What is the recommended dose of hydromorphone (opioid) for a shot?

Hydromorphone Dosing for Injection

For opioid-naïve patients, the recommended starting dose of intravenous hydromorphone is 0.2 mg to 1 mg administered every 2 to 3 hours as needed for pain. 1

Initial Dosing Guidelines

• For intravenous (IV) administration, the injection should be given slowly over at least 2-3 minutes to minimize adverse effects 1
• For intramuscular (IM) or subcutaneous (SC) administration, the usual starting dose is 1 mg to 2 mg every 2-3 hours as necessary 1
• In patients with hepatic or renal impairment, initiate treatment with one-fourth to one-half the usual starting dose 1

Patient-Specific Considerations

• For opioid-naïve patients with acute pain, a lower starting dose (0.2-0.5 mg) may help minimize the risk of opioid toxicity while still providing adequate pain control 2
• For patients already on opioids, calculate an equianalgesic dose based on their current regimen 3
• When converting from IV morphine to IV hydromorphone, use a ratio of approximately 5:1 (10 mg IV morphine = 2 mg IV hydromorphone) 3

Dose Titration

• If a patient is receiving a continuous infusion of hydromorphone and develops breakthrough pain, it is reasonable to give a bolus dose equal to or double the hourly infusion rate 3
• If a patient receives two bolus doses in an hour, consider doubling the infusion rate 3
• IV hydromorphone bolus doses should be ordered every 15 minutes as required for adequate pain control 3

Special Populations

• For patients with kidney dysfunction, even low doses of hydromorphone (1-2 mg IV) can potentially cause neurotoxicity including tremors, agitation, and myoclonus 4, 5
• In elderly patients or those with comorbidities, consider starting at the lower end of the dosing range (0.2 mg IV) 1

Conversion from IV to Oral Hydromorphone

• When converting from IV to oral hydromorphone, use a conversion ratio of approximately 1:2.5 (1 mg IV = 2.5 mg oral) 6
• When converting from IV hydromorphone to oral morphine equivalent daily dose (MEDD), use a ratio of approximately 1:11.5 (1 mg IV hydromorphone = 11.5 mg oral morphine equivalent) 6

Safety Considerations

• Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals 1
• Respiratory depression can occur at any time during opioid therapy, especially when initiating and following dose increases 1
• Monitor patients closely for signs of opioid toxicity, particularly those with renal impairment, even when using low doses 4, 5
• Do not abruptly discontinue hydromorphone in physically-dependent patients 1

Comparative Efficacy

• Hydromorphone has been shown to have a quicker onset of action compared to morphine, making it potentially superior for acute pain management 3
• The potency of hydromorphone (approximately 5-7 times more potent than morphine) allows for smaller volume administration, which may be beneficial in certain clinical scenarios 3