Hydromorphone Review

A semi-synthetic opioid agonist that is very similar to morphine. It acts primarily at m-opioid receptors but also has a lesser effect on delta, kappa, and sigma receptors.

A large number of studies have compared the analgesic efficacy and side-effect profile of hydromorphone to morphine. This has led to the development of clinical lore that favours the use of hydromorphone in patients undergoing patient-controlled analgesia (PCA). However, several important differences exist.


Hydromorphone is a potent analgesic that acts directly at the opioid receptors in the brain and spinal cord to reduce pain. Its effects are similar to those of morphine. Like all opioids, it can be addictive and may cause physical dependence. It also has the potential to cause a wide variety of side effects, which can be serious. It is listed as a Schedule II drug under the United States Controlled Substances Act and in the drugs laws of most countries worldwide.

Hydromorphone and morphine are both used to treat severe pain. They both belong to the family of medications called opioids, but hydromorphone is more powerful than morphine. It is available as a tablet, a solution for injection, and a suppository. It is a Schedule II drug, meaning it has a high risk of misuse and addiction.

Several different types of trials have been conducted to test the effectiveness of hydromorphone as a pain reliever in people with cancer. The results of these trials have varied. One trial showed that hydromorphone was no better than a placebo in relieving pain in people with cancer, but another study found that it was significantly more effective than a placebo at reducing pain. However, the studies had very small numbers of participants and did not measure important outcomes such as quality of life.

Side effects of this medication include dizziness, drowsiness, nausea and vomiting, numbness or tingling in the hands or feet, itching, constipation, changes in mood (euphoria or depression), mental clouding, hallucinations, and seizures. It is not recommended to drive or operate heavy machinery while taking hydromorphone, because it can slow your reactions.

If you have liver or kidney problems, your doctor may need to change the dose of hydromorphone that you take. It can also interact with some medicines that affect serotonin levels, such as tricyclic antidepressants and some medications for depression. In severe cases, hydromorphone can cause a reaction that includes muscle rigidity and spasms, changes in mental state including agitation, confusion, delirium, and coma. It can also cause a very low blood pressure.


Hydromorphone is a semisynthetic opioid that has been used for pain relief in cancer and chronic non-malignant pain. It has been compared to morphine in a number of trials and is often considered to have an equivalent efficacy and side effect profile. It is a potent opioid that is readily absorbed into the bloodstream following oral administration and rapidly converted to morphine in the liver and the gut. It is also administered parenterally by intravenous, intramuscular and subcutaneous routes. It is well characterized in terms of its pharmacokinetics and pharmacodynamics in both immediate release oral preparations and modified-release products such as OROS.

Modified-release hydromorphone formulations have been developed to provide for more flexible dosing intervals and to improve patient compliance thereby leading to better pain control. A 12-hour modified-release hydromorphone product has been compared to an immediate-release oxycodone in patients with chronic severe pain and demonstrated improved clinical efficacy and safety.

As with other opioids, hydromorphone can be habit-forming and may cause withdrawal symptoms if doses are reduced or stopped suddenly. Withdrawal symptoms can include restless feeling, diarrhea, shivering, sweating, runny nose, sneezing, goose bumps, nausea, stomach cramps and fast heart rate. These symptoms can be minimized or eliminated by gradually reducing the dosage under medical supervision.

It is recommended that hydromorphone not be used in infants under one year of age. It should be avoided during pregnancy and breast-feeding. It passes into the breast milk and may harm a nursing infant. Inform your doctor if you are pregnant or breastfeeding.

If you are taking this medication, tell your doctor or pharmacist if you have any other allergies. This medication contains hydrochloride and may contain other ingredients such as lactose, magnesium stearate, sodium phosphate, starch and/or polyethylene glycol.


Hydromorphone is a potent opioid that is used to control moderate-to-severe pain. It works by binding to various opioid receptors and decreasing the brain’s response to pain. It also has antitussive and analgesic properties. It can be administered orally, intravenously, and topically. It is a controlled substance and must be prescribed by a doctor. It is often used to treat pain caused by cancer, nerve disorders, and other conditions. It can cause serious side effects if not taken correctly. People should always follow the directions on their prescription.

The medication can cause drowsiness, so it is important to avoid engaging in potentially dangerous activities while taking it. It can be particularly dangerous if you drive or operate heavy machinery. In addition, it can cause constipation, so you should drink plenty of water to prevent this symptom. It can be dangerous to mix hydromorphone with other medications that act on serotonin, such as tricyclic antidepressants and selective serotonin reuptake inhibitors. The combination can lead to a severe reaction, including muscle rigidity and spasms, difficulty moving, changes in mental state, delirium, agitation, and coma.

This drug is absorbed in the upper small intestine and is extensively metabolized in the liver, with formation of several renally excreted, water-soluble metabolites. Approximately 62% of an oral dose is eliminated by the liver on first pass. Consequently, its oral bioavailability is lower than that of other opioids. However, it can still provide adequate analgesia when the dosage is adjusted accordingly.

Oral formulations begin to work within 30 minutes, reach peak concentrations between 30 and 60 minutes, and have a half-life of 2 to 3 hours. They produce a wide range of side effects, including nausea, vomiting, dizziness, drowsiness, and constipation.

Long-term use of hydromorphone can cause addiction and physical dependency. It should only be used when needed for the shortest possible duration. Patients should be monitored closely and weaned off the medication gradually to avoid withdrawal symptoms. Withdrawal can occur even after only a few days of reduced dosing, so it is important to take the medication exactly as directed.


Hydromorphone is an opioid medicine. It reduces feelings of pain by blocking the way nerves signal pain to the brain. It can also cause side effects such as drowsiness, dizziness, nausea and vomiting. This medication should be used only under the care of a doctor. It should be kept out of reach of children and pets. Talk to your doctor about how much you should take and for how long. If you are taking this medication, tell your doctor or pharmacist if you have any other medical conditions, especially if you have liver disease, kidney problems or a history of addiction.

The risk of developing a serious opioid-related problem is increased if this medication is taken with other drugs that depress the central nervous system, such as alcohol, tranquilizers and antidepressants. It is important to tell your doctor about all medications, vitamins and supplements you are taking. This medication may affect your adrenal gland function, so your doctor will monitor it if you have a history of adrenal gland problems. It is not recommended to take this medication during pregnancy. It can pass into breast milk and may harm a nursing baby.

Morphine and hydromorphone have similar pharmacodynamic properties in terms of analgesia-respiratory depression ratio and analgesic potency. However, the onset and duration of action are shorter for hydromorphone. The choice of opioid should be guided by patient history, as there is idiosyncratic response to both morphine and hydromorphone in some patients.

Compared to the first-generation opioid analgesics, OROS extended-release hydromorphone is well tolerated in patients who were converted from other opioids in a multicenter, open label study of cancer and non-cancer pain patients. On average, it took twelve days for patients to become stable on OROS hydromorphone. OROS is not recommended for use in neonates or the elderly, because of its faster onset and shorter duration of action.

The Take Home Naloxone program gives Australians the opportunity to access naloxone without a prescription, to help them in the event of an opioid overdose. To find out more, visit the Choosing Wisely website.