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Hydromorphone (Dilaudid)
(prescription opioids)
Summary of Opioids
Opioids are commonly prescribed because of their effective
analgesic, or pain relieving, properties. Studies have shown that
properly managed medical use of opioid analgesic compounds is safe
and rarely causes addiction. Taken exactly as prescribed, opioids
can be used to manage pain effectively.
Among the compounds that fall within this class—sometimes referred
to as narcotics—are morphine, codeine, and related medications.
Morphine is often used before or after surgery to alleviate severe
pain. Codeine is used for milder pain. Other examples of opioids
that can be prescribed to alleviate pain include oxycodone (OxyContin—an
oral, controlled release form of the drug); propoxyphene (Darvon);
hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine
(Demerol), which is used less often because of its side effects. In
addition to their effective pain relieving properties, some of these
medications can be used to relieve severe diarrhea (Lomotil, for
example, which is diphenoxylate) or severe coughs (codeine).
Opioids act by attaching to specific proteins called opioid
receptors, which are found in the brain, spinal cord, and
gastrointestinal tract. When these compounds attach to certain
opioid receptors in the brain and spinal cord, they can effectively
change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that
mediate what we perceive as pleasure, resulting in the initial
euphoria that many opioids produce. They can also produce
drowsiness, cause constipation, and, depending upon the amount
taken, depress breathing. Taking a large single dose could cause
severe respiratory depression or death.
Opioids may interact with other medications and are only safe to use
with other medications under a physician's supervision. Typically,
they should not be used with substances such as alcohol,
antihistamines, barbiturates, or benzodiazepines. Since these
substances slow breathing, their combined effects could lead to
life-threatening respiratory depression.
Hydromorphone
Hydromorphone is a drug
which was researched and developed in Germany in 1924, and
introduced to the mass market beginning in 1926. It is used to relieve
moderate to severe
pain and severe, painful dry coughing. Hydromorphone is known by the
trade names Hydal, Sophidone, Hydrostat, Hydromorfan,
Hydromorphan, Laudicon, Palladone and most famously,
Dilaudid. An extended-release version of Palladone called Palladone
SR was available for a short time in the United States before being
voluntarily withdrawn from the market after an FDA advisory released in July
2005 warned of a high overdose potential when taken with alcohol; it is
still available in the United Kingdom as of March 2007, and in most other
European countries. Another extended-release version called Hydromorph
Contin, manufactured as controlled release capsules, continues to be
produced and distributed in Canada by Purdue Pharma Inc. in Pickering,
Ontario.
Hydromorphone is becoming more popular in the treatment of
chronic pain in many countries, and it is used as a substitute for heroin and morphine
where one or both of these drugs are not marketed. Hydromorphone is
preferred even over morphine in many cases on account of hydromorphone's
superior solubility and speed of onset and less troublesome side effect
profile and lower dependence liability as compared to morphine and heroin.
Many chronic pain patients find that hydromorphone has a spectrum of actions
which suit them just as well as morphine, and better than synthetics like methadone
or
levorphanol in alleviating suffering, as contrasted with simple
pain of equal objective intensity. Hydromorphone's side effect profile is
closer to that of
dihydromorphine than that of morphine and resultantly produces less
nausea and vomiting and fewer histamine-related side effects than morphine.
The major hazards of hydromorphone include respiratory and CNS
depression. To a lesser degree, circulatory depression, respiratory
arrest, shock and cardiac arrest have occurred. The most frequently
observed adverse effects are sedation, nausea, vomiting,
constipation, lightheadedness, dizziness and sweating.
* page last updated 5/19/2008
Source:
National Institute on Drug
Abuse (NIDA), various other sources
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