Hydromorphone Hydrochloride (C17H19NO3 • MW 285.34)
is the brand name for Dilaudid, a narcotic analgesic manufactured by Abbott Laboratories Inc.
Dilaudid is in the analgesic, antiussive, anesthesia adjunct, opioid analgesic category and Schedule II of the Controlled Substances Act. Street names for Dilaudid include Little D and Dillies.
Each Dilaudid tablet includes the following inactive ingredients: lactose anhydrous, and magnesium stearate. Dilaudid tablets may contain traces of sodium bisulfite.
While morphine was first used medicinally as a painkiller, ironically, it was touted as a cure for opium addiction. It quickly replaced opium as a recreational drug and doctor recommended cure-all and became readily available from drugstores or through the mail. Morphine was used during the American Civil War as a surgical anesthetic and was sent home with many wounded soldiers for relief of pain. At the end of the war, over 400,000 people had the “army disease,” or, morphine addiction.
In 1906 the Pure Food and Drug Act enacted various labeling laws and importation restrictions and the Harrison Narcotics Act (1914) prohibited possession of narcotics unless prescribed by a physician. Despite legislation, morphine maintained much of its popularity until heroin came into use.
Dilaudid is a strong narcotic analgesic, commonly prescribed for the relief of moderate to severe pain. Dilaudid has two to eight times the painkilling effects of morphine.
Typically, this drug is used for conditions associated with severe pain. Such indications include burns, cancer, surgical pain, injury, heart attack, and other conditions.
Dilaudid tablets are intended to be swallowed whole and are available in 1 mg, 2 mg, 3 mg, 4 mg, and 8 mg strengths for oral administration. 3 mg suppositories are also available. In the oral liquid formula, each mL contains 1 mg HCl hydromorphone and miscellaneous non-medicinal ingredients.
When abused, Dilaudid tablets are taken orally, crushed and then snorted, or dissolved in water and “cooked” for intravenous injection.
Never increase the amount or frequency without your doctor’s approval, or take this drug for any reason other than the one prescribed.
Hydromorphone’s effects are markedly similar to morphine, except the euphoria is closer to codeine. Nausea and vomiting is quite rare, and sedation is practically non-existent.
Hydromorphone’s abuse potential comes from the fact that its euphoric intravenous rush is very similar to heroin’s. Hydromorphone is one of the most prescribed opioids in the relief of pain for the terminally ill due to its minimal side effects and high potency.
Generally, when given intravenously, Dialudid’s analgesic action is apparent within 15 minutes and remains in effect for more than 5 hours. The onset of action of oral hydromorphone is somewhat slower, with measurable analgesia occurring within 30 minutes.
Typical side effects of Dilaudid usage include anorexia, anxiety, constipation, dizziness, drowsiness, fear, impairment of mental and physical performance, inability to urinate, mental clouding, mood changes, nausea, restlessness, sedation, somnolence, sluggishness, troubled and slowed breathing, and vomiting.
Dilaudid is a narcotic with an addiction liability similar to that of morphine. For this reason, the same precautions should be taken in administering this drug as with morphine.
Rapid intravenous injection of Dilaudid increases the possibility of adverse effects, such as hypotension and respiratory depression. Extreme caution must be used.
As with any narcotic analgesic agent, the usual precautions should be observed and the possibility of respiratory depression should be kept in mind. If a patient shows signs of hypersensitivity to Dilaudid, the treatment should be stopped.
Possible Food and Drug Interactions when taking this Medication:
Dilaudid is a central nervous system depressant and therefore intensifies the effects of alcohol. Do not drink alcohol while taking this medication.
Check with your doctor before combining Dilaudid with the following:
* Antiemetics such as Compazine and Phenergan
* Antihistamines such as Benadryl
* General anesthetics
* Other central nervous system depressants such as Nembutal, Restoril
* Other narcotic analgesics such as Demerol and Percocet
* Phenothiazines such as Thorazine
* Sedative/hypnotics such as Valium and Halcion
* Tranquilizers such as Xanax
* Tricyclic antidepressants such as Elavil and Tofranil
Serious overdose with hydromorphone presents with respiratory depression, extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia (very slow heart rate) and hypotension. In severe cases, apnea, circulatory collapse, cardiac arrest and death may occur.
Dilaudid has a moderately high dependency potential, with addiction or dependence occurring when used for longer than a few weeks, or at high doses. People who have been dependent on alcohol or other drugs in the past generally have a greater chance of becoming addicted to Dilaudid.
Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of hydromorphone.
Tolerance is when ever increasing doses are required to produce the same degree of analgesia. Tolerance is initially manifested by a decreased duration of analgesic effect, followed by decreases in the intensity of analgesia. Tolerance develops over days, weeks, or months. The rate of tolerance varies among patients.
Psychic dependence is unlikely when hydromorphone is used for a short period of time.
Physical dependence is when continued use of the drug is needed to avoid withdrawal symptoms. This problem only becomes relevant after several (2 weeks to 2 months) of continued narcotic use. When taken as directed, Dilaudid can produce physical dependence in a few weeks time.
According to the FDA, addiction is characterized by compulsive use, use for non-medical purposes, and continued use despite harm or risk of harm.
Patients no longer requiring Dilaudid, should set a gradual taper schedule to avoid acute withdrawal.
Withdrawal symptoms from Dilaudid can occur four to five hours after the last dose and continue for 7 to 10 days.
Dilaudid withdrawal symptoms can be severe and include: anxiety, insomnia, profuse sweating, muscle spasms, chills, shivering, restlessness, yawning, disturbed sleep, irritability, anxiety, weakness, twitching and spasms of muscles, restless legs, nausea, anorexia, vomiting, intestinal spasm, diarrhea, repetitive sneezing, hot and cold flashes, severe back, leg and abdominals pains and cramps. Frequently, an increase in body temperature, blood pressure, respiratory and heart rate may be present.
If you have used Dilaudid for more than a few weeks, do not stop taking it without first checking with your doctor. Suddenly stopping this medicine may cause severe withdrawal side effects. Your doctor will gradually taper your dosage before stopping completely.
The severity of withdrawal symptoms experienced is directly related to the amount of Dilaudid taken and the length of time over which it has been taken.
To avoid severe withdrawal, regular Dilaudid users must taper down slowly under a knowledgeable physician’s care, or, enter a detox center for 24/7 treatment. With a moderate to severe addiction from relatively long term use, an in patient detox in a hospital or medical supervised setting is highly recommended for its multi- disciplinary approach. Dependence resulting from even a few weeks of regular use can usually be handled under a physician’s supervision with minimal discomfort. Treatment will ultimately depend on the degree of addiction.
However a person chooses to free themselves from the clutches of a drug, there is one constant each needs: Support. Narcotics Anonymous remains a successful choice for many addicts, with world-wide availability. The “information age” has produced numerous on line support forums, popular with many recovering addicts, useful to some addicts as their sole means of support and for others, as adjunct therapy. Drug addiction is treatable, with help out there for everyone.