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HYDROMORPHONE ER (HYDROMORPHONE HCL)
- Chronic pain with opioid tolerance
- Severe pain with opioid tolerance
12 mg tablet,extended release 24 hr
- 1 tablet (12 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
16 mg tablet,extended release 24 hr
- 1 tablet (16 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
32 mg tablet,extended release 24 hr
- 1 tablet (32 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
8 mg tablet,extended release 24 hr
- 1 tablet (8 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
Chronic pain with opioid tolerance
- 1 tablet (8 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (12 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (16 mg) by oral route once daily at the same time eachday swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (16 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (24 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (32 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (32 mg) by oral route once daily at the same time eachday swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (64 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
Severe pain with opioid tolerance
- 1 tablet (8 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (12 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (16 mg) by oral route once daily at the same time eachday swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (16 mg) by oral route once daily at the same time each day swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (24 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 1 tablet (32 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (32 mg) by oral route once daily at the same time eachday swallowing whole. Do not break, crush, dissolve and/or chew.
- 2 tablets (64 mg) by oral route once daily swallowing whole. Do not break, crush, dissolve and/or chew.
- Depade
- naltrexone
- naltrexone microspheres
- Revia
- Vivitrol
Contraindicated
- Buprenex
- buprenorphine
- buprenorphine-naloxone
- butorphanol tartrate
- Butrans
- nalbuphine
- sodium oxybate
- Suboxone
- Xyrem
- Zubsolv
Severe
Moderate
- Fanatrex
- gabapentin
- gabapentin enacarbil
- Gralise
- Gralise 30-day Starter Pack
- Horizant
- Neurontin
- Acute asthma attack
- Paralytic ileus
Contraindicated
- Alcohol intoxication
- Coma
- Drug abuse
- Gastrointestinal obstruction
- History of opioid overdose
- Hypotension
- Intracranial hypertension
- Renal disease with moderate to severe impairment
- Respiratory depression
- Systemic mastocytosis
Severe
Moderate
- Acute pancreatitis
- Adrenal cortical insufficiency
- Biliary tract disorder
- Cachexia
- Chronic obstructive pulmonary disease
- Constipation
- Cor pulmonale
- Debilitation
- Disease of liver
- Seizure disorder
- Urinary retention
HYDROMORPHONE ER (HYDROMORPHONE HCL)
- Chronic pain with opioid tolerance
- Severe pain with opioid tolerance
- Pruritus of skin
- Anorexia
- Constipation
- Dizziness
- Drowsy
- Dysphoric mood
- Flushing
- General weakness
- Headache disorder
- Hyperhidrosis
- Hypotension
- Mood changes
- Nausea
- Vomiting
- Xerostomia
More Frequent
Severe
Less Severe
- Acute confusion
- Atelectasis
- Bradycardia
- Ileus
- Involuntary muscle movement
- Laryngismus
- Respiratory depression
- Tachycardia
- Biliary spasm
- Blurred vision
- Diplopia
- Dyspnea
- Insomnia
- Miosis
- Nervousness
- Sedation
- Syncope
- Vertigo
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Adrenal cortical insufficiency
- Allergic dermatitis
- Anaphylaxis
- Androgen deficiency
- Angioedema
- Body fluid retention
- Bronchospastic pulmonary disease
- Dehydration
- Dyskinesia
- Encephalopathy
- Extrasystoles
- Gastrointestinal hypomotility
- Hallucinations
- Hypertension
- Hyperuricemia
- Hyperventilation
- Hypogonadotropic hypogonadism
- Hypoxia
- Intracranial hypertension
- Myoclonus
- Orthostatic hypotension
- Seizure disorder
- Severe hypotension
- Skin rash
- Sleep apnea
- Suicidal ideation
- Urticaria
Less Severe
- Abdominal distension
- Abnormal sexual function
- Acute abdominal pain
- Aggressive behavior
- Agitation
- Arthralgias
- Ataxia
- Chills
- Cramps
- Depression
- Diarrhea
- Dream disorder
- Dry eye
- Dysarthria
- Dysgeusia
- Dysphagia
- Dysuria
- Edema of the oral soft tissue
- Erectile dysfunction
- Eructation
- Erythema
- Euphoria
- Flatulence
- Gastroenteritis
- Hyperreflexia
- Hypesthesia
- Increased appetite
- Increased urinary frequency
- Infertility
- Lethargy
- Libido changes
- Muscle rigidity
- Muscle spasm
- Nystagmus
- Palpitations
- Paranoid disorder
- Paresthesia
- Peripheral edema
- Sedation hangover effect
- Sneezing
- Symptoms of anxiety
- Tinnitus
- Tremor
- Urinary retention
- Weight loss
Contraindicated
Hydromorphone (Ex.Rel)
Safety and efficacy not established. Potential increased sensitivity to effects, adverse CNS effects and risk for fatal respiratory depression.
- 1 Day – 13 Years
- 1 Safety and efficacy not established. Potential increased sensitivity to effects, adverse CNS effects and risk for fatal respiratory depression.
Severe Precaution
Hydromorphone (Ex.Rel)
Potential increased sensitivity to effects, adverse CNS effects and respiratory depression. No safety and efficacy established.
- 13 Years – 18 Years
- Potential increased sensitivity to effects, adverse CNS effects and respiratory depression. No safety and efficacy established.
Management or Monitoring Precaution
None
Hydromorphone
- Severity Level:
2
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose
Contraindicated
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Precaution Exists
Hydromorphone
Limited data report adverse effects; monitor for dyspnea,feeding difficulties
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Drug shown to have adverse effect | Limited data report adverse effects; monitor for dyspnea,feeding difficulties |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Hydromorphone
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
No Known Risk
None
- Hydromorphone has a risk for abuse and addiction, which can lead to overdose and death. Hydromorphone may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of hydromorphone that works, and take it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br />Be sure you know how to take hydromorphone and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.<br /><br /> Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away. Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits.<br /><br />Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy.<br /><br />Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms.<br /><br />Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight. Hydromorphone extended-release should be used only if you have been regularly taking moderate to large amounts of opioid pain medication. This medication may cause overdose (even death) if taken by a person who has not been regularly taking opioids.<br /><br /> This product is designed to slowly release hydromorphone. Do not break, crush, dissolve, or chew this medication. Taking broken, crushed, dissolved, or chewed forms of extended-release hydromorphone could cause a fatal overdose.
| Chronic pain with opioid tolerance | |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| Z79.891 | Long term (current) use of opiate analgesic |
| Severe pain with opioid tolerance | |
| G89.1 | Acute pain, not elsewhere classified |
| G89.11 | Acute pain due to trauma |
| G89.12 | Acute post-thoracotomy pain |
| G89.18 | Other acute postprocedural pain |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M26.62 | Arthralgia of temporomandibular joint |
| M54.5 | Low back pain |
| M54.6 | Pain in thoracic spine |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
| Z79.891 | Long term (current) use of opiate analgesic |
| 0-9 | A-Z |
|---|---|
| G89.1 | Acute pain, not elsewhere classified |
| G89.11 | Acute pain due to trauma |
| G89.12 | Acute post-thoracotomy pain |
| G89.18 | Other acute postprocedural pain |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M26.62 | Arthralgia of temporomandibular joint |
| M54.5 | Low back pain |
| M54.6 | Pain in thoracic spine |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
| Z79.891 | Long term (current) use of opiate analgesic |
| Z79.891 | Long term (current) use of opiate analgesic |
Formulary Reference Tool