Patients with chronic cancer pain, requiring an opioid analgesic, may tolerate one opioid better than another.
Hydromorphone may be an alternative analgesic for patients troubled by the adverse effects of morphine.
Aust Prescr 2000;23:84-7
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Hydromorphone may be an alternative analgesic for patients troubled by the adverse effects of morphine.
Aust Prescr 2000;23:84-7
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The recommended starting dose for oral treatment is 2-4 mg every four hours. A daily oral dose of hydromorphone 6.5-7.5 mg is equivalent to 40-60 mg of morphine or 10-20 mg of methadone. An intramuscular or subcutaneous dose of hydromorphone 1.3-2.0 mg is equivalent to 10 mg of morphine or methadone. A high potency formulation is available for use in narcotic-tolerant patients; this should not be confused with the standard parenteral formulation as an overdose may result.
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Oral hydromorphone is rapidly absorbed, but first-pass metabolism reduces the bioavailability to 25%. The drug is rapidly and widely distributed throughout the body. Most of the absorbed dose is metabolised, so hydromorphone is contraindicated in hepatic impairment. As the major metabolite is excreted in the urine, the drug is also contraindicated in renal impairment. As the half-life of hydromorphone is 2-3 hours, the dose can be rapidly titrated.
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