Duration of Action of Hydromorphone Extended Release
Extended-release hydromorphone has a duration of action of 12-24 hours, depending on the specific formulation, with most common formulations designed for twice-daily (12-hour) dosing. 1, 2
Pharmacokinetic Properties
Extended-release hydromorphone formulations are designed to provide sustained analgesia through controlled drug delivery systems:
- Most extended-release hydromorphone products utilize osmotic technology (OROS) to deliver consistent plasma concentrations over 24 hours 2, 3
- The controlled-release capsule formulation is specifically designed for twice-daily (every 12 hours) administration 1
- Steady-state plasma levels are typically achieved within 48-72 hours after initiation of therapy 2
Clinical Applications
Extended-release hydromorphone is indicated for:
- Management of moderate to severe chronic pain requiring continuous, around-the-clock opioid analgesia for an extended period
- Patients with stable opioid requirements who need sustained analgesia 3
Dosing Considerations
When converting patients to extended-release hydromorphone:
- The values for absorption, bioavailability, and maximum plasma concentration after administration of controlled-release hydromorphone every 12 hours are equivalent to those of immediate-release tablets given every 4 hours (at three times the dose) 1
- When converting from immediate-release to extended-release formulations, the same total daily dose can be used, divided into once or twice daily dosing depending on the formulation 4
- A 5:1 morphine-to-hydromorphone conversion ratio is typically used when switching from oral morphine to extended-release hydromorphone 2
Safety Considerations
Important precautions when using extended-release hydromorphone:
- Patients should be monitored for respiratory depression, particularly during initiation and dose titration 5
- The risk of respiratory depression is significantly higher with intravenous administration compared to oral administration 5
- Breakthrough pain during extended-release therapy may require supplemental immediate-release opioid medication 2, 3
- Dose stabilization (defined as a 3-day period with unchanged daily dose and ≤3 doses of rescue medication) is typically achieved within 12 days (range 3-33 days) 2
Comparative Efficacy
When comparing hydromorphone to other opioids:
- Hydromorphone is approximately 5-7 times more potent than oral morphine 6
- For acute pain management, hydromorphone (0.015 mg/kg IV) is considered comparable or potentially superior to morphine (0.1 mg/kg IV) due to its quicker onset of action 6
- Extended-release hydromorphone provides consistent plasma concentrations and sustained around-the-clock analgesia, making it well-suited for long-term pain management 3
Common Pitfalls
To avoid complications when using extended-release hydromorphone:
- Do not confuse immediate-release and extended-release formulations, as this can lead to significant overdose
- Extended-release formulations should never be crushed, chewed, or dissolved as this destroys the controlled-release mechanism and can lead to rapid absorption and overdose
- Careful dose conversion is essential when switching between different opioids or formulations 5
- Regular assessment of pain control, side effects, and continued need for opioid therapy is necessary during long-term use 3