"Nov. 2, 2012 -- Safety steps taken in the wake of the fungal meningitis outbreak have worsened drug shortages, raising questions about whether the U.S. must choose between the safety and the availability of crucial medicines.
DOSAGE AND ADMINISTRATION
DILAUDID (hydromorphone hydrochloride) ORAL LIQUID: The usual adult oral dosage of DILAUDID (hydromorphone hydrochloride) ORAL LIQUID is one-half (2.5 mL) to two teaspoonfuls (10 mL) (2.5 mg - 10 mg) every 3 to 6 hours as directed by the clinical situation. Oral dosages higher than the usual dosages may be required in some patients. DILAUDID (hydromorphone hydrochloride) 8 mg TABLET: The usual starting dose for DILAUDID (hydromorphone hydrochloride) tablets is 2 mg to 4 mg, orally, every 4 to 6 hours. Appropriate use of the DILAUDID (hydromorphone hydrochloride) 8 mg TABLET must be decided by careful evaluation of each clinical situation.
A gradual increase in dose may be required if analgesia is inadequate, as tolerance develops, or if pain severity increases. The first sign of tolerance is usually a reduced duration of effect.
Individualization of Dosage
The dosage of opioid analgesics like hydromorphone hydrochloride should be individualized for any given patient, since adverse events can occur at doses that may not provide complete freedom from pain.
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 (see PRECAUTIONS -Geriatric Use).
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 hydrochloride) 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 DILAUDID (hydromorphone hydrochloride) using 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 hydrochloride) .
Once the total daily dosage of DILAUDID (hydromorphone hydrochloride) 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 hydrochloride) calculated from equivalence tables should be given for the first few doses, then increased as needed according to the patient's response.
Since the pharmacokinetics of hydromorphone are affected in hepatic and renal impairment with a consequent increase in exposure, Patients with hepatic and renal impairment should be started on a lower starting dose (See CLINCIAL PHARMCOLOGY: Pharmcokinetics and Metabolism).
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.
OPIOID ANALGESIC EQUIVALENTS WITH APPROXIMATELY EQUIANALGESIC
|Nonproprietary (Trade) Name||IM or SC Dose||ORAL Dose|
|Morphine sulfate||10 mg||40-60 mg|
|Hydromorphone HCl (DILAUDID)||1.3-2 mg||6.5-7.5 mg|
|Oxymorphone HCl (Numorphan)||1-1.1 mg||6.6 mg|
|Levorphanol tartrate (Levo-Dromoran)||2-2.3 mg||4 mg|
|Meperidine, pethidine HCl (Demerol)||75-100 mg||300-400 mg|
|Methadone HCl (Dolophine)||10 mg||10-20 mg|
|* Dosages, and ranges of dosages represented, are a compilation of estimated equipotent dosages from published references comparing opioid analgesics in cancer and severe pain.|
DILAUDID (hydromorphone hydrochloride) ORAL LIQUID is a clear, sweet, slightly viscous liquid. It is available in:
Bottles of 1 pint (473 mL)-NDC# 0074-2452-02
DILAUDID (hydromorphone hydrochloride) 8 mg TABLETS are white and triangular shaped, embossed with the number 8 on one side and bisected and embossed with a double SI on the other side. They are available in:
Bottles of 100-NDC# 0074-2426-14
Storage: Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F). [See USP Controlled Room Temperature]. Protect from light.
A schedule Narcotic. DEA Order Form is Required. Abbott Laboratohbs. North Chicago. IL 60064, U.S.A.
Last reviewed on RxList: 8/12/2011
This monograph has been modified to include the generic and brand name in many instances.
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