Hydromorphone

Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is a morphinan opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may be used by mouth or by injection into a vein, muscle, or under the skin. Effects generally begin within half an hour and last for up to five hours. A 2016 Cochrane review (updated in 2021) found little difference in benefit between hydromorphone and other opioids for cancer pain.

"Dihydromorphinone" redirects here. Not to be confused with dihydromorphine (Paramorfan, etc.), a different opioid.

Hydromorphone
Clinical data
Trade namesDilaudid, Palladone, others
Other namesDihydromorphinone
AHFS/Drugs.comMonograph
MedlinePlusa682013
License data
Pregnancy
category
  • AU: C
Dependence
liability		High
Addiction
liability		High
Routes of
administration		By mouth, intramuscular, intravenous, subcutaneous
Drug classOpioid
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityBy mouth: 30–35%, Intranasal: 52–58%, IV/IM: 100%
Protein binding20%
MetabolismLiver
Onset of action15 to 30 min
Elimination half-life2–3 hours
Duration of action4 to 5 hrs
ExcretionKidney
Identifiers
  • 4,5-α-Epoxy-3-hydroxy-17-methyl morphinan-6-one
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.006.713
Chemical and physical data
FormulaC17H19NO3
Molar mass285.343 g·mol−1
3D model (JSmol)
Solubility in waterHCl salt: 333
SMILES
  • O=C4[C@@H]5Oc1c2c(ccc1O)C[C@H]3N(CC[C@]25[C@H]3CC4)C
  • InChI=1S/C17H19NO3/c1-18-7-6-17-10-3-5-13(20)16(17)21-15-12(19)4-2-9(14(15)17)8-11(10)18/h2,4,10-11,16,19H,3,5-8H2,1H3/t10-,11+,16-,17-/m0/s1 Y
  • Key:WVLOADHCBXTIJK-YNHQPCIGSA-N Y
  (verify)

Common side effects include dizziness, sleepiness, nausea, itchiness, and constipation. Serious side effects may include abuse, low blood pressure, seizures, respiratory depression, and serotonin syndrome. Rapidly decreasing the dose may result in opioid withdrawal. Generally, use during pregnancy or breastfeeding is not recommended. Hydromorphone is believed to work by activating opioid receptors, mainly in the brain and spinal cord. Hydromorphone 2 mg IV is equivalent to approximately 10 mg morphine IV.

Hydromorphone was patented in 1923. Hydromorphone is made from morphine. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2021, it was the 261st most commonly prescribed medication in the United States, with more than 1 million prescriptions.

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