Hydromorphone: pharmacology and clinical applications in cancer patients

  title={Hydromorphone: pharmacology and clinical applications in cancer patients},
  author={Nabeel Sarhill and Declan Walsh and Kristine A. Nelson},
  journal={Supportive Care in Cancer},
Abstract Hydromorphone 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… 
Hydrocodone and Acetaminophen
The combination of hydrocodone with acetaminophen is much more efficacious in several randomized studies without any significant changes in adverse effects.
The Side Effects of Morphine and Hydromorphone Patient-Controlled Analgesia
There was no systematic difference between morphine and hydromorphone in opioid-related side effects and neither was there any difference in efficacy of pain control or patient satisfaction when patients self-titrated to equal drug effect as measured by equianalgesia and pupillary miosis.
Hydromorphone in the management of cancer-related pain: an update on routes of administration and dosage forms.
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  • Medicine
    Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques
  • 2007
This review focuses on the use of hydromorphone for the management of cancer-related pain emphasizing on the various routes of administration as well as dosage forms, and providing a direction for the preference of a particular route depending on the need for a rapid effect and the individual's situation.
Hydromorphone use for acute pain: Misconceptions, controversies, and risks.
There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain.
The effect of hydromorphone for postoperative analgesia in children
It is demonstrated that hydromorphone can be effectively used for postoperative pain relief in young patients and there were no significant differences in adverse events and satisfaction score of analgesia between two groups.
Opioids in renal failure and dialysis patients.
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  • Medicine, Biology
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  • 2004
Bioavailability and Pharmacokinetics of Intranasal Hydromorphone in Patients Experiencing Vasomotor Rhinitis
Background and objectiveNarcotic analgesics such as hydromorphone undergo an extensive first-pass effect resulting in a low systemic bioavailability following oral administration. Alternative dosing


Clinical pharmacokinetics of morphine.
Morphine (M) is recommended by the World Health Organization as the treatment of choice for moderate-to-severe cancer pain and is formed to a greater extent after oral administration; it is not, however, usually found in plasma.
Absolute Bioavailability of Hydromorphone After Peroral and Rectal Administration in Humans: Saliva/Plasma Ratio and Clinical Effects
The saliva sampling for the hydromorphone concentration was found to be a useful noninvasive technique for the estimation of the elimination half‐life of hydromOrphone.
The mode of action of promethazine in potentiating narcotic drugs.
Promethazine premedication should be reserved for situations where the use of intravenous anaesthetics is anticipated and may prove to be a useful drug in certain other situations where too rapid inactivation of the principal drug presents a therapeutic problem.
Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: comparison of two clinical experiences.
The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover.
Transdermal fentanyl: suggested recommendations for clinical use.
  • R. Payne
  • Medicine, Biology
    Journal of pain and symptom management
  • 1992
The Pharmacokinetics of Heroin in Patients with Chronic Pain
It is concluded that heroin is a pro-drug that serves to determine the distribution of its active metabolites and that oral heroin is converted to morphine and appears to be an inefficient means of providing morphine to the systemic circulation.