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Strong opioid

Hydromorphone hydrochloride

Brand names: Palladone

Hydromorphone hydrochloride is a potent opioid analgesic used for the management of moderate to severe pain, including cancer pain.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a full agonist at mu-opioid receptors in the central nervous system, producing analgesia and other opioid effects.

Prescribing in practice

  • Respiratory depression is the most serious risk, especially on initiation, dose increase, in opioid-naive patients or with other CNS depressants, and the modified-release and immediate-release products are not interchangeable milligram for milligram.
  • It is a controlled drug with potential for dependence, misuse and diversion, requiring appropriate prescribing and storage.
  • Use reduced exposure and extra caution in the elderly and in renal or hepatic impairment, and anticipate and manage constipation.

Monitoring

Monitor pain control, sedation, respiratory rate and bowel function, particularly during initiation and dose titration.

Counselling the patient

  • It can cause drowsiness; do not drive or operate machinery if affected and avoid alcohol.
  • Take regular laxatives for constipation and never exceed the prescribed dose.

Evidence & guidelines

Use of strong opioids for pain, including titration and safety monitoring, is supported by NICE guidance on opioids in palliative care and MHRA opioid safety advice.

Reference: Palliative care formulary; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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