DILAUDID

 

DESCRIPTION / DEFINITIONS: The active ingredient of Dilaudid is hydromorphone hydrochloride, which is made from morphine, and is used primarily as a painkiller. It is an opioid, also known as a narcotic, and is available in tablets, liquid, and in powders used to form an injectible solution.

ABUSE: Dilaudid is derived from morphine and has a very high potential for abuse, as is covered in the black box warning from the FDA. It is similar to fentanyl, oxycodone, hydromorphone, methadone, oxymorphone and drugs that contain those ingredients.

ADDICTION / DEPENDENCE: Dilaudid addiction and dependence is common. And it is possible to become dependent or addicted even if you’re taking the drug as directed. This is the case with most opioids. It’s important to take the lowest dose, for the shortest period of time.

SIDE EFFECTS:  Dilaudid has a long list of side effects, some of which can be dangerous. They include bronchospasm (wheezing or shortness of breath caused by restricted airflow), cardiac arrest, confusional states, double vision, depression, convulsions and depressed appetite.  See more complete list below.

WITHDRAWAL SYMPTOMS: Withdrawal symptoms include: abdominal cramps, nausea, increased blood pressure and heart rate, anxiety and insomnia. See more complete list below.

TREATMENT: Trying to stop taking Dilaudid without medical supervision can be dangerous, painful, and uncomfortable. Medical detox is safe, and can help reduce withdrawal symptoms to make it more comfortable. Call us to talk to a Detox Advisor.

DESCRIPTION / DEFINITIONS

Dilaudid (hydromorphone hydrochloride) is an opioid – also known as a narcotic – and is available in tablets, liquid, and in powders used to form an injectible solution.

It is primarily prescribed for pain severe enough to need an opioid, but for which no other pain medication or other solution has worked.

It is a Schedule II drug, which means that although it currently has a medical use, it has high potential for abuse and dependence, can lead to severe psychological or physical dependence, and is dangerous.

The Dilaudid label reveals many dangers:

WARNING: RISK OF MEDICATION ERRORS; ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS

Risk of Medication Errors 
Ensure accuracy when prescribing, dispensing, and administering DILAUDID Oral Solution. Dosing errors due to confusion between mg and mL can result in accidental overdose and death.

Addiction, Abuse, and Misuse 
DILAUDID Oral Solution and DILAUDID Tablets expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing DILAUDID Oral Solution or DILAUDID Tablets, and monitor all patients regularly for the development of these behaviors and conditions.

Life-Threatening Respiratory Depression 
Serious, life-threatening, or fatal respiratory depression may occur with use of DILAUDID Oral Solution and DILAUDID Tablets. Monitor for respiratory depression, especially during initiation of DILAUDID Oral Solution or DILAUDID Tablets or following a dose increase.

Accidental Ingestion 
Accidental ingestion of even one dose of DILAUDID Oral Solution or DILAUDID Tablets, especially by children, can result in a fatal overdose of hydromorphone.

Neonatal Opioid Withdrawal Syndrome 
Prolonged use of DILAUDID Oral Solution or DILAUDID Tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants 
Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

Reserve concomitant prescribing of DILAUDID Oral Solution OR DILAUDID Tablets and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.

Limit dosages and durations to the minimum required.

Follow patients for signs and symptoms of respiratory depression and sedation.

ABUSE

Dilaudid is classed by the DEA as a Schedule II drug, which means:

  1. The drug or substance has a high potential for abuse.
  2. The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
  3. Abuse of the drug or other substances may lead to severe psychological or physical dependence.

Abuse is common and generally involves forged prescriptions, “doctor-shoppers,” pharmacists and physicians, armed robberies, robberies of pharmacies and nursing homes.

ADDICTION / DEPENDENCE

As with other opioids, Dilaudid is easy to become dependent upon or addicted to. The body sometimes builds a tolerance to Dilaudid over time, so it no longer creates the painkilling effect it did when you first started taking it. Consequently, you need to take more. The more you take, and the longer you take it, the higher the risk for dependence and addiction.

Also, the more you take, the greater your chances of experiencing side effects, some of which can be very dangerous – even life-threatening. See side effects below.

HALF LIFE AND METABOLISM

The biological half-life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of Dilaudid is approximately 4 hours.

Dilaudid is extensively metabolized via glucuronidation in the liver, with greater than 95% of the dose metabolized to hydromorphone-3-glucuronide along with minor amounts of 6-hydroxy reduction metabolites.

CYP enzymes are responsible for the metabolism of Dilaudid.

CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

OPIOID INDUCED HYPERALGESIA

There is increasing medical research showing that taking opioids like Dilaudid for longer than six months can create a condition called Opioid Induced Hyperalgesia. This is a condition where the opioids actually make the pain receptors more sensitive and, therefore, make the pain greater. A person with this condition is required to take more and more of the opioid to try to address the pain but finds that, instead, the pain gets worse.

SIDE EFFECTS

Although some of the side effects of Dilaudid can be mild, many more can be extremely dangerous. They include:

  • anaphylactic symptoms – an acute allergic reaction that prompts the immune system to respond. The symptoms can include: fainting, lightheadedness, low blood pressure, dizziness, flushing, difficulty breathing, rapid breathing, shortness of breath,  wheezing, hives, swelling under the skin, blue skin from poor circulation, rashes, nausea,  vomiting, fast heart rate, feeling of impending doom, itching, tongue swelling, difficulty swallowing, facial swelling, mental confusion, nasal congestion, or impaired voice.
  • abdominal pain
  • abnormal dreams
  • adrenal insufficiency – which may include symptoms of nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure.
  • agitation
  • allergic-type reactions
  • antidiuretic effects – suppression of urine formation
  • anxiety
  • apnea – temporarily stopping breathing, especially when asleep
  • biliary colic – gallbladder or gallstone attack, manifested by sharp, cramping pain or a constant dull ache in the middle to right upper abdomen
  • blurred vision
  • bradycardia – abnormally slow heart action
  • bronchospasm – wheezing or shortness of breath caused by restricted airflow from a tightening of the muscles that line the airways (bronchi) in your lungs.
  • cardiac arrest – when the heartmalfunctions and suddenly stops beating unexpectedly
  • chills
  • circulatory depression –
  • confusional state
  • constipation
  • convulsions
  • decreased appetite
  • depression
  • diarrhea
  • double vision
  • disorientation
  • dizziness
  • drowsiness
  • dry mouth
  • dyskinesia – impairment of voluntary movements resulting in fragmented or jerky motions (as in Parkinson’s disease)
  • dysphoria – a state of unease or generalized dissatisfaction with life
  • dyspnea – difficult or labored breathing
  • erectile dysfunction
  • euphoria
  • fatigue

  • feeling abnormal
  • flushing
  • hallucination
  • headache
  • hyperalgesia – abnormally heightened sensitivity to pain
  • hyperhidrosis – excessive sweating of the palms, soles, groin, face or head, and armpits
  • hypertension – high blood pressure
  • hypotension – low blood pressure, may be severe
  • ileus –lack of movement in the intestines that can result in bowel obstruction
  • increased intracranial pressure – some of the symptoms include headache, nausea, vomiting, increased blood pressure, decreased mental abilities, confusion about time, and then location and people as the pressure worsens, double vision, pupils that don’t respond to changes in light, shallow breathing, seizures, loss of consciousness, coma. These symptoms could also indicate other serious conditions such as a stroke, a brain tumor, or a recent head injury.
  • infertility
  • insomnia
  • involuntary muscle contractions
  • laryngospasm – spasm of the vocal cords that temporarily makes it difficult to speak or breathe
  • lethargy
  • life-threatening or less severe asthmatic episodes in certain susceptible people
  • lightheadedness
  • breastfeeding mothers may pass the drug to the baby as low levels of opioid analgesics have been detected in human milk
  • increase in the frequency of seizures in patients with seizure disorders, and may increase the risk of seizures occurring in other clinical settings associated with seizures.
  • Miosis – excessive constriction of the pupil of the eye
  • mood altered
  • muscle rigidity
  • myoclonus – spasmodic jerky contraction of groups of muscles
  • nausea
  • nervousness
  • not safe to drive or operate heavy machinery
  • nystagmus –rapid, involuntary movement of the eyes. They can move side to side, up and down, or in a circle.
  • oropharyngeal swelling – swelling in the throat
  • orthostatic hypotension – dizziness and fainting upon standing up
  • palpitations
  • paraesthesia – an abnormal sensation such as tingling, tickling, pricking, numbness or burning of a person’s skin with no apparent physical cause.

  • peripheral edema – swelling, usually in the lower limbs, caused by accumulation of fluid.
  • Presyncope – a state of lightheadedness, muscular weakness, blurred vision, and feeling faint
  • profound sedation, respiratory depression, coma, and death may result from concomitant use with benzodiazepines, other CNS depressants such as non-benzodiazepine sedatives, hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, and alcohol
  • pruritus – severe itching of the skin
  • rash
  • respiratory arrest – cessation of breathing
  • respiratory depression – breathing rate and depth is especially low. The symptoms include tiredness, daytime sleepiness, shortness of breath, slow and shallow breathing, depression.
  • Serotonin syndrome:(when taken in combination with serotonergic drugs) -serotonin syndrome is a group of potentially life-threatening symptoms that include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea, associated with serotonergic drugs. Serotonergic drugs are used to treat migraine. depression and other mood disorders.
  • shock – a critical condition that is brought on by a sudden drop in blood flow through the body
  • sleepiness
  • spasm of the sphincter of Oddi (a muscle that relaxes during a meal to allow bile and pancreatic juice to flow into the intestine). When in spasm, the symptoms can include abdominal pain (the most common symptom), nausea, vomiting, fever, chills, and diarrhea.
  • sweating
  • syncope – temporary loss of consciousness caused by a fall in blood pressure
  • tachycardia – abnormally rapid heart rate
  • taste alteration
  • tremor
  • urinary hesitation
  • urinary retention
  • urticaria – a rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling
  • vasodilation that can reduce cardiac output and blood pressure.
  • visual impairment
  • vomiting
  • weakness


WITHDRAWAL SYMPTOMS

Withdrawing from Dilaudid can be painful and dangerous. The longer you take it, and the more you take, the stronger the withdrawal symptoms are likely to be. Although it does vary from person to person. Some of the symptoms you can experience include:

  • abdominal cramps
  • anorexia
  • anxiety
  • backache
  • chills
  • diarrhea
  • increased blood pressure
  • increased heart rate
  • increased respiratory rate
  • insomnia
  • irritability
  • joint pain

  • lacrimation – shedding tears, more than usual, like you have something in your eye
  • myalgia – pain in a muscle or group of muscles
  • mydriasis – dilation of the pupil of the eye
  • nausea
  • perspiration
  • restlessness
  • rhinorrhea – a runny nose, as with hay fever or a cold
  • vomiting
  • weakness
  • yawning


TREATMENT

Coming off Dilaudid needs medical supervision for safety. Plus, the withdrawal symptoms can be very uncomfortable and most people who try to stop on their own go back on the drug because of how bad they feel. A good medical detox facility can help relieve the pain and discomfort while keeping you safe. Call us to talk to a Detox Advisor.