Hydromorphone is a pain-relieving opioid analgesic. Hydromorphone is Narcotic Analgesics; this means that it acts on the central nervous system to relieve pain. Doctors prescribe hydromorphone to patients experiencing high levels of pain, which can not be cured by other analgesics. However, the use of hydromorphone is regulated because it is a drug that has a high propensity to cause addiction.
Hydromorphone is available as a liquid syrup, oral tablet or as an injectable. Hydromorphone is often referred to by its brand name: Dilaudid or Palladone or Exalgo, depending on the company that manufactured it. Opioid-resistant patients are given the extended-release tablets of hydromorphone to manage their pain for a more extended period compared to the regular oral hydromorphone tablets.
How long does Hydromorphone stay in your system? (Blood, Urine, Saliva, Hair)
Once hydromorphone is taken in the body, it is metabolized and later excreted via urine. However, about 3% of the original drug can still be detected in the blood after five half-lives. It can remain detectable in the blood for 24 hours, urine for 3-4 days, saliva for 24-36 hours, and hair for 90 days.
The half-life of hydromorphone is about two to four hours. The half-life of a drug is the time it takes for the blood concentration of a drug to be halved. However, this half-life is not constant in all individuals. It varies from one person to another due to several factors, which are age, genetics, overall health, diet, weight, and the health of the liver.
| Test | Saliva | Blood | Urine | Hair |
|---|---|---|---|---|
| Time | 24-36 hour | 24 hours | 3-4 days | 90 days |
How long does it take to feel the effects?
It takes approximately half an hour for an orally administered drug to reach the peak plasma concentration. The drug will remain active for 4-8 hours. Medications with an extended drug formulation will take longer for it to be excreted from the body.
The metabolites of hydromorphone are hydromorphone-3-glucoronide, hydromorphone-6-glucoronide, and nor-hydromorphone
Hydromorphone Side effects
Even though hydromorphone is given for pain relief, it is associated with several side effects such as flushing of the skin, euphoria, drowsiness, dry mouth, itching of the skin, constipation, difficulty in urination, and edema, especially of the feet.
Some patients may be allergic to hydromorphone, and it may present with the typical signs of allergy that may be confused with the side effects of hydromorphone.
Some distinct signs are indicators of an allergic reaction, which are feeling of chest tightness, itching, muscle stiffness, and loss of coordination of movement. Others include difficulty in breathing, inflammation of the face, eyes, and throat.
Cases of hydromorphone allergies must be reported immediately to a physician as they may be fatal.
Patients with a history of depression are not advised to take hydromorphone as they have a higher propensity for abuse. Hydromorphone is also contradicted in patients with low blood pressure, as the drug works by lowering the blood pressure. This may exacerbate their condition – alcoholics due to the risk associated with the additive sedation effect of hydromorphone and alcohol.
As earlier stated hydromorphone is an opiate drug; it is therefore associated with drug abuse and addiction. Hydromorphone causes physical and psychological dependence. It is advised that patients on hydromorphone to exercise caution when taking their medication. They should only take what is given to them as prescribed by their doctor. Do not chew or try to crush tablets or dissolve the contents of a capsule as this may potentiate an overdose. Taking a higher dose or increasing the frequency of taking one’s medication will only cause one to be an addict.
New research has shown that cases of opioid-related deaths due to opioid overdose have been on the rise in the US. About 50% of the opiate addicts are patients who are on opioids for the management of pain. It is, therefore, not a surprise when such a patient overdose on the same.
Signs of an Opioid Overdose.
How would a patient who has overdosed on hydromorphone present with? They have cold, clammy skin; most patients will be euphoric and unable to comprehend their surroundings. The patient presents with weakness of the muscles. Their eyes are pin-point (the pupils will be dilated), and they have lost consciousness. In addition, they will present with reduced breathing rate and reduced heart rate.
What should somebody do when their loved one Overdoses?
?In case of a hydromorphone overdose, one should call 911 and get an ambulance. Observe the patient as you wait for help.
One can also call the poison control helpline 1-800-222-1222 or visit their website to get more information on what to do. However, it is of paramount importance to call help first as hydromorphone overdose is a life-threatening condition.
For patients who are addicts and they relapse frequently, it is advised to have a Naloxone inhalant on the standby. Naloxone is a medication that reverses the effects of hydromorphone and other opiates. It works by antagonizing the drug at its receptor site. The dose should be given as per the instructions provided.
Such patients must enroll in an Addiction Recovery Program or a Rehabilitation Center near you.
Dangerous drug-drug interactions.
Opiate analgesics like hydromorphone are highly potent drugs. They may easily interact with other medications that may be co-administered, and this may lead to a life-threatening condition. Examples of drugs that should not be co-administered with hydromorphone are:
- Benzodiazepines such as diazepam, lorazepam, and chlordiazepoxide
- General anesthetic agents such as propofol, ketamine, and midazolam
- Anticholinergics such as diphenhydramine and tolterodine
- Antihistamines, especially those that cause sedation
- Antidepressants like Tricyclic Antidepressants and Mono- Amine Inhibitors
- Anticonvulsants such as phenytoin and valproates
- Some herbs like St John’s Wort and other tryptophan-containing food such as sardines
The above-listed drugs cause sedation, and concurrent use with hydromorphone will potentiate depression of the Central Nervous System to a point where it will cause respiratory depression, which can be fatal.
