Hydromorphone: pharmacology and clinical applications in cancer patients

Abstract

Hydromorphone is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low. The kidney excretes hydromorphone and its metabolites. Some metabolites may have greater analgesic activity than hydromorphone itself but are unlikely to contribute to the pharmacological activity of hydromorphone. With the exception of pruritus, sedation and nausea and vomiting, which may occur less after hydromorphone than after morphine, the side-effects of these drugs are similar. On a milligram basis hydromorphone is five times as potent as morphine when given by the oral route, and 8.5 times as potent as morphine when given intravenously.

The Role of Opioid Analgesics in the Treatment of Pain in Cancer Patients

“…Hydromorphone in small amount is also metabolized to 6-hydroxy-hydromorphone, but its role is unknown. Due to glucuronidation, the risk of hydromorphone pharmacokinetic interactions with other drugs seems to be low (Sarhill et al, 2001). Adverse effects are similar to those of morphine; however, hydromorphone less frequently induces nausea and vomiting, constipation, itching, and probably more slowly develops tolerance to analgesia (Wirz et al, 2008).…”

Oral osmotisches Hydromorphon für die symptomatische Behandlung chronischer Osteoporose bedingter Schmerzen unter alltäglichen Routinebedingungen

“…Seit Jahrzehnten wird Hydromorphon sicher und erfolgreich in der Therapie chronischer Schmerzen eingesetzt [7,8] . Hydromorphonhydrochlorid ist ein halbsynthetisches, hydrogeniertes Keton des Morphins, das ü ber eine ungef ä hr 5-mal st ä rkere analgetische Potenz als Morphin verf ü gt [9] . Vertr ä glichkeit und analgetische Wirksamkeit von schnell-freisetzenden Darreichungsformen von Hydromorphon konnten in zahlreichen klinischen Studien gezeigt werden [7,8] .…”

Identification and synthesis of norhydromorphone, and determination of antinociceptive activities in the rat formalin test

“…Like morphine, hydromorphone is also a A-opioid analgesic, and it is used for the relief of moderate to severe pain (Sarhill et al, 2001). Hydromorphone is about 8 times as potent as morphine in relieving postoperative pain (Mahler and Forrest Jr, 1975) and chronic cancer pain (Houde, 1986), although a 5:1 potency ratio has been reported after intravenous bolus administration in healthy volunteers undergone repeated electrical tooth pulp stimulation (Coda et al, 1997).…”