How to convert from Dilaudid (hydromorphone) 1.5mg PO TID to Dilaudid XR (hydromorphone extended-release)?

Converting from Immediate-Release to Extended-Release Hydromorphone

When converting from immediate-release hydromorphone (Dilaudid) 1.5mg PO TID to extended-release hydromorphone (Dilaudid XR), calculate the total daily dose of immediate-release hydromorphone and administer the same total daily dose as a once-daily extended-release formulation.

Conversion Process

1. Calculate total daily dose of current regimen:

   • Hydromorphone immediate-release 1.5mg × 3 times daily = 4.5mg total daily dose 1

2. Convert to extended-release formulation:

   • Administer 4.5mg of hydromorphone extended-release once daily 1
   • If 4.5mg extended-release tablet is not available, round to the nearest available strength (typically 4mg or 6mg) based on pain control and tolerability 1

3. Monitor during transition:

   • Provide breakthrough pain medication (immediate-release hydromorphone) during the first 24 hours of transition 1
   • Assess pain control and side effects within 24-48 hours of conversion 1

Clinical Considerations

• Benefits of extended-release formulation:

  • Reduced dosing frequency (once daily versus three times daily) 2
  • More consistent blood levels with fewer peaks and troughs 2
  • Potentially improved pain control through maintenance of therapeutic levels 2
  • Possibly fewer side effects due to avoidance of peak concentrations 2, 3

• Cautions:

  • Extended-release formulations are not recommended for unstable pain requiring frequent dose adjustments 1
  • Pain should be relatively well-controlled on the immediate-release formulation before switching 1
  • Extended-release tablets must be swallowed whole and not crushed, chewed, or dissolved 3

• Dosage adjustments:

  • If pain was well-controlled on immediate-release formulation, maintain the same total daily dose 1
  • If pain control was inadequate, consider increasing the dose by 25% when converting 1
  • If side effects were problematic, consider reducing the dose by 25% 1

Follow-up Recommendations

• Evaluate efficacy and tolerability within 24-48 hours after conversion 1
• Adjust dosage based on pain control and side effects 1
• Continue to provide breakthrough pain medication as needed until optimal dose of extended-release formulation is established 1