Classifications: narcotic (opiate) agonist; analgesic; Therapeutic: narcotic analgesic
Pregnancy Category: C
Controlled Substance: Schedule II
2 mg, 4 mg, 8 mg tablets; 5 mg/5 mL oral liquid; 1 mg/mL, 10 mg/mL injection
Semisynthetic derivative structurally similar to morphine but with 810 times more potent analgesic effect. Has more
rapid onset and shorter duration of action than morphine, and is reported to have less hypnotic effect.
An effective narcotic analgesic that controls mild to moderate pain. Also has antitussive properties.
Relief of moderate to severe pain and control of persistent nonproductive cough.
Intolerance to opiate agonists; opiate-na?ve patients; acute bronchial asthma, COPD, upper airway obstruction, decreased
respiratory reserve, severe respiratory depression; pregnancy (category C); lactation.
Abrupt discontinuation, alcoholism; angina; biliary tract disease; older adults; epidural administration; GI disease, GI
obstruction; head trauma; heart failure; hepatic disease; hypotension, hypovolemia, oliguria, prostatic hypertrophy; pulmonary
disease; renal disease, renal impairment; paralytic ileus; increased intracranial pressure; inflammatory bowel disease;
labor; latex hypersensitivity; obstetric delivery; bladder obstruction; cardiac arrhythmias, cardiac disease; respiratory
depression; seizure disorder, seizures; substance abuse; surgery; ulcerative colitis; urethral stricture, urinary retention;
neonates, and infants <6 mo.
Route & Dosage
|Moderate to Severe Pain
Adult: PO 24 mg q46h prn in na?ve patients SC/IM/IV 0.752 mg q46h depending on patient response
Child: PO 0.030.08 mg/kg q46h (max: 5 mg/dose) IV 0.015 mg/kg q46h prn
Adult: PO 1 mg q34h prn
Child (612 y): PO 0.5 mg q34h prn
- Note: A fixed schedule when narcotic therapy is initiated provides more effective management than a prn schedule.
IV administration to infants, children: Verify correct IV concentration and rate of infusion with physician.
PREPARE: Direct: Dilute each dose in at least 5 mL of sterile water or NS. IV Infusion: Using Dilaudid-HP, reconstitute 250 mg dry powder vial immediately prior to use with 25 mL sterile water for injection to
yield 10 mg/mL. Final dilution of Dilaudid-HP 250 and HP 500 (supplied 500 mg/50 mL) must be ordered by physician.
ADMINISTER: Direct: Give 2 mg or fraction thereof over 35 min. IV Infusion: Both final volume and rate of infusion must be ordered by physician.
INCOMPATIBILITIES Solution/additive: Prochlorperazine, sodium bicarbonate, thiopental. Y-site: Amphotericin B cholesteryl, minocycline, phenytoin, sargramostim, tetracycline, thiopental.
- A slight discoloration in ampules or multidose vials causes no loss of potency.
- Store in tight, light-resistant containers at 15°30° C (59°86° F).
Adverse Effects (≥1%)GI:
Nausea, vomiting, constipation
Euphoria, dizziness, sedation, drowsiness. CV:
Hypotension, bradycardia or tachycardia. Respiratory: Respiratory depression. Special Senses:
and other cns depressants
compound sedation and CNS depression
. Herbal: St. John's wort, kava
may increase sedation.
60% absorbed from GI tract. Onset:
15 min IV, 30 min PO. Peak:
3090 min. Duration:
34 h. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Note baseline respiratory rate, rhythm, and depth and size of pupils before administration. Respirations of 12/min or less
and mitosis are signs of toxicity. Withhold drug and promptly notify physician.
- Monitor vital signs at regular intervals. Drug-induced respiratory depression may occur even with small doses and increases
progressively with higher doses.
- Assess effectiveness of pain relief 30 min after medication administration.
- Monitor drug effects carefully in older adult or debilitated patients and those with impaired renal and hepatic function.
- Assess effectiveness of cough. Drug depresses cough and sigh reflexes and may induce atelectasis, especially in postoperative
patients and those with pulmonary disease.
- Note: Nausea and orthostatic hypotension most often occur in ambulatory patients or when a supine patient assumes the head-up
- Monitor I&O ratio and pattern. Assess lower abdomen for bladder distension. Report oliguria or urinary retention.
- Monitor bowel pattern; drug-induced constipation may require treatment.
Patient & Family Education
- Request medication at the onset of pain and do not wait until pain is severe.
- Use caution with activities requiring alertness; drug may cause drowsiness, dizziness, and blurred vision.
- Avoid alcohol and other CNS depressants while taking this drug.