Strong opioid
Hydromorphone hydrochloride
Brand names: Palladone
Adult dose
Dose: PO immediate-release 1.3mg every 4h; modified-release 4mg every 12h. Use opioid-equivalence tables when switching from morphine (≈5–7× more potent PO)
Route: PO/SC
Frequency: q4h or q12h
Dose adjustments
Renal
Useful in renal impairment as alternative to morphine
Clinical pearls
- Cancer pain, particularly when morphine intolerant or in renal impairment
- Specialist palliative care prescribing
Contraindications
- Acute respiratory depression
- Paralytic ileus
- Raised intracranial pressure (caution)
Side effects
- Constipation
- Drowsiness
- Nausea
- Respiratory depression
- Confusion
- Pruritus
- Dependence
Interactions
- CNS depressants
- MAOIs
- Other opioids (additive)
Monitoring
- Pain
- Sedation
- Bowel function
- Respiratory rate
Reference: BNF; Palliative care formulary; https://bnf.nice.org.uk/drugs/hydromorphone-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- Finnegan Neonatal Abstinence Scoring Tool (FNAST) · Neonatal Abstinence Syndrome
- Modified Finnegan Neonatal Abstinence Score (NAS) · Neonatal
- Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal · Critical Care