromorphone ) 8mg are similar to those of other potent opioid analgesics, such as morphine and heroin. The major hazards of Dilaudid (hydromorphone) 8mg include dose-related respiratory depression, urinary retention, bronchospasm and sometimes circulatory depression. More common side effects include lightheadedness, dizziness, sedation, itching, constipation, nausea, vomiting, headache, perspiration, and hallucinations. These symptoms are common in ambulatory patients and in those not experiencing severe pain. Massive overdoses are rarely observed in opioid-tolerant individuals, but when they occur, they may lead to circulatory system collapse. Symptoms of overdose include respiratory depression, drowsiness leading to coma and sometimes to death, drooping of skeletal muscles, low heart rate and decreasing blood pressure..In the setting of prolonged use, high dosage, and/or kidney dysfunction, hydromorphone has been associated with neuroexcitatory symptoms such as tremor, myoclonus, agitation, and cognitive dysfunction.This toxicity is less than that associated with other classes of opioids such as the pethidine class of synthetics in particular.
The analgesic activity of Dilaudid (Hydromorphone) 8mg is due to the parent drug, hydromorphone. Hydromorphone is rapidly absorbed from the gastrointestinal tract after oral administration and undergoes extensive first-pass metabolism. In vivo bioavailability following single-dose administration of theDilaudid (Hydromorphone) 8 mg tablet is approximately 24% (coefficient of variation 21%). Bioequivalence between the Dilaudid (Hydromorphone) 8 mg tablet and an equivalent dose of Dilaudid (Hydromorphone) oral liquid has been demonstrated. Dose proportionality between Dilaudid (Hydromorphone) 8 mg tablet and other strength Dilaudid (Hydromorphone) 8mg tablets (2 and 4 mg) has not been established.
Safe and effective administration of opioid analgesics to patients with acute or chronic pain depends upon a comprehensive assessment of the patient. The nature of the pain (severity, frequency, etiology, and pathophysiology) as well as the concurrent medical status of the patient will affect selection of the starting dosage.
In non-opioid-tolerant patients, therapy with hydromorphone is typically initiated at an oral dose of 2-4 mg every four hours, but elderly patients may require lower doses .
In patients receiving opioids, both the dose and duration of analgesia will vary substantially depending on the patient’s opioid tolerance. The dose should be selected and adjusted so that at least 3-4 hours of pain relief may be achieved. In patients taking opioid analgesics, the starting dose of Dilaudid (Hydromorphone) should be based on prior opioid usage. This should be done by converting the total daily usage of the previous opioid to an equivalent total daily dosage of oral using Dilaudid (Hydromorphone) an equianalgesic table (see below). For opioids not in the table, first estimate the equivalent total daily usage of oral morphine, then use the table to find the equivalent total daily dosage of Dilaudid (Hydromorphone) .
Once the total daily dosage of Dilaudid (Hydromorphone) has been estimated, it should be divided into the desired number of doses. Since there is individual variation in response to different opioid drugs, only 1/2 to 2/3 of the estimated dose of Dilaudid (Hydromorphone) calculated from equivalence tables should be given for the first few doses, then increased as needed according to the patient’s response.
In chronic pain, doses should be administered around-the-clock. A supplemental dose of 5-15% of the total daily usage may be administered every two hours on an “as-needed” basis.
Periodic reassessment after the initial dosing is always required. If pain management is not satisfactory and in the absence of significant opioid-induced adverse events, the hydromorphone dose may be increased gradually. If excessive opioid side effects are observed early in the dosing interval, the hydromorphone dose should be reduced. If this results in breakthrough pain at the end of the dosing interval, the dosing interval may need to be shortened. Dose titration should be guided more by the need for analgesia than the absolute dose of opioid employed.