Hydromorphone

Observational studies

In an open, single and multiple dose study, intranasal hydromorphone hydrochloride 1 and 2 micrograms were evaluated for tolerability and safety in 24 healthy volunteers [ ]. Repeated intranasal administration of hydromorphone every 6 hours was well tolerated and adverse reactions were generally mild to moderate and as expected for this drug.

Comparative studies

In a retrospective review of 37 patients with chronic non-malignant pain (mostly from failed lumbosacral spine surgery) treated with intrathecal hydromorphone, there was an analgesic response in six of the 16 patients who were switched from morphine to hydromorphone because of poor pain relief [ ]. Opioid-related adverse reactions, such as nausea, vomiting, pruritus, and sedation, were also reduced by hydromorphone in the 21 patients who were switched to hydromorphone because of morphine-related adverse reactions, especially 1 month after use. These results should be treated cautiously, because of the limitations of a retrospective study that lacks strict inclusion criteria, with obvious population bias and under-reporting, and without standardized procedures for rotation to hydromorphone.

Three randomized, double-blind comparisons of morphine and hydromorphone have been reported. Modified-release hydromorphone hydrochloride 4 mg bd was compared with modified-release morphine sulfate 30 mg bd in 89 patients with cancer pain [ ]. In all, 88 adverse reactions were thought to be directly related to the study medication. Other adverse events were related to the disease process, the re-emergence of pain, or not specified.

In a comparison of hydromorphone and morphine delivered by continuous subcutaneous infusion in 74 patients with severe cancer pain, the number of adverse reactions was small and comparable in both groups [ ].

Hydromorphone 0.015 mg/kg intravenously has been compared with intravenous morphine 0.1 mg/kg in 198 patients attending the emergency department for acute severe pain [ ]. There was adequate pain relief in the two groups and the adverse reactions were similar, except for pruritus, which was not experienced in those who received hydromorphone.

Hydromorphone 10 micrograms/kg (n = 20) as caudal blockade has been compared with clonidine 2 micrograms/kg (n = 20) and morphine 50 micrograms/kg (n = 20) in children aged 6 months to 6 years undergoing ureteral reimplantation [ ]. Those who were given hydromorphone and morphine had significantly more nausea and vomiting (90% and 80% respectively compared with 50%) and pruritus (70% and 75% compared with 30%) than those who were given clonidine.

When epidural morphine (Duramorph 10 micrograms/kg/hour) was compared with epidural fentanyl (1 microgram/kg/hour) and epidural hydromorphone (1 microgram/kg/hour) in 90 children undergoing orthopedic procedures, hydromorphone was considered to be safe and efficacious [ ]. The combined incidences of pruritus, nausea, and vomiting were 25%, 20%, and 10% respectively and for pruritus alone 35%, 15%, and 8% respectively.