Hydromorphone (IR/IV)

Strong Opioid·Analgesia - Opioids

Severe acute and chronic pain

S8PBSOPIOIDDilaudid, Jurnista (SR)2 mg tablet+1

Max Dose

Titrated

Potency

5x MORPHINE

Renal Safe

PREFERRED

Half-life

2-3 h

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.

Maximum Dose

Titrated to effect.

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.

Avoid / Cautions

Severe respiratory depression, asthma attack. Pregnancy Category C.

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)

Hydromorphone (IR/IV)

Strong Opioid·Analgesia - Opioids

Severe acute and chronic pain

S8PBSOPIOIDDilaudid, Jurnista (SR)2 mg tablet+1

Max Dose

Titrated

Potency

5x MORPHINE

Renal Safe

PREFERRED

Half-life

2-3 h

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.

Maximum Dose

Titrated to effect.

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.

Avoid / Cautions

Severe respiratory depression, asthma attack. Pregnancy Category C.

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)