Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C17H19NO3.ClH |
Molecular Weight | 321.799 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 4 / 4 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
Cl.CN1CC[C@]23[C@H]4OC5=C(O)C=CC(C[C@@H]1[C@@H]2CCC4=O)=C35
InChI
InChIKey=XHILEZUETWRSHC-NRGUFEMZSA-N
InChI=1S/C17H19NO3.ClH/c1-18-7-6-17-10-3-5-13(20)16(17)21-15-12(19)4-2-9(14(15)17)8-11(10)18;/h2,4,10-11,16,19H,3,5-8H2,1H3;1H/t10-,11+,16-,17-;/m0./s1
Hydromorphone (also known as dihydromorphinone and the brand name Dilaudid among others) is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low. The kidney excretes hydromorphone and its metabolites. Some metabolites may have greater analgesic activity than hydromorphone itself but are unlikely to contribute to the pharmacological activity of hydromorphone. With the exception of pruritus, sedation and nausea and vomiting, which may occur less after hydromorphone than after morphine, the side-effects of these drugs are similar. Hydromorphone interacts predominantly with the opioid mu-receptors. These mu-binding sites are discretely distributed in the human brain, with high densities in the posterior amygdala, hypothalamus, thalamus, nucleus caudatus, putamen, and certain cortical areas. It also binds with kappa and delta receptors which are thought to mediate spinal analgesia, miosis and sedation.
CNS Activity
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL237 Sources: https://www.ncbi.nlm.nih.gov/pubmed/16433932 |
279.0 nM [EC50] | ||
Target ID: CHEMBL236 Sources: https://www.ncbi.nlm.nih.gov/pubmed/9301669 |
|||
Target ID: CHEMBL233 Sources: https://www.ncbi.nlm.nih.gov/pubmed/18789923 |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Palliative | DILAUDID-HP Approved UseDILAUDID INJECTION is indicated for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate. DILAUDID-HP INJECTION is indicated for use in opioid-tolerant patients who require higher doses of opioids for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate. Patients considered opioid tolerant are those who are taking for one week or longer,around-the-clock medicine consisting of at least 60 mg oral morphine per day, or at least 25 mcg transdermal fentanyl per hour, or at least 30 mg oral oxycodone per day, or at least 8 g oral hydromorphone per day, or at least 25 mg oral oxymorphone per day, or at least 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid for one week or longer. Patients must remain on around-the-clock opioids while administering DILAUDID-HP Launch Date1984 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
5.5 ng/mL |
8 mg single, oral dose: 8 mg route of administration: Oral experiment type: SINGLE co-administered: |
HYDROMORPHONE HYDROCHLORIDE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
23.7 ng × h/mL |
8 mg single, oral dose: 8 mg route of administration: Oral experiment type: SINGLE co-administered: |
HYDROMORPHONE HYDROCHLORIDE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
2.6 h |
8 mg single, oral dose: 8 mg route of administration: Oral experiment type: SINGLE co-administered: |
HYDROMORPHONE HYDROCHLORIDE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
81% |
8 mg single, oral dose: 8 mg route of administration: Oral experiment type: SINGLE co-administered: |
HYDROMORPHONE HYDROCHLORIDE plasma | Homo sapiens population: HEALTHY age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
540 mg single, intrathecal Overdose Dose: 540 mg Route: intrathecal Route: single Dose: 540 mg Sources: |
unhealthy, 27 |
Disc. AE: Sleepiness, Nausea... AEs leading to discontinuation/dose reduction: Sleepiness Sources: Nausea |
2 mg 3 times / day multiple, intravenous Recommended Dose: 2 mg, 3 times / day Route: intravenous Route: multiple Dose: 2 mg, 3 times / day Sources: |
unhealthy, 40 |
Disc. AE: Respiratory arrest... AEs leading to discontinuation/dose reduction: Respiratory arrest (grade 5) Sources: |
4 mg 4 times / day multiple, oral Recommended Dose: 4 mg, 4 times / day Route: oral Route: multiple Dose: 4 mg, 4 times / day Sources: |
unhealthy, 67.7 |
Disc. AE: Somnolence, Aspiration pneumonia... AEs leading to discontinuation/dose reduction: Somnolence (serious, 1.14%) Sources: Aspiration pneumonia (grade 5, 1.14%) Toxic skin eruption (serious, 1.14%) Nausea and vomiting (serious, 1.14%) |
10 mg single, intravenous Overdose Dose: 10 mg Route: intravenous Route: single Dose: 10 mg Sources: |
unhealthy |
Disc. AE: Cardio-respiratory arrest... AEs leading to discontinuation/dose reduction: Cardio-respiratory arrest (grade 5) Sources: |
2 mg 6 times / day multiple, subcutaneous|intramuscular Recommended Dose: 2 mg, 6 times / day Route: subcutaneous|intramuscular Route: multiple Dose: 2 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Disc. AE: Respiratory depression... AEs leading to discontinuation/dose reduction: Respiratory depression Sources: |
4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Disc. AE: Addiction, Abuse... AEs leading to discontinuation/dose reduction: Addiction Sources: Abuse Respiratory depression (grade 3-5) Withdrawal syndrome neonatal (grade 3-5) Coma (grade 5) |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Nausea | Disc. AE | 540 mg single, intrathecal Overdose Dose: 540 mg Route: intrathecal Route: single Dose: 540 mg Sources: |
unhealthy, 27 |
Sleepiness | Disc. AE | 540 mg single, intrathecal Overdose Dose: 540 mg Route: intrathecal Route: single Dose: 540 mg Sources: |
unhealthy, 27 |
Respiratory arrest | grade 5 Disc. AE |
2 mg 3 times / day multiple, intravenous Recommended Dose: 2 mg, 3 times / day Route: intravenous Route: multiple Dose: 2 mg, 3 times / day Sources: |
unhealthy, 40 |
Aspiration pneumonia | grade 5, 1.14% Disc. AE |
4 mg 4 times / day multiple, oral Recommended Dose: 4 mg, 4 times / day Route: oral Route: multiple Dose: 4 mg, 4 times / day Sources: |
unhealthy, 67.7 |
Nausea and vomiting | serious, 1.14% Disc. AE |
4 mg 4 times / day multiple, oral Recommended Dose: 4 mg, 4 times / day Route: oral Route: multiple Dose: 4 mg, 4 times / day Sources: |
unhealthy, 67.7 |
Somnolence | serious, 1.14% Disc. AE |
4 mg 4 times / day multiple, oral Recommended Dose: 4 mg, 4 times / day Route: oral Route: multiple Dose: 4 mg, 4 times / day Sources: |
unhealthy, 67.7 |
Toxic skin eruption | serious, 1.14% Disc. AE |
4 mg 4 times / day multiple, oral Recommended Dose: 4 mg, 4 times / day Route: oral Route: multiple Dose: 4 mg, 4 times / day Sources: |
unhealthy, 67.7 |
Cardio-respiratory arrest | grade 5 Disc. AE |
10 mg single, intravenous Overdose Dose: 10 mg Route: intravenous Route: single Dose: 10 mg Sources: |
unhealthy |
Respiratory depression | Disc. AE | 2 mg 6 times / day multiple, subcutaneous|intramuscular Recommended Dose: 2 mg, 6 times / day Route: subcutaneous|intramuscular Route: multiple Dose: 2 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Abuse | Disc. AE | 4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Addiction | Disc. AE | 4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Respiratory depression | grade 3-5 Disc. AE |
4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Withdrawal syndrome neonatal | grade 3-5 Disc. AE |
4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Coma | grade 5 Disc. AE |
4 mg 6 times / day multiple, oral Recommended Dose: 4 mg, 6 times / day Route: oral Route: multiple Dose: 4 mg, 6 times / day Sources: |
unhealthy Health Status: unhealthy Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: 6.0 |
weak [IC50 >50 uM] | |||
Page: 6.0 |
weak [IC50 >50 uM] | |||
Page: 6.0 |
weak [IC50 >50 uM] | |||
Page: 6.0 |
weak [IC50 >50 uM] | |||
Page: 6.0 |
weak [IC50 >50 uM] |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes | ||||
yes | ||||
yes | ||||
yes |
PubMed
Title | Date | PubMed |
---|---|---|
Survey of pain management therapy provided for children with sickle cell disease. | 1992 Apr |
|
Clonazepam treatment of myoclonic contractions associated with high-dose opioids: case report. | 1992 May |
|
Opioid equianalgesic conversion: the right dose. | 2001 Jul-Aug |
|
A convenient synthesis of delta(7,8)-morphinan-6-one and its direct oxidation to 14-hydroxy-delta(7,8)-morphinan-6-one. | 2002 Aug 5 |
|
Epidural and intrathecal analgesia for cancer pain. | 2002 Dec |
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Screening extemporaneously compounded intraspinal injections with the bacterial endotoxins test. | 2002 Dec 15 |
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New directions in pain management. | 2002 Feb |
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Role of urine toxicology testing in the management of chronic opioid therapy. | 2002 Jul-Aug |
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Clinical pharmacology of opioids for pain. | 2002 Jul-Aug |
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The use of methadone for cancer pain. | 2002 Jun |
|
Pain management for joint arthroplasty: preemptive analgesia. | 2002 Jun |
|
The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour. | 2002 Jun-Jul |
|
Postthoracotomy pain management. | 2002 May |
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Activation profiles of opioid ligands in HEK cells expressing delta opioid receptors. | 2002 Nov 18 |
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Opioid rotation in the treatment of joint pain. A review of 67 cases. | 2002 Oct |
|
Simultaneous quantitation of opioids in blood by GC-EI-MS analysis following deproteination, detautomerization of keto analytes, solid-phase extraction, and trimethylsilyl derivatization. | 2002 Oct |
|
A field evaluation of five on-site drug-testing devices. | 2002 Oct |
|
Detection of cocaine analytes and opiates in nails from postmortem cases. | 2002 Oct |
|
Input characteristics and bioavailability after administration of immediate and a new extended-release formulation of hydromorphone in healthy volunteers. | 2002 Oct |
|
Fentanyl-associated syndrome of inappropriate antidiuretic hormone secretion. | 2002 Sep |
|
In vivo pain relief effectiveness of an analgesic-anesthetic carrying biodegradable controlled release rod systems. | 2003 |
|
Envenomation by the Mexican beaded lizard: a case report. | 2003 |
|
Postoperative analgesia and sedation in the adult intensive care unit: a guide to drug selection. | 2003 |
|
Morphine and hydromorphone for postoperative analgesia: focus on safety. | 2003 Apr |
|
Embolized crospovidone (poly[N-vinyl-2-pyrrolidone]) in the lungs of intravenous drug users. | 2003 Apr |
|
Calculating opioid dose conversions #36. | 2003 Aug |
|
Summary version of the Standards, Options and Recommendations for the use of analgesia for the treatment of nociceptive pain in adults with cancer (update 2002). | 2003 Aug |
|
Is the analgesic effect of systemic lidocaine mediated through opioid receptors? | 2003 Aug |
|
Comparison of morphine and hydromorphone analysis on reversed phase columns with different diameters. | 2003 Aug 8 |
|
A systematic review of hydromorphone in acute and chronic pain. | 2003 Feb |
|
Hydromorphone transfer into breast milk after intranasal administration. | 2003 Feb |
|
Postoperative hypoxemia and hypercarbia in healthy dogs undergoing routine ovariohysterectomy or castration and receiving butorphanol or hydromorphone for analgesia. | 2003 Feb 1 |
|
Quantification of the O- and N-demethylated metabolites of hydrocodone and oxycodone in human liver microsomes using liquid chromatography with ultraviolet absorbance detection. | 2003 Feb 25 |
|
Catheter-associated masses in patients receiving intrathecal analgesic therapy. | 2003 Jan |
|
Activity of opioid ligands in cells expressing cloned mu opioid receptors. | 2003 Jan 4 |
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Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations. | 2003 Jul |
|
Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. | 2003 Jul |
|
[Pain therapy with semisynthetic opioids. Patients have opioid-type side effects more rarely]. | 2003 Jul 10 |
|
Management of postoperative pain after T6 corpectomy: use of epidural bupivacaine and sufentanil--a case report. | 2003 Jun |
|
Oral oxycodone: new preparation. No better than oral morphine. | 2003 Jun |
|
Using saccadic eye movements as objective measures of tolerance in methadone dependent individuals during the hydromorphone challenge test. | 2003 Mar |
|
Changes in intraocular pressure and pupil size following intramuscular administration of hydromorphone hydrochloride and acepromazine in clinically normal dogs. | 2003 Mar |
|
Opioid ligands having delayed long-term antagonist activity: potential pharmacotherapies for opioid abuse. | 2003 Mar |
|
Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, part I. | 2003 Mar-Apr |
|
Antinociceptive effects of hydromorphone, bupivacaine and biphalin released from PLGA polymer after intrathecal implantation in rats. | 2003 May |
|
Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. | 2003 Nov |
|
Antihyperalgesic effect of simultaneously released hydromorphone and bupivacaine from polymer fibers in the rat chronic constriction injury model. | 2003 Nov 14 |
|
[Combined use of intrathecal morphine and diclofenac suppository for postoperative analgesia after caesarean section]. | 2003 Oct |
|
The use of long-acting opioids in chronic pain management. | 2003 Sep |
|
Oral vs. i.v. hydromorphone. Add a measure of caution. | 2003 Sep |
Sample Use Guides
Subcutaneous or Intramuscular Administration: The usual starting dose of DILAUDID INJECTION is 1 mg to 2 mg every 2 to 3 hours as necessary. Depending on the clinical situation, the initial starting dose may be lowered in patients who are opioid naïve.
Intravenous Administration: The initial starting dose is 0.2 to 1 mg every 2 to 3 hours. Intravenous administration should be given slowly, over at least 2 to 3 minutes, depending on the dose. The initial dose should be reduced in the elderly or debilitated and may be lowered to 0.2 mg.
Route of Administration:
Other
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Classification Tree | Code System | Code | ||
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FDA ORPHAN DRUG |
499415
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NCI_THESAURUS |
C67413
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NCI_THESAURUS |
C1506
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C436
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200-762-6
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CHEMBL398707
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L960UP2KRW
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117862
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m6110
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SUB02573MIG
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203177
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100000090577
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1323000
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5462347
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L960UP2KRW
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71-68-1
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5791
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DBSALT000444
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DTXSID90991291
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ACTIVE MOIETY
SUBSTANCE RECORD