Dilaudid (hydromorphone hydrochloride)

DILAUDID is a narcotic analgesic; its principal therapeutic effect is relief of pain. The precise mechanism of action of DILAUDID and other opiates is not known, although it is believed to relate to the existence of opiate receptors in the central nervous system. There is no intrinsic limit to the analgesic effect of DILAUDID; like morphine, adequate doses will relieve even the most severe pain. Clinically, however, dosage limitations are imposed by the adverse effects, primarily respiratory depression, nausea, and vomiting, which can result from high doses.

DILAUDID has diverse additional actions. It may produce drowsiness, changes in mood and mental clouding, depress the respiratory center and the cough center, stimulate the vomiting center, produce pinpoint constriction of the pupil, enhance parasympathetic activity, elevate cere- brospinal fluid pressure, increase biliary pressure, produce transient hyperglycemia.

Generally, the analgesic action of parenterally administered DILAUDID is apparent within 15 minutes and usually remains in effect for more than five hours. The onset of action of oral DILAUDID is somewhat slower, with measurable analgesia occurring within 30 minutes.
In human plasma the half-life of a DILAUDID 4 mg tablet is 2.6 hours. In a random crossover study in six subjects, 4 mg of oral DILAUDID produced a mean concentration/ time curve similar to that of 2 mg DILAUDID I.V., after the first hour.


WARNINGS

Respiratory Depression: DILAUDID produces dose-related respiratory depression by acting directly on brain stem respiratory centers. DILAUDID also affects centers that control respiratory rhythm, and may produce irregular and periodic breathing.

Head Injury and Increased Intracranial Pressure: The respiratory depressant effects of narcotics and their capacity to elevate cerebra-spinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure. Furthermore, narcotics produce effects which may obscure the clinical course of patients with head injuries.

Acute Abdominal Conditions: The administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.


PRECAUTIONS

Special Risk Patients: DILAUDID should be used with caution in elderly or debilitated patients and those with impaired renal or hepatic function, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture. As with any narcotic analgesic agent, the usual precautions should be observed and the possibility of respiratory depression should be kept in mind.

Cough Reflex: DILAUDID suppresses the cough reflex; as with all narcotics, caution should be exercised when DILAUDID is used postoperatively and in patients with pulmonary disease.

Usage in Ambulatory Patients: Narcotics may impair the mental and or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery; patients should be cautioned accordingly.

drug Interactions: Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, tranquilizers, sedative-hypnotics, tricyclic antidepressants or other CNS depressants (including alcohol) concomitantly with DILAUDID may exhibit an additive CNS depression. When such combined therapy is contemplated, the dose of one or both agents should be reduced.

Parenteral Administration: The parenteral form of DILAUDID may be given intravenously, but the injection should be given very slowly. Rapid intravenous injection of narcotic analgesics increases the possibility of side effects such as hypotension and respiratory depression.

Pregnancy: Pregnancy Category C. DILAUDID has been shown to be teratogenic in hamsters when given in doses 600 times the human dose. There are no adequate and well-controlled studies in pregnant women. DILAUDID should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent. The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexea, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever. The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose. There is no consensus on the best method of managing withdrawal. Chlorpromazine 0.7 to 1.0 mg/kg q.h. phenobarbital 2 mg/kg q.h. and paregoric 2 to 4 drops/kg q4h, have been used to treat withdrawal symptoms in infants. The duration ot therapy is 4 to 28 days, with the dosages decreased as tolerated.

Labor and Delivery: As with all narcotics, administration of DILAUDID to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used.

Nursing Mothers: it is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from DILAUDID, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use: Safety and effectiveness in children have not been established.

Where can I get some

LMAO

Painstaking

PS Right before you die!

I am curious as to if you can even function in any capacity while on dilaudid. How does it compare with fentanyl and demerol in pain relief and effects.

Painstaking -

I use 250Mcg of Duragesic (2 100s and 1 50), and when I have breakthrough pain I use 4mg or 8mg Dilaudid tablets.

As far as functioning, it's hard to function without! Granted, I've been using it for some time, but I find 2mg of Dilaudid gives the same pain relief as 2 10/325 Hydrocodone.

Just my experience
T

So probably comparable to percocet 10 then, didn't figure that. I wonder if it would be more suited for my migraines. I have recently been swayed to believe out of the narcotic analgesics, Demerol is one of the better ones to treat migraines that are of the more severe kind.

Painstaking

Personally, I find Dilaudid to be more functional than hydrocodone, morphine or fentanyl, and about equal with oxycodone. Drowsiness is the primary side effect, instead of an actual 'high' that fentanyl, morphine and hydrocodone gives me. You should certainly try it if you have difficulties with the side effects of any of the other narcotic analgesics, as everyone will react differently with the side effects.

This medication was prescribed for me because Tylox (5mg oxycodone) did nothing, I mean NOTHING, to relieve pain. I took 150mg of oxy (30 pills) within 40 hours - didn't even care about the amount of tylenol. Surgeon said "Dilaudid 4mg should help". It saved me from going back to the hospital.

For me the side effects were much more gentle than either hydrocodone or oxycodone. No nausea, no dizzy feelings. Just great pain relief and a sense that everything was going to be alright.

Now I see why some think of oxy and hydro as mere candy when compared to this gentle giant of a pain killer.

I have been taking dilaudid 4mg for 6 months my doctor prescribes me 90 every twenty days. I have severe back injuries 2 bulging discs a torn disc and 3 compression fractures and after taking it this long it does nothing for pain I more just have to have it to feel normal and not have withdrawls, I wish I would have never taken it, the physical pain of my injuries are easier to deal with than the pain of not having the dilaudid.

Wow, and here I wish I had a sympathetic enough doctor to prescribe me any dilaudid. I know it is a hardcore drug and shouldnt be used long term but for those real ainful moments I hear it is the best.

IT IS the real deal WITH BILL MCNEIL. If morphine is the gold standard of pain killers, hydromorph is the diamond. You can have your oxy, your fent, your black tar, but for my back and feet, I'll take a pretty yellow number 4 any day of the week. I'm talkin legit pain killin folks, but anyway you slice it, or dice it, it's the shizzel. And b4 ya goin runnin down to tha street to buy some, yes, it's even worse than morph to come off of, SO BE VERY CAREFUL. You don't wanna be caught short on this stuff. Be safe, be very safe, J

This is definately the king of the mountain when it comes to pain medicine. Shouldn't be given outside of a hospital settings unless extremely needed. I see it used quite frequently in the ER to treat very painful things such as kidney stones.

Definatley agree with Jason. But oxymorphone out does dialaudid in my opinion. Of course, they only make it in suppositories now, because it was so abused in the past. That being said, I recently heard that they are trying to get FDA approval for a time released pill, which would be the same as Oxycontin is to oxycodone. Now that would be a painkiller!

They already came out w/Palladone, er for hm. But they recalled it for some reason. In any case, be careful. J (I've never had oxymor., but I'm sure it's effective)

Would diludid be in the same catagory as Demerol? I was given that after I had some knee surgery, and within 15 minutes after I took it, I was out COLD for about 12 hours. I cant imagine taking that as a pain reliever on a regular basis, but I am asking because I really dont know.

Dilaudid is very powerfull (~10X morphine) molar:molar, parentally, and even more so orally. Fine effects of hydromorphone are that it:

1) Lacks almost all of the nasty side effects of morphine, and to some degree, even H.

2) Is almost completely lacking in euphoria compaared to many narcotics which also have greater side effects (yes, hydrocodone and oxycodone produce much more euphoria than hydromorphone). But produces more euphoria than methadone.

3) Can cause a unique physical rush akin to H injection (momentary tightening feeling some equate with orgasm).

Oxymorphone is more potent, gram per gram. Part of the reason Dilaudid has such a reputation is that the tablets classically are relatively pure, so injection method is relatively easy. The thing about Dilaudid, is it is very powerful, and has very few if any side fx. The powerful sublime effect is for the true gourmets.

Yes, Dils are known as the creme de la creme. Downside is they are short acting.

Can a dentist prescribe Dilaudid or Fentanyl for severe mouth pain or would it be a waste to ask?

has ayone here considered that dilaudid is easily made from hydrocodone in 95% yeild in one step by refluxing in 48% hydrobromic acid for 15 minutes. I read a lot of complaints about the pharmacuetical beaurocracy, why not circumvent these establishments with pragmatic chemistry?

Dihydrocodeinone(hydrocodone) can be demethylated with 48%aq HBr to yield hydromorphone
J. Org. Chem. 3, 204 (1938)
9g Ethyldihydrocodeinone in 45ml 48% HBr, reflux 14 min, dilute with 100ml water and basify with NaOH. Wash with ether to remove non-phenolic material, add excess ammonium chloride and extract with 4000ml diethyl ether [in at least two dozen portions], evaporate the ether and recrystallize from alcohol to give 8.4g ethyldihydromorphone
48%aq HBr to demethylate the methoxy ether on about a half-dozen alkyl dihydrocodeinone derivatives via a 20-30 min. reflux.
"All yields are over 95%"

I obtained the article it is verbatim what is said here.
In the case of 7-substituted analouges the alpha-beta orientation affects it's lability towards acids as to it's decomp. to phenantherenes, hydrocodone is not 7-substituted so this is irrelevant.
a modification to this procedure would be to use other solvents (methylene chloride is good), and to lower th PH with colid CO2 as opposed to ammonium chloride (this is trivial though.

Informative post.

the same thing can be done with dihydrocodeine (HBr demethylation)
this version uses 10% HBR in acetic acid.
I think this is because you will get SN2 reaction of the 6-hydroxy group. in the case of the hydrocodone no SN2 because it is ketonic, so in the case of dihydrocodeine the acid conc. has to be diminished and the solvent non-aqueous (as the formation of +H3O ions will impedede the HBr from doing it's job.)I can't find the reference on that one though.
dihydromorphine is 2X morphine.

there are 4,000 known synthetic opiods, (not all are controlled either)
a book called "opiod anagelsics" by casy and parfait is excellent reading they provide many references in this book as to synthesis and pharmacology.

Nowadays, no way. Especially Fentanyl, I have never heard of any dentist, oral surgeon or endodontist prescribing that. Hydrocodone of darvocet seen to be standard practice nowadays.

While I applaud your interesting knowledge and reference of chemical processing which is intriguing to me, this is not www.ClandestineDrugMakers.com, it's simply DrugBuyers.com. You may be posting on the wrong forum altogether here buddy. Pretty interesting though.

it does have withdrawals from what I 've heard. but no first-hand experience.

I've found that if taken properly, and I do mean exactly how it's prescribed by a compassionate Doctor, I had very little if any WDs. It's a med usually scripted for short periods of time just so you don't get hooked on it.

However, I've been scripted #150 8mg for before and after a surgery. There was a long wait for surgery and they added in about how much I would need during recovery. They were ample in their judgement as I still have 20 or 30 of them left.

So you see, I did not go off with this med and take it like candy. It's a med you want to really use seldomly. I didn't abuse the med, therefore I personally had 0 WDs. I think in the US 8mg is the highest dosage in pill form, but I'm not sure. Also, if you take this med for more than 5 days straight, then you will go through WDs, the more days after 5 you are on this med the longer the WDs will last. So if you aren't careful and you just take this for long periods on a regular basis 2 or 3 times a day you will definitely go thru WDs.

I personally took as little as humanly possible for the shortest possible amount of time, never to exceed a couple of days. So it's a very short term med in my opinion. I would not want this as my main pain reliever, after a month even on a smaller 4mg dose you will WD hardcore. It won't be pretty and you'll probably wish you were dead.

This is a serious drug IMO that should REALLY be careful with. Take it for a day or two and you'll have no WDs and it should effectively wipe out your pain.

If taken for longer periods I wish you all the best, but don't say we didn't warn you.

My doc scripts a few each month to prevent a trip to ER...about 25 a month. I only take them when I need them. I usually use them each and every month, and get refills every two months.

I truly believe too, that you have to respect his med.

Hmmmm... my doctor will prescibe these over anything else (because of the "purity"). I get the 4mgs.. Personally, they do very little for me. I'd rather have hydro! The WD sounds scary but I think any WD would be!

4mgs does little for me too, but 8mg is perfect for me when this type of pain killer is warranted. Although, they don't work as well for headaches as Demerol. I rather think that is a choice med for bad headaches. So that's as sparing as I get. This med isn't to fool with.