Hydromorphone (By mouth)

Introduction

Hydromorphone (hye-droe-MOR-fone)

Treats moderate to severe chronic pain. The extended-release tablets are used to treat moderate to severe pain in opioid-tolerant patients when around-the-clock pain relief is needed for a long time. This medicine is a narcotic analgesic. Palladone? (extended-release capsule) was withdrawn from the US market on July 15, 2005.

Brand Name(s)

Dilaudid, Exalgo

There may be other brand names for this medicine.

When This Medicine Should Not Be Used

You should not use this medicine if you have had an allergic reaction to hydromorphone or sulfites. Do not use this medicine to treat pain that you only have once in a while (or "as needed"). You should not use this medicine if you have breathing or lung problems (such as severe asthma, hypercapnia [high carbon dioxide level in your blood], or respiratory depression), a serious bowel problem called paralytic ileus, stomach or bowel blockage, or had a recent stomach surgery or procedure. You should not use this medicine if you are not opioid-tolerant. For pregnant women, you should not use this medicine during labor and delivery of your child.

How to Use This Medicine

Liquid, Tablet, Long Acting Tablet

• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.
• You may take this medicine with or without food.
• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.
• Swallow the extended-release tablet whole. Do not crush, break, or chew it.
• While taking the extended-release form of this medicine, part of the tablet may pass into your stools. This is normal and is nothing to worry about.
• Drink plenty of fluids to help avoid constipation.
• Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.
• If the medicine comes in contact with your skin, rinse it with cool water right away.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose..
• If you are using the extended-release tablets, do not take another dose of this medicine within 24 hours.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

How to Store and Dispose of This Medicine

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed. Flush all unused medicine down the toilet after you have finished your treatment.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• There are many medicines that can interact with hydromorphone. Make sure your doctor knows about all other medicines you are using.
• Make sure your doctor knows if you are using a buprenorphine (Buprenex®), butorphanol (Stadol®), nalbuphine (Nubain®), pentazocine (Talwin®), muscle relaxants (such as cyclobenzaprine, pancuronium, tubocurarine, Flexeril®, or Pavulon®), or a phenothiazine medicine (such as prochlorperazine, Compazine®, Mellaril®, Phenergan®, Thorazine®, or Trilafon®). Tell your doctor if you have used an MAO inhibitor (MAOI) such as Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days.
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.
• Do not drink alcohol while you are using this medicine.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blue lips, fingernails, or skin.
• Change in how much or how often you urinate.
• Extreme weakness, shallow breathing, sweating, or cold or clammy skin.
• Lightheadedness, dizziness, or fainting.
• Severe stomach pain, constipation, or vomiting.
• Seizures or tremors.
• Shortness of breath or troubled breathing.
• Slow, fast, or irregular heartbeat.

If you notice these less serious side effects, talk with your doctor:

• Confusion, hallucinations (seeing things that are not there), nervousness, or extreme change in behavior.
• Dry mouth, nausea, vomiting, or loss of appetite.
• Feelings of extreme happiness or sadness.
• Muscle or joint pain.
• Sleepiness or unusual drowsiness.
• Tiredness or weakness.
• Trouble sleeping.
• Warmth or redness in your face, neck, arms, or upper chest.

Warnings While Using This Medicine

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart disease, heart rhythm problems, low blood pressure, an underactive thyroid, Addison's disease, pancreas problems, an enlarged prostate, problems with urination, cystic fibrosis, trouble swallowing, or stomach problems (such as inflammatory bowel disease, "short gut" syndrome, peritonitis, or Meckel's diverticulum). Tell your doctor if you have a low blood volume, cancer, glaucoma or any condition that causes increased pressure in your eye, depression, mental problems, severe scoliosis, or a history of head injury, brain tumor, seizures, or stroke. Tell your doctor if you have a history of alcohol or drug abuse.
• Tell your doctor if you have any kind of breathing problem, such as asthma, chronic obstructive pulmonary disease (COPD), cor pulmonale, hypoxia or hypercapnia (low oxygen or high carbon dioxide level in your blood), or hypoventilation (breathing too slowly).
• Symptoms of an overdose include: extreme dizziness or weakness, shortness of breath, slow heartbeat or breathing, seizures, and cold, clammy skin. In case of overdose, call your doctor right away.
• This medicine may contain sodium metabisulfite, a sulfite that may cause allergic reactions including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using this medicine.
• This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.
• Do not stop using this medicine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• This medicine may make you dizzy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. Getting up slowly from a sitting or lying position may also help.
• If your symptoms do not improve or if they get worse, call your doctor.
• This medicine may cause constipation. This is more common if you use it for a long time. Ask your doctor if you should also use a laxative to prevent and treat constipation.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.