hydromorphone

(hye droe MOR fone)
Dilaudid, Dilaudid-5, Hydrostat IR, Palladone

What is the most important information I should know about hydromorphone?

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Do not stop taking hydromorphone suddenly if you have been taking it continuously for more than 5 to 7 days. Stopping suddenly could cause withdrawal symptoms and make you uncomfortable. Your doctor may want to gradually reduce the dose to decrease side effects.

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Hydromorphone will cause drowsiness and fatigue. Avoid alcohol, sleeping pills, antihistamines, sedatives and tranquilizers except under the supervision of your doctor. These may increase drowsiness, which may be dangerous.

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Hydromorphone may also cause constipation. Drink plenty of water (six to eight full glasses a day) to lessen this side effect. Increasing the amount of fiber in the diet can also help to alleviate constipation.

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Never take more hydromorphone than is prescribed. If your pain is not being adequately treated, talk to your doctor.

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Certain extended-release forms of hydromorphone (including Palladone) should only be taken if you have been using other narcotic pain medications and your body has gotten used to them (opioid tolerant). An extended-release form of hydromorphone should not be the first narcotic pain medication that has been prescribed to you and should not be used if you will only need pain medicine for a short time or will only be using it occasionally (as needed).

What is hydromorphone?

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Hydromorphone is in a class of drugs called narcotic analgesics. It relieves pain.

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Hydromorphone is used to treat moderate-to-severe pain. Hydromorphone is also a cough suppressant.

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Hydromorphone may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking hydromorphone?

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Hydromorphone is habit forming and should only be used under close supervision by those with an alcohol or drug addiction.

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Before taking this medication, tell your doctor if you have

kidney disease;

liver disease;

asthma or other breathing or lung problems;

urinary retention or problems urinating;

a paralytic ileus;

mental problems including depression or hallucinations (seeing or hearing things that are not there);

low blood pressure;

an enlarged prostate;

hypothyroidism;

seizures or epilepsy;

gallbladder disease;

a head injury; or

Addison's disease or other adrenal gland problems.

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You may not be able to take hydromorphone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

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Hydromorphone is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Hydromorphone may cause addiction and withdrawal symptoms as well as other harmful effects in a newborn baby when taken during pregnancy. Do not take hydromorphone without first talking to your doctor if you are pregnant or could become pregnant during treatment.

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Hydromorphone passes into breast milk and may cause addiction and withdrawal symptoms in a nursing baby. Do not take hydromorphone without first talking to your doctor if you are breast-feeding a baby.

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If you are younger than 18 years of age or older than 60 years of age, you may be more likely to experience side effects from hydromorphone therapy. Use extra caution.

How should I take hydromorphone?

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Take hydromorphone exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

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Take each dose with a full glass of water.

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Take hydromorphone with food or milk if it upsets your stomach.

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Never take more of this medication than is prescribed for you. Too much hydromorphone could be very harmful.

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Take the extended-release hydromorphone capsules (including Palladone) at the same time everyday. If you miss a dose take it as soon as you remember and then take the next dose 24 hours later.

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Do not break, crush, dissolve, chew or open the extended-release hydromorphone capsules (including Palladone). Swallow the extended-release hydromorphone capsules whole. The capsules are designed to release medication over a 24 hour period. Taking broken, crushed, dissolved or chewed extended-release hydromorphone capsules could cause a potentially fatal overdose of hydromorphone.

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To ensure that you get a correct dose, measure the liquid form of hydromorphone with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

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Do not stop taking hydromorphone suddenly if you have been taking it continuously for more than 5 to 7 days. Stopping suddenly could cause withdrawal symptoms and make you feel uncomfortable. Your doctor may want to gradually reduce your dose.

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Avoid getting hydromorphone liquid on your skin. It can be absorbed through your skin, and you may get too large a dose.

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Use the suppositories rectally as directed by your doctor. If you do not know how to use them, ask you doctor, nurse, or pharmacist for instructions.

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Hydromorphone will cause constipation. Increase the amount of fiber and water (at least six to eight full glasses daily) in your diet to prevent constipation.

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Do not share this medication with anyone else.

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Store hydromorphone at room temperature away from moisture and heat.

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Store hydromorphone in safe place well out of reach of children.

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Discard any opened bottle of hydromorphone solution after 90 days.

What happens if I miss a dose?

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Take the missed dose as soon as you remember. Do not take a double dose of this medication. Wait the prescribed amount of time before taking your next dose.

What happens if I overdose?

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Seek emergency medical attention.

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Symptoms of a hydromorphone overdose include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, and small pupils.

What should I avoid while taking hydromorphone?

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Avoid alcohol while taking hydromorphone. Alcohol will greatly increase the drowsiness and dizziness caused by hydromorphone and could be dangerous.

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Also avoid sleeping pills, tranquilizers, sedatives, and antihistamines except under the supervision of your doctor. These medications also may cause dangerous sedation.

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Use caution when driving, operating machinery, or performing other hazardous activities. Hydromorphone may cause drowsiness. If you experience drowsiness, avoid these activities.

What are the possible side effects of hydromorphone?

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If you experience any of the following serious side effects, stop taking hydromorphone and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

slow, weak breathing;

seizures;

cold, clammy skin;

severe weakness or dizziness; or

unconsciousness.

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Other, less serious side effects may be more likely to occur. Continue to take hydromorphone and talk to your doctor if you experience

constipation;

dry mouth, nausea, vomiting, or decreased appetite;

dizziness, tiredness, or lightheadedness;

muscle twitches;

sweating;

itching;

decreased urination; or

decreased sex drive.

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Hydromorphone is habit forming. Do not stop taking it suddenly.

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Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect hydromorphone?

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Do not take hydromorphone if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. Dangerous side effects could result.

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The most serious interactions affecting hydromorphone are with those drugs that also cause sedation. The following drugs may lead to dangerous sedation if taken with hydromorphone:

antihistamines such as brompheniramine (Dimetane, Bromfed, others), diphenhydramine (Benadryl, Nytol, Compoz, others), chlorpheniramine (Chlor-Trimeton, Teldrin, others), and others;

tricyclic antidepressants, such as amitriptyline (Elavil) and doxepin (Sinequan), and serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil);

other commonly used antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil);

anticholinergics such as belladonna (Donnatal), clidinium (Quarzan), dicyclomine (Bentyl, Antispas), hyoscyamine (Levsin, Anaspaz), ipratropium (Atrovent), propantheline (Pro-Banthine), and scopolamine (Transderm-Scop);

phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), and prochlorperazine (Compazine); and

tranquilizers and sedatives such as phenobarbital (Solfoton, Luminal), amobarbital (Amytal), secobarbital (Seconal), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flurazepam (Prosom), and temazepam (Restoril).

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Do not take any of the drugs listed above without the approval of your doctor.

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Drugs other than those listed here may also interact with hydromorphone. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

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Your pharmacist has additional information about hydromorphone written for health professionals that you may read.

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.