From the Guidelines
The Minimum Effective Dose Daily (MEDD) of hydromorphone (Dilaudid) at 3.5 mg intravenously (IV) is not established, however, a commonly used dose range is 0.3-1.5 mg IV as needed for pain management, with 0.3 mg being a more conservative starting point to assess patient response and minimize potential side effects 1.
Key Considerations
- The dose range of 0.3-1.5 mg IV is recommended for adult patients who are opioid-naive, and the correct dose and interval for opioid administration are those that relieve dyspnea or pain without intolerable adverse effects 1.
- The dose should be increased as needed to produce the desired effect or until intolerable side effects occur, and reassessment of the drug’s effects on the patient and titration of the opioid are the mainstays of successful management 1.
- It is essential to note that these dosing recommendations do not apply to patients who have previously used opioids, as their dosages will be higher and must be individualized 1.
Dosing Recommendations
- For adult patients, the recommended starting dose of hydromorphone is 0.3-1.5 mg IV, with a duration of effect of 3-4 hours 1.
- For pediatric patients, the recommended starting dose is 0.015-0.03 mg/kg IV, with a duration of effect of 3-4 hours 1.
- The pediatric dosage (adjusted for body weight) should not exceed the corresponding adult dose 1.
From the Research
Minimum Effective Dose Daily (MEDD) of Hydromorphone
- The MEDD of hydromorphone at 3.5 mg intravenously (IV) is not directly stated in the provided studies 2, 3, 4, 5, 6.
Hydromorphone Potency and Administration
- Hydromorphone is a potent opioid analgesic, with a potency 8.5 times that of morphine when administered intravenously 6.
- The effective analgesic dose for 90% of patients (ED90) of intrathecal hydromorphone is 75 μg, with a potency ratio to intrathecal morphine of 2:1 3.
Intravenous Hydromorphone Administration
- A study comparing fast (iv push) versus slow (iv piggyback) administration of iv hydromorphone found no difference in abuse liability potential between the two methods, but slow infusion resulted in less sedation 5.
- The pharmacology of hydromorphone, including its potency and administration routes, is well-studied, but there is limited data on its use for acute pain and its potential for abuse 4.