Page 132 - 2026 SMOG

HYDROMORPHONE (DILAUDID)
Class/Mechanism of Action
• Opioid Analgesic
Binds to opioid receptors within the CNS, increasing pain threshold and altering pain reception;
inhibits ascending pain pathways (blocking painful stimulus); produces CNS depression.
˚ Onset of action: <5min; Peak effect: 10–20min; Duration: 1–4hr
Indications
• Labeled Indications
˚ Moderate to severe pain
Contraindications
• Hypersensitivity to hydromorphone or any component of the formulation
• Severe respiratory depression/acute or severe asthma (in the absence of resuscitative equipment
or ventilator support)
• GI obstruction, including paralytic ileus
Adverse Reactions/Precautions
• Always be prepared for the use of paralytics and intubation (maintain positive control of airway)
• Head trauma: Use with extreme caution in head injury, or suspected increased ICP;
exaggerated increase in ICP may occur
• May cause hypotension; use with caution in hypovolemic patients
• May cause life-threatening respiratory depression and apnea
• CNS depression: Impairs physical and mental abilities
• Dizziness, headache, syncope
• Use of hydromorphone is not recommended in patients taking MAOI or within 14 days of
discontinuing treatment.
• Pregnancy: Use with caution; use the lowest dose for the duration of pain.
• Lactation: Use with caution; monitor infant
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Acute Pain (Moderate-to-Severe) Acute Pain (Moderate-to-Severe)
• IV/IO (SLOW) • IV/IO (SLOW)
˚ 0.5mg (range 0.25–2mg) q1–6hr prn ˚ Infants >6 months weighing >10kg:
0.01–0.015mg/kg/dose q3–6hr prn
(long-acting, fewest side effects)
• IM ˚ Children/Adolescents weighing <50kg:
˚ 1–2mg 0.015mg/kg/dose q3–6hr prn
Note: Critically ill patients require a lower ˚ Children/Adolescents ≥50kg
dose; opioid tolerant patients may require a (Opioid-naive):
higher dose 0.2–0.6mg q2–4hr prn; patients with
prior opioid exposure may tolerate higher
initial doses

124 • MEDICATIONS