Strong Opioid·Analgesia - Opioids

Hydromorphone (IR/IV)

Severe acute and chronic pain

S8PBSOPIOIDDilaudid, Jurnista (SR)2 mg tablet+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

Titrated

Caution: Potency

5x MORPHINE

Renal Safe

PREFERRED

Half-life

2-3 h

Cautions

Avoid / Cautions

Severe respiratory depression, asthma attack. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, pure mu-opioid agonist. Approximately 5 to 7 times stronger than Morphine. The absolute opioid of choice for patients with renal failure.

Clinical Focus

Dosing errors are fatal. 1mg of Hydromorphone equals 5-7mg of Morphine. Do not confuse the ampoules.

Bottom Line

Hydromorphone (IR/IV) is a potent opioid 5-8x stronger than morphine preferred in renal impairment, but its high potency increases the risk of dosing errors and fatal respiratory depression.

Formulation & Access

Brand Names

Dilaudid, Jurnista (SR)

Oral Routes

Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL).

Parenteral

Ampoules (2 mg/1 mL or 10 mg/1 mL high potency) for IV / SC.

Prescribing & PBS

Highly Restricted (S8).

Indications & Use

Primary

PBSTGA

Severe acute and chronic pain.

Clinical Place

The go-to IV opioid for patients with an eGFR < 30. Also used heavily in palliative care for SC syringe drivers due to high solubility (small volume required).

Quick reference

Class & Role

Strong Opioid — Highly potent, pure mu-opioid agonist.

Route / Formulation

Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL). (Dilaudid, Jurnista (SR))

Usual Dose & Max

PO 1-2 mg q4-6h PRN. OR IV 0.2 - 0.5 mg STAT. Titrated to effect.

Key Indication Doses

Acute Severe Pain (Opioid Naive): PO 1-2 mg q4-6h PRN. OR IV 0.2 - 0.5 mg STAT. Renal Impairment: Does not produce toxic active metabolites. Safe to use in severe CKD and dialysis, though start low as base clearance is mildly delayed.

Best Uses

Hydromorphone (IR/IV) is a potent opioid 5-8x stronger than morphine preferred in renal impairment, but its high potency increases the risk of dosing errors and fatal respiratory depression.

Key Risks

Respiratory: Profound respiratory depression. High risk of fatal overdose due to staff confusing it with morphine dosing. Neurological: Sedation, euphoria, extreme dependence. Gastrointestinal: Constipation.

Key Interactions

Benzodiazepines, CNS depressants.

Monitoring

Strict monitoring of SpO2, RR, and Sedation Score. Double-check the ampoule concentration. The 'HP' (High Potency) ampoule is 10mg/mL. Giving 1mL of this to a naive patient is equivalent to 50-70mg of IV Morphine and will kill them instantly.

Clinical Pearl

If an elderly patient with a fractured NOF has an eGFR of 15, Morphine will give them seizures, and Oxycodone will accumulate. Hydromorphone is clean and safe, making it the definitive choice in nephrology/geriatrics.

Access

Dilaudid, Jurnista (SR)2 mg tablet

Brand: Dilaudid, Jurnista (SR)
Formulation: Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Strong Opioid·Analgesia - Opioids

Hydromorphone (IR/IV)

Severe acute and chronic pain

S8PBSOPIOIDDilaudid, Jurnista (SR)2 mg tablet+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

Titrated

Caution: Potency

5x MORPHINE

Renal Safe

PREFERRED

Half-life

2-3 h

Cautions

Avoid / Cautions

Severe respiratory depression, asthma attack. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, pure mu-opioid agonist. Approximately 5 to 7 times stronger than Morphine. The absolute opioid of choice for patients with renal failure.

Clinical Focus

Dosing errors are fatal. 1mg of Hydromorphone equals 5-7mg of Morphine. Do not confuse the ampoules.

Bottom Line

Hydromorphone (IR/IV) is a potent opioid 5-8x stronger than morphine preferred in renal impairment, but its high potency increases the risk of dosing errors and fatal respiratory depression.

Formulation & Access

Brand Names

Dilaudid, Jurnista (SR)

Oral Routes

Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL).

Parenteral

Ampoules (2 mg/1 mL or 10 mg/1 mL high potency) for IV / SC.

Prescribing & PBS

Highly Restricted (S8).

Indications & Use

Primary

PBSTGA

Severe acute and chronic pain.

Clinical Place

The go-to IV opioid for patients with an eGFR < 30. Also used heavily in palliative care for SC syringe drivers due to high solubility (small volume required).

Quick reference

Class & Role

Strong Opioid — Highly potent, pure mu-opioid agonist.

Route / Formulation

Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL). (Dilaudid, Jurnista (SR))

Usual Dose & Max

PO 1-2 mg q4-6h PRN. OR IV 0.2 - 0.5 mg STAT. Titrated to effect.

Key Indication Doses

Best Uses

Hydromorphone (IR/IV) is a potent opioid 5-8x stronger than morphine preferred in renal impairment, but its high potency increases the risk of dosing errors and fatal respiratory depression.

Key Risks

Key Interactions

Benzodiazepines, CNS depressants.

Monitoring

Clinical Pearl

Access

Dilaudid, Jurnista (SR)2 mg tablet

Brand: Dilaudid, Jurnista (SR)
Formulation: Tablets (2 mg, 4 mg, 8 mg). Oral liquid (1 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.