Textbook and Publication Errata
Error in Lexi-Comp publications
within the monograph for hydromorphone dosing
Lexi-Comp has noted an error in their publications within
the monograph for the dosing of hydromorphone.
The current field reads:
Pain:
Adults:
Oral, I.M., I.V., S.C.: 1-4 mg/dose every 4-6 hours
as needed; usual adult dose: 2 mg/dose
Rectal: 3 mg every 6-8 hours
It should read:
Acute pain (moderate to severe): Adults: Note: These are
guidelines and do not represent the maximum doses that may
be required in all patients. Doses should be titrated to pain
relief/prevention.
Oral:
Initial: Opiate-naive: 2-4 mg every 3-4 hours as needed;
patients with prior opiate exposure may require higher initial
doses
Usual dosage range: 2-8 mg every 3-4 hours as needed
I.V.: Initial: Opiate-naive: 0.2-0.6 mg every 2-3
hours as needed; patients with prior opiate exposure may tolerate
higher initial doses
Note: More frequent dosing may be needed.
Mechanically-ventilated patients (based on 70 kg patient):
0.7-2 mg every 1-2 hours as needed; infusion (based on 70
kg patient): 0.5-1 mg/hour
Patient-controlled analgesia (PCA): Initial: Opiate-naive:
Consider lower end of dosing range; after loading: 0.05-0.4
mg/dose; usual lockout range: 5-10 minutes
Epidural: Initial: 0.8-1.5 mg/dose; infusion: 0.15-0.3
mg/hour
I.M., S.C.: Note: I.M. use may result in variable
absorption and a lag time to peak effect.
Initial: Opiate-naive: 0.8-1 mg every 4-6 hours; patients
with prior opiate exposure may require higher initial doses
Usual dosage range: 1-2 mg every 3-6 hours as needed
Rectal: 3 mg every 4-8 hours as needed
Chronic pain: Patients taking opioids chronically
may become tolerant and require doses higher than the usual
dosage range to maintain the desired effect. Tolerance can
be managed by appropriate dose titration. There is no optimal
or maximal dose for hydromorphone in chronic pain. The appropriate
dose is one that relieves pain throughout its dosing interval
without causing unmanageable side effects.
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