IV Dilution &
Medication Reference

Stability data:

Stable for at least 24 hours at 25°C, protected from light in most common large-volume parenteral solutions

Protect from light.

Keep covered in carton until time of use.

Drug Dependence
Hydromorphone Hydrochloride Injection can produce drug dependence of the morphine type and therefore has the potential for being abused. Psychic dependence, physical dependence and tolerance may develop upon repeated administration of Hydromorphone Hydrochloride Injection and it should be prescribed and administered with the same degree of caution appropriate for the use of morphine. Since Hydromorphone Hydrochloride Injection is indicated for use in patients who are already tolerant to and hence physically dependent on narcotics, abrupt discontinuance in the administration of Hydromorphone Hydrochloride Injection is likely to result in a withdrawal syndrome.

Infants born to mothers physically dependent on Hydromorphone Hydrochloride Injection will also be physically dependent and may exhibit respiratory difficulties and withdrawal symptoms.

Impaired Respiration
Respiratory depression is the chief hazard of Hydromorphone Hydrochloride Injection. Respiratory depression occurs most frequently in the elderly, in the debilitated, and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation.
Hydromorphone Hydrochloride Injection should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients even usual therapeutic doses of narcotic analgesics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.

Head Injury and Increased Intracranial Pressure
The respiratory depressant effects of Hydromorphone Hydrochloride Injection with carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or preexisting increase in intracranial pressure. Narcotic analgesics including Hydromorphone Hydrochloride Injection may produce effects which can obscure the clinical course and neurologic signs of further increase in pressure in patients with head injuries.

Hypotensive Effect
Narcotic analgesics, including Hydromorphone Hydrochloride Injection, may cause severe hypotension in an individual whose ability to maintain his blood pressure has already been compromised by a depleted blood volume, or a concurrent administration of drugs such as phenothiazines or general anesthetics (see also Precautions - Drug Interactions). Hydromorphone Hydrochloride Injection may produce orthostatic hypotension in ambulatory patients.

Hydromorphone Hydrochloride Injection should be administered with caution to patients in circulatory shock, since vasodilation produced by the drug may further reduce cardiac output and blood pressure.