Hydromorphone: evolving to meet the challenges of today's health care environment

Clin Ther. 2013 Dec;35(12):2007-27. doi: 10.1016/j.clinthera.2013.09.027. Epub 2013 Nov 28.

Abstract

Background: Hydromorphone, a potent analogue of morphine, has long had an important role in pain management and is included in several international guidelines for managing pain. Advances in hydromorphone formulations and the ways in which hydromorphone is being used clinically today warrant a review of the drug's pharmacotherapeutic utility.

Objective: The history and recent advances in hydromorphone pharmacotherapy are reviewed. Areas covered include the pharmacologic and metabolic profile of hydromorphone, the role of hydromorphone in pain management, formulations and routes of administration, and issues related to relative opioid potencies, equianalgesic ratios, and opioid rotation. Because hydromorphone, like all opioids, carries a risk of misuse, abuse, and illicit diversion, the related issues of tamper-resistant formulations and "dose-dumping" of extended-release formulations are discussed.

Conclusions: Due to the epidemic of prescription opioid overdoses associated with prescription opioid abuse in the United States, development of tamper-resistant opioid formulations that avoid dose-dumping issues has become a significant goal of pharmaceutical manufacturers. The current formulation of hydromorphone extended-release potentially provides the benefits of long-acting hydromorphone (ie, continuous pain control, increased quality of life, freedom to perform daily activities) to appropriate patients, while reducing the risks of abuse and without compromising safety.

Keywords: extended-release; hydromorphone; opioids; pain.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics, Opioid / pharmacology*
  • Analgesics, Opioid / therapeutic use*
  • Dosage Forms
  • Drug Administration Schedule
  • Humans
  • Hydromorphone / pharmacology*
  • Hydromorphone / therapeutic use*
  • Opioid-Related Disorders / prevention & control
  • Pain / drug therapy*
  • Pain Management*
  • Patient Selection
  • United States

Substances

  • Analgesics, Opioid
  • Dosage Forms
  • Hydromorphone