HydroMorphone (Dilaudid) Basics

[ChiselD]

SWIM will say that heating does kill the high, as his first time ever using IV, he tried about 3 mils of D, and didn't even get ANY sort of rush because his friend heated the solution. The next day SWIM took the last 4 mils of an 8, and another friend showed him that no heat is needed, and 2 mils got him off nicely

Reputation Comments on this post:

Everything I have read here and abroad confirms that heating hydromorphone is a bad idea

[This is bat country]

Hydromorph contin + Methylphenidate report


SWIM mixed (eyeballed~) 1/3-1/4 of a 12mg hydromorph contin capsule. Insufflated, felt quite drunk, went to get cigarettes, came back, and ate two 10mg methyphenidate IR tabs and insufflated an additional. Nice rush, wasn't sure what to expect since hydromorph contin is not documented a whole lot on the web. Will do again- will not IV though due to possible problems with binders, inexperience, and increased addiction potential.

[I_8_my yellow crayon]

This is not a post about how to use hydropmorphone, nor does it condone any illegal activity. It is for informational purposes only. This thread is a little sloppy, so hopefully this info helps some. Here are the basics.

Hydromorphone- is a synthetic opioid that was first synthesized in Germany in 1924. After two years of further research and developement, a hydromorphone hydrochloride tablet under the brand name dilaudid was introduced to the market in 1926 by knoll.

Hydromorphone Street Names- Dillies(refering to dilaudid tablets of any size), Crazy 8's(refering to the 8mg hydromorphone hcl), D, Hydro's( mainly referred to this in canada, meaning the hydromorph Contins) Hillbilly Heroin.


Hydromorphone- Hydromorphone is a hydrogenated ketone derivative of morphine that acts as a narcotic analgesic. It has a shorter duration of action than morphine. Hydromorphone is approximately 8 times more potent on a milligram basis than morphine. In addition, hydromorphone is better absorbed orally than is morphine. In clinical settings, Hydromorphone exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Its primary actions of therapeutic value are analgesia and sedation. Hydromorphone appears to increase the patient's tolerance for pain and to decrease discomfort, although the presence of the pain itself may still be recognized. In addition to analgesia, alterations in mood, euphoria and dysphoria, and drowsiness commonly occur. Opioids also produce respiratory depression by direct action on brain stem respiratory centers.

Hydromorphone's action- Hydromorphone is a narcotic analgesic; its principal therapeutic effect is relief of pain. Hydromorphone interacts predominantly with the opioid mu-receptors. These mu-binding sites are discretely distributed in the human brain, with high densities in the posterior amygdala, hypothalamus, thalamus, nucleus caudatus, putamen, and certain cortical areas. They are also found on the terminal axons of primary afferents within laminae I and II (substantia gelatinosa) of the spinal cord and in the spinal nucleus of the trigeminal nerve. In clinical settings, Hydromorphone exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Hydromorphone also binds with kappa-receptors which are thought to mediate spinal analgesia, miosis and sedation.

Who Should Use Hydromorphone?

Only a physician should decide if hydromorphone is the right drug for you. It is used for moderate to severe pain.

Who Should Not Use Hydromorphone?

-First and foremost, patient with a history of drug or alcohol abuse should not use this medication, or be closely monitered by the prescribing physician. It should only be taken as prescribed, and dosage should never be increased without consulting the prescribing physician.

-Anyone with an allergy to narcotic analgesics or to any of the ingrediants in this medication.

-Anyone with Acute Asthma or other obstructive airway disease.

-Anyone with Acute respiratory depression

-Severe central nervous system depression or sedation

-Increased intrcranial pressure

-Pulmonary adema






Biotransformation- Primarily hepatic. After absorption hydromorphone is metabolized by the liver to the glucuronide conjugate which is then excreted in the urine. Hydromorphone is metabolized to the major metabolites hydromorphone-3-glucuronide, hydromorphone-3-glucoside and dihydroisomorphine-6-glucuronide.

Preparations- Hydromorphone comes in many different forms for different routes of administration. Hydromorphone comes in the forms of.

Capsule- Extended release taken by mouth generally every 12 hours. Is generally given for chronic pain.

Liquid- Intramuscular, Intravenous, Oral. Is generally used for acute pain, or post/op pain.

Powder- Is generally for making a solution, for a specific dose. In most cases is administered via the intravenous route. Many different uses for the powder form.

Solution- To be administered via intravenous route. For post/op pain, and acute pain.

Suppository- For rectal administration. Usually this route is preferred in the elderly, or children, in instances where needles or intravenous cannot be used, or is given at nightime due to the drug's effects lasting for a longer duration when administered rectally. There are 100's of different circumstances where hydromorphone is used in its suppository form, which is up to the discreation of the physician.

Syrup- Oral, generally mixed in a cough syrup in very small doses, used as a cough suppressant. Note this drug is usually used as a third line cough suppressant when other medications are not working for severe dry cough.

Hydromorphone being central nervous system depressant, should only be used in conjunction with other CNS depressants under a doctors supervision. Dosage should never be increased without first consulting the treating physician.

Hydromorphone Side-Effects that are less frequent

Nervous System
Weakness, headache, agitation, tremor, uncoordinated muscle movements, alterations of mood (nervousness, apprehension, depression, floating feelings, dreams), muscle rigidity, paresthesia, muscle tremor, blurred vision, nystagmus, diplopia and miosis, transient hallucinations and disorientation, visual disturbances, insomnia, increased intracranial pressure.

Cardiovascular
Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension

Gastrointestinal
Constipation, biliary tract spasm, ileus, anorexia, diarrhea, cramps, taste alteration.

Dermatologic
Ulticaria(hives) or other skin rashes.

Hydromorphone -Most common side-effects

The most frequently observed adverse effects are light-headedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain.

The following Medications may interact with hydromorphone

• alcohol
• amphetamines
• anesthetics
• antihistamines that cause drowsiness
• anticholinergic medications (e.g., benztropine, hyoscyamine)
• barbiturates
• beta-blockers
• chloral hydrate
• cimetidine
• glutethimide
• MAO inhibitors (e.g., selegiline, procarbazine, tranylcypromine) taken within the past 14 days

• naltrexone
• methocarbamol
• other narcotic analgesics
• phenothiazines (e.g., chlorpromazine, promethazine, perphenazine)
• quinidine
• sedatives
• thiopental
• tricyclic antidepressants

Indications for overdose of Hydromorphone

-Bluish colored fingernails or fingertips.
-Slow or shallow breathing, labored breathing
-Cold clammy skin
-Coma
-Confusion
-Dizziness
-Drowsiness
-Fatigue
-Lightheadedness
-Loss of consciousness
-Low blood pressure
-Muscle twitches
-Pinpoint pupils
-Spasms of the stomach and intestines
-Weakness
-Weak pulse

Hydromorphone is marketed under many different trade names in many different countries. The first two are the common ones marketed in North America.

Hydromorph Contin- Canadian time released version. This comes in 3mg(green) 6mg(pink) 12mg(orange) 18mg(yellow) 24mg(grey) and 30mg(red).

hydromorph contin.jpg This is a 12mg Hydromorph Contin Capsule Marketed in Canada. As said above, all other dosages are in the same type of capsule with the same type of markings, except larger doses are larger capsules and the colors differ.

Palladone - On September 24, 2004, the Food and Drug Administration (FDA) approved for marketing an extended release capsule formulation (Palladone) containing 12, 16, 24 and 32 mg hydromorphone. Palladone, was indicated for the management of persistent, moderate to severe pain. Its use was restricted to opioid-tolerant patients requiring continuous, around-the-clock analgesia with a high potency opioid for an extended period of time (weeks to months) or longer.
Within 6 months following the launch of Palladone, new data was provided by the sponsor of Palladone, to the FDA showing that drinking alcohol while taking Palladone may cause rapid release (dose dumping) of hydromorphone, leading to high drug levels in the body, with potentially fatal effects. In view of these new data and at the FDA’s request, the sponsor suspended the sales and marketing of Palladone in July 2005.

productpalladone.gif Palladone Capsules

Palladone SR- Marketed in the United Kingdom and other European countries. Time-released. Palladone SR is available in 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 30 mg, 32 mg, 52 mg Time-released capsules.

Dilaudid- Marketed in the United States and Canada.

dilaudid 2mg.jpg This is a 2mg Dilaudid tablet marketed in the USA.

usa dilaudid 4mg.jpg This is a 4mg Dilaudid tablet marketed in the USA.

Dilaudid- These are Dilaudid tablets marketed in Canada

canadian dilaudid 2mg.jpg This is a 2mg Dilaudid Tablet Marketed in Canada

canadian dilaudid 4mg.jpg This is a 4mg Dilaudid Tablet Marketed in Canada

canadian dilaudid 8mg.jpg This is a 8mg Dilaudid Tablet Marketed in Canada






Note: There are so many generics that they cannot simply be posted.

Some of the trade names found in the rest of the world are.

Hydal
Sophidone
Hydrostat Hydromorfan
Hydromorphan
Laudicon
Hymorphan
Opidal

Please take into consideration the brand names vary from country to country. Here are a few of the known hydromorphone manufacturers..

Purdue Pharma
Purdue-Frederick
Ethex
Knoll
Abbott
Endo
Mallenkroft
Merck
Mundipharma
Lannacher

Hydromorphone Legal Status

In the United States of America it is classified as a Schedule II narcotic. It falls within the same parameters as morphine, hydrocodone, oxycodone, oxymorphone,merperidine, codeine, dihydrocodeine, fentanyl, thebaine, and many other like opiates/opioids. Also take notice that some of these narcotics are only Schedule II if they are in thier pure forms. Also note, certain laws differ in many of the States. Some of the States won't Schedule a certain substance under state law, but it may be scheduled under state law in another state.

Most countries in the European Union are a party to the Single convention on narcotic drugs, the 1971 Convention on psychotropic substances, and the 1988 United Nations Convention Against Illicit traffic in Narcotic Drugs and Psychotropic substances. From what I have found, Hydromorphone falls under Schedule I of the UN convention act. Therefore it is a sunstance with a highly addictive nature, but has legitimate medical usage in select patients.

In Canada, Hydromorphone is a Schedule I narcotic. Mostly controlled in the same ways as in the United States. Any pure form of hydrocodone, codeine, oxycodone,oxymorphone, morphine, fentanyl, dihydrocodeine, Acetorphine, Paramorphine(thebaine), and all of their salts and esters. Also note that the consequences for violations of the controilled substance act of Canada is less severe than the United States. Also note that law differs from province to province, however, all provinces in Canada have to follow the federal law. There are some opiate derivatives that are not covered under the controlled substance act, and this is where sometimes the province steps in and schedules the drug. The same goes for the United States.

In The United Kingdom, Hydromorphone falls under Class A substances. It is subject to strict conditions. If one is found guilty under the Misuse of Drugs Act, with a Class A drug such as Hydromorphone, they may be subject to imprisonment, and or fines. It would depend wheather or not it falls under Possession or Supply.

Reputation Comments on this post:

Nice compilation of basics