Use of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] as the First Opioid Analgesic:
Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] is for use in opioid tolerant patients only. Do not use Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] for patients who are not tolerant to the respiratory depressant or sedating effects of opioids.
Subcutaneous or Intramuscular Administration:
The usual starting dose is 1 mg to 2 mg every 2 to 3 hours as necessary for pain, and the lowest dose necessary to achieve adequate analgesia. Depending on the clinical situation, the initial starting dose may be lowered in patients who are opioid naïve. Titrate the dose based upon the individual patient’s response to their initial dose of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)].
Intravenous Administration:
The initial starting dose is 0.2 mg to 1 mg every 2 to 3 hours. Intravenous administration should be given slowly, over at least 2 to 3 minutes, depending on the dose. The initial dose should be reduced in the elderly or debilitated and may be lowered to 0.2 mg.
Conversion From Other Opioids to Hydromorphone Hydrochloride Injection [high potency formulation (HPF)]:
There is inter-patient variability in the potency of opioid drugs and opioid formulations. Therefore, a conservative approach is advised when determining the total daily dosage of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)]. It is safer to underestimate a patient's 24-hour Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] dosage than to overestimate the 24-hour Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] dosage and manage an adverse reaction due to overdose.
If the decision is made to convert to Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] from another opioid analgesic using publicly available data, convert the current total daily amount(s) of opioid(s) received to an equivalent total daily dose of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] and reduce by one-half due to the possibility of incomplete cross tolerance. Divide the new total amount by the number of doses permitted based on dosing interval (e.g., 8 doses for every-three-hour dosing). Titrate the dose according to the patient's response.
Use Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] ONLY for patients who require the higher concentration and lower total volume of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)]. Because of its high concentration, the delivery of precise doses of Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] may be difficult if low doses of hydromorphone are required. Therefore, use Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] only if the amount of hydromorphone required can be delivered accurately with this formulation.
Base the starting dose for Hydromorphone Hydrochloride Injection [high potency formulation (HPF)] on the prior dose of Hydromorphone Hydrochloride Injection or on the prior dose of an alternate opioid.