Naltrexone and nalmefene are opioid receptor antagonists that can precipitate withdrawal symptoms when used along with hydromorphone, decreasing its analgesic effect. Proper medication check with institutional regulations is mandatory before opioid administration. The risk of medication error is another potential harm, where the medical staff (doctor or nurse) provides the patient with a wrong formulation or the wrong dose. Whenever neonatal withdrawal syndrome is a possibility, adequate management should be available, which includes proper administration of morphine to the neonate. For this purpose, prolonged treatment of hydromorphone is to be avoided during pregnancy. Neonatal withdrawal syndrome occurs in the neonates of women with chronic hydromorphone usage. The required dose is 0.4 mg to 2 mg every 2 to 3 minutes when needed, and not to exceed 0.001 mg/kg or 10 mg. In cases of a suspected overdose, naloxone is the immediate therapeutic response in the intravenous, intramuscular, or subcutaneous form. Concerning signs include confusion, dizziness, bluish lips and fingernails, cold skin, constricted pupils, and weak blood pressure. Overdose and life-threatening respiratory depression can happen in cases of accidental ingestion or intended abuse. Patients who no longer need chronic treatment should be weaned off the medication gradually, to avoid withdrawal symptoms. Chronic users require regular monitoring with a clear plan for the duration of treatment. It requires careful administration in cases of concomitant psychiatric illness.Īddiction, abuse, and misuse are all potential risks affecting hydromorphone users. Hydromorphone should also to be avoided in genitourinary obstructions, central nervous system (CNS) depression, hypotension, and hypovolemia. Postoperative ileum should prompt careful administration of hydromorphone, to prevent prolonged ileus. Hydromorphone is to be avoided in any gastrointestinal obstruction or hypomotility, including ileus. In terminal cancer patients, clinicians should not restrain opioid therapy even when signs of respiratory depression are evident. Hydromorphone is contraindicated in patients reporting allergies to the drug itself, sulfites, or any other component of the formulation used.Ĭlinicians should not administer this drug to patients with bronchial asthma, or any other form of respiratory disease with clinical respiratory compromise this can induce respiratory arrest. The equivalence of hydromorphone to other opioids will follow later.Īs seen above, oral tablets can be in the immediate release form and an extended-release form. The residual unchanged form gets excreted in the urine (7%) and the feces (1%). Metabolism occurs in the liver through glucuronidation where most of it converts to hydromorphone-3-glucuronide.Įxcretion is mainly through urine in the glucuronidated form. The volume of distribution is 4 L/kg, where 8% to 19% of the drug is protein bound. Half-life is approximately 11 hours but varies between 8 to 15 hours. Half-life is 2 to 3 hours.Įxtended-release formulations have an onset of action at 6 hours, peak at 9 hours, and lasts 13 hours. Immediate-release oral formulations have an onset of action at 15 to 30 minutes, peak at 30 to 60 minutes, and last 3 to 4 hours. The latter cannot be crushed, chewed, or dissolved, because it will void immediate release of the formulation. Oral: Patients can take it orally with or without food in the immediate or extended-release form. Intramuscular, intravenous, or subcutaneous: injected at a concentration up to 10 mg/ml. 2002 1(1):13-20.Īmerican Society of Anesthesiologists.Hydromorphone administration can be through intramuscular, intravenous, subcutaneous, or oral routes. The neurobiology of opioid dependence: implications for treatment. Morphine versus hydromorphone: does choice of opioid influence outcomes? Pain Res Treat. Prescription of controlled substances: benefits and risks. Dosing and titration of opioids: How much, how long, and how and when to stop? Opioid oral morphine milligram equivalent (MME) conversion factors table for prescription drug coverage.Ĭenters for Disease Control and Prevention. US Department of Health and Human Services (HHS). Prescription opioids drug facts.ĭepartment of Justice/Drug Enforcement Agency. Opioid medications.Ĭenters for Disease Control and Prevention (CDC).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |