Hydromorphone

Chemical

Morphine derivative

Use

Pain in Palliative Care (this includes chronic cancer pain)

Moderate-Severe Pain

Presentation

Oral solution 1mg/ml

Ampoules 2mg/ml, 10mg/ml, 50mg/ml

Vials 500mg/50ml

HM has higher H2O solubility cf Morphine, enabling administration of high doses in low volumes (10mg/ml) and thus has smaller volume requirements which is particularly beneficial for s/c administration in palliative care

Dose

Titrated

PO 6.5-7.5mg HM = po 40-60mg M

Route

PO/IM/IV/SC/Intrathecal

Onset

15mins

DoA

t1/2β 2.5h

MoA

d, k, µ Agonist

PD

CNS: More sedation & less euphoria cf M

RESP: Respiratory depression

PK

A

D

Vd 4L/kg

PPB 20%

M

Hepatic glucuronidation to HM-3-glucuronide and CYP3A$ and CYP2C9 to Nothydromorphone

HUGE 1st pass metabolism 62% of administered dose

E

Urinary excretion of metabolites

Adverse Effects

Dry mouth, dizziness, N&V, dependence, tolerance, withdrawal syndrome