Hydromorphone: Uses And Side Effects

Hydromorphone is a semi-synthetic derivative of morphine analgesic drug that has 5 times more potent activity, although with a shorter action.

Although we will see it later, it owes its analgesic action to the interaction with μ-opioid receptors, which are found both in the central nervous system and in smooth muscle.

It can be administered both enterally and parenterally. Binding to μ receptors is the cause of both analgesic effects and adverse reactions.

Opioid analgesics are one of the great pillars that constitute the pharmacological range for the treatment of moderate-severe pain, especially in acute pain and pain derived from an oncological disease.

In the treatment of acute pain, clinical trials have shown that this drug has analgesic equivalence similar to that of other opioids.

Regarding the treatment of cancer pain, it has been evaluated with respect to other opioids and with different formulations. It has been found to be equivalent to morphine in terms of analgesic efficacy and side effects.

Finally, in the treatment of non-cancer chronic pain, there are still no controlled clinical trials that provide scientific evidence for the efficacy of the use of hydromorphone in these patients.

A little history of hydromorphone

Hydromorphone, as we have seen, is a semi-synthetic derivative of morphine. It was synthesized in Germany in 1921. The first results on the clinical efficacy of hydromorphone were published in 1926. However, it was not until 1981 when the pharmacokinetic and pharmacodynamic properties of this molecule were studied in different studies.

It is a drug marketed under different brand names and in different pharmaceutical forms with different doses. The immediate release preparations are not marketed in Spain.

How does hydromorphone work in the body?

Hydromorphone is a potent μ-opioid receptor agonist. These receptors, like the other types of opiate receptors, are coupled to G proteins and act as modulators, both positive and negative, of the synaptic transmission that takes place through this protein.

Hydromorphone does not alter the pain threshold of nerve endings, nor does it affect the transmission of impulses along peripheral nerves.

The analgesia it produces is due to the changes it produces in the perception of pain at the spinal level by binding to these receptors. This drug, like other opioids, has a very high pain relief ceiling.

Adverse reactions of hydromorphone

Hydromorphone, like all drugs on the market, is not exempt from producing a series of adverse effects.

We understand adverse effects as all those events produced in an undesirable and unintended way that are expected in treatment with a drug.

In this sense, among the most frequent adverse effects that have been observed in patients treated with this drug, we can mention the following:

• Sickness.
• Vomiting
• Constipation.
• Drowsiness.
• Euphoria.
• Dry mouth.
• Vertigo.

As for the serious adverse reactions that have been associated with the treatment with this drug, they include respiratory depression and apnea, as well as circulatory depression, respiratory arrest, shock and cardiac arrest.

Conclution

Despite the fact that hydromorphone has a pharmacological, analgesic profile and side effects to morphine, there are still controversies regarding the equianalgesic doses between these two drugs and between oral and parenteral doses.

Today, there are not many studies that have published data on the quality of the role of hydromorphone in the treatment of chronic pain originating from an oncological disease. Therefore, further research in this area should be carried out and more clinical trials studying the use of hydromorphone in these types of patients should be carried out.