Hydromorphone is a strong opioid analgesic very similar to morphine, although it is a more selective μ-receptor agonist. It is used widely in North America as an alternative for diamorphine which is not available. It is available in 4-hourly normal release, and 12-hourly slow release preparations, but the injection is not routinely available in the UK.

It is a useful alternative opioid in selected patients who develop side effects with morphine. Hydromorphone has been used successfully and without toxicity in renal failure,[1] but it has also been reported to cause neuro-excitatory effects in some patients.[2] Hydromorphone is approximately 5-7.5 times as potent as morphine orally.

Indications

• Alternative opioid if morphine causes unacceptable side-effects, especially -
• Opioid-induced pruritus[3]

Using Hydromorphone

• Hydromorphone should be used in the same way as morphine (remember a laxative).
• The capsules can be broken open and sprinkled on soft cold foods.