Neonatal Drug Therapy Manual

Hydromorphone

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Dilaudid
Classification: 
Opiate Agonist
Original Date: 
January 2017
Indications: 
  • Analgesia
  • Sedation
Administration: 
  • IV direct: over 2 - 3 minutes
  • IV intermittent infusion
  • IV continuous infusion
  • PO
Dosage: 
  • IV direct: 5 - 15 mcg/kg/dose (0.005 - 0.015 mg/kg/dose) Q2-4h PRN

Hydromorphone Equivalents

1 mg 1000 mcg
0.1 mg/mL 100 mcg/mL

Dose check:

Dose___ mg multiplied by 1000 = Dose ___ mcg

Divide dose (mcg) by pt weight (kg) for ___ mcg/kg (5 - 15 mcg/kg/dose)

Volume to be administered: Divide dose (mcg) by concentration (mcg/mL) = ___ mL required for dose

  • IV continuous infusion: 3 - 5 mcg/kg/hour (0.003 - 0.005 mg/kg/hour)
  • PO: 0.03 - 0.06 mg/kg/dose Q4h PRN
Side Effects: 
  • CNS: CNS depression, lethargy
  • CVS: hypotension
  • GI: ileus
  • Respiratory: respiratory depression
Parameters to Monitor: 
  • BP, HR
  • RR, oxygen saturation
  • bowel sounds, abdominal distension
Reconstitution and Stability: 

CHEO:

IV direct:

- Use hydromorphone 0.04 mg/mL (40 mcg/mL) - 3 mL prefilled syringe prepared by pharmacy

- If patient receiving hydromorphone by continuous infusion, use appropriate setting on pump to administer bolus dose

 

IV continuous infusion:

- Use hydromorphone 0.04 mg/mL (40 mcg/mL) 20 mL prefilled syringe prepared by pharmacy

 

TOH:

IV continuous infusion:

  • Hydromorphone 2 mg/mL
    • Take 0.2 mL (0.4 mg) and add to 19.8 mL of D5W
    • Final concentration: 0.02 mg/mL (20 mcg/mL)
Compatibility: 

- Solutions Compatible: D5W, 0.45%NaCl, 0.9%NaCl, D5W/0.45%NaCl, D5W/0.9%NaCl

Y-site compatible: amino acids/dextrose with up to 40 mmol/L KCl, cefotaxime, dobutamine, dopamine, epinephrine, fentanyl, furosemide, gentamicin, heparin, midazolam,milrinone, morphine, norepinephrine, SMOF, tobramycin, vancomycin

Incompatible: cefazolin, cloxacillin, lipids (fat emulsion), phenobarbital, phenytoin

References: 

- Taketomo CK, Hodding JH, Kraus DM, Pediatric DM. Pediatric Dosage Handbook 22nd  Edition. Hudson: Lexi-Comp Inc; 2015

- American Society of Health-System Pharmacists (ASHP). Handbook on Injectable Drugs 19th Edtion, Bethesda: ASHP 2017

- Association des pharmaciens des etablissements de santé du Quebec (A.P.E.S.). Care Beyond Cure: Management of Pain and Other Symptoms 4th Edition, Montreal: A.P.E.S. 2009

 

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