Hydromorphone

Why is this medicine prescribed?

Hydromorphone is used to relieve severe pain. Hydromorphone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Hydromorphone comes as a solution (liquid) and a tablet to take by mouth. The liquid is usually taken every 3 to 6 hours and the tablets are usually taken every 4 to 6 hours as needed for pain.

Use a dose-measuring spoon or cup to measure the correct amount of hydromorphone solution for each dose, not a regular household spoon. Mix your dose with half a glass of water and swallow the mixture. Ask your doctor or pharmacist if you need help getting or using a measuring device.

Your doctor may adjust your dose of hydromorphone during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with hydromorphone. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with hydromorphone. Do not take more of it or take it more often than prescribed by your doctor.

Talk to your doctor or pharmacist about access to rescue medicines, naloxone or nalmefene,while taking hydroxymorphone. Rescue medications can reverse the life-threatening effects of anopioid overdose and are available over the counter or with a prescription. Make sure that youand your family members and people usually around you know how to recognize an overdose,how to use naloxone or nalmefene, and what to do until emergency medical help arrives. Yourdoctor or pharmacist will show you and others how to use it. If symptoms of an overdose occur,they should give the first dose of naloxone, call 911 immediately, and stay with you and watchyou closely until emergency medical help arrives. If your symptoms return, the person shouldgive you another dose of the rescue medication. Additional doses may be given every 2 to 3minutes, if symptoms return before medical help arrives.

Do not stop taking hydromorphone without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking hydromorphone, you may experience withdrawal symptoms including restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle or joint pain, widening of the pupils (black circles in the middle of the eyes), irritability, anxiety, backache, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, or fast heartbeat.

What special precautions should I follow?

Before taking hydromorphone,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any otherdrugs, foods or substances. Tell your doctor or pharmacist about the allergy and whatsymptoms you had

• some medications should not be taken with hydromorphone. Make sure you have discussed anymedications you are currently taking or plan to take before starting hydromorphone with your doctorand pharmacist. Before starting, stopping, or changing any medications while using hydromorphone,please get the advice of your doctor or pharmacist.

• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, or tranylcypromine.

• the following nonprescription or herbal products may interact with hydroxymorphone: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using hydroxymorphone. Do not start these medications while using hydroxymorphone without discussing it with your healthcare provider.

• tell your doctor if you have slowed breathing, asthma, chronic pulmonary disease (COPD), or other lung problems; paralytic ileus (condition in which food does not move through the intestines), or a blockage in the stomach or intestines. Your doctor may tell you not to take hydromorphone.

• tell your doctor if you have or have ever had a brain tumor, or any condition that increases the amount of pressure in your brain; seizures; or gallbladder, pancreas, liver, thyroid, heart, or kidney disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If youbecome pregnant while taking hydromorphone, call your doctor.

• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking hydromorphone.

• you should know that hydromorphone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

• you should know to not drink alcoholic beverages while you are taking hydromorphone. Alcohol can make the side effects from hydromorphone worse.

• you should know that hydromorphone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

• you should know that hydromorphone may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking hydromorphone.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

If you are taking the tablets or solution, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medicine cause?

Hydromorphone may cause side effects. Tell your doctor if any of these symptoms or those in the SPECIAL PRECAUTIONS section are severe or do not go away:

• dry mouth
• nausea, vomiting
• sweating
• mood changes
• flushing
• itching
• decreased sexual desire, inability to get or keep an erection

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• rash; hives; hoarseness; difficulty breathing or swallowing; or swelling of the face, mouth, tongue or throat
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, or diarrhea
• nausea, vomiting, loss of appetite, weakness, or dizziness
• new pain or pain from touch or doing ordinary tasks such as combing your hair
• difficulty swallowing, regurgitation (bringing up swallowed food into throat and mouth), pain in the chest area
• seizures
• chest pain, changes in heartbeat
• extreme drowsiness
• unusual snoring or long pauses during breaths during sleep

Hydromorphone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Dispose of any medication that is outdated or no longer needed through a medicine take-back program. If you do not have a take-back program nearby or one that you can access promptly, flush any hydromorphone liquid or tablets that are outdated or no longer needed down the toilet.Talk to your pharmacist about the proper disposal of your medication.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• slow or shallow breathing, difficulty breathing, unusual snoring
• sleepiness, unable to respond or wake up
• cold, clammy skin
• narrowing or widening of the pupils (dark circles in the middle of the eyes)
• slowed heartbeat

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking hydromorphone.

This prescription is not refillable. If you continue to have pain after you finish the hydromorphone, call your doctor.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

Brand name(s)

• Dilaudid^®
• Exalgo^®¶
• Palladone^®¶
• also available generically

Other name(s)

• dihydromorphinone