Abstract
Hydromorphone is a semi-synthetic opioid that acts mainly on the μ-opioid receptor. Hydromorphone has a fast onset of action, usually within 5 min, and its effectiveness peaks at approximately 20 min, which makes it favourable in the postoperative setting. It plays a role in the management of moderate to severe chronic pain. The most common adverse effects of hydromorphone are hypotension, bradycardia, and respiratory distress. The aim of this study was to determine the trend in the use of hydromorphone analgesics and to evaluate hydromorphone-related toxicity in King Abdulaziz Medical City-Central Region (KAMC-CR). A retrospective, cross-sectional study was carried out in KAMC-CR, and medical and pharmacological data were retrieved from electronic health records for adult patients who used hydromorphone between December 2014 and December 2015. The characteristics of the enrolled patients, including measured blood pressure, heart rate, respiration rate, oxygen saturation, and pain severity score, were collected. Moreover, we identified patients who received naloxone as a hydromorphone antidote. A total of 153 patients were included; 64.1% were male and 35.8% were female. The mean age of the included patients was 55.5 years old (+/− 18.6). Although the majority of patients reported an improvement in pain severity, 75 patients (49%) needed naloxone to overcome adverse effects of hydromorphone. The mean age of patients who received naloxone was 56.2 years old (+/− 20.5), their mean weight was 75.9 kg (+/− 17.2), and 61.3% of them were male (n = 46). Among those who received naloxone, 84% patients (n = 63) had received hydromorphone intravenously. The risk of respiratory depression was significantly higher in patients who received hydromorphone intravenously (IV) than in those who received it orally (p = 0.02). Hydromorphone can have adverse effect. Thus, we recommend evaluating cardiac parameters, oxygen saturation, respiration rate, and pain severity before administering hydromorphone, particularly in patients who have a high risk of cardiorespiratory adverse events, such as patients with cardiac disease, asthma, or chronic obstructive pulmonary disease. Additionally, we recommend the use of appropriate hydromorphone doses in cases of conversion from other opioid therapy or changes between oral and IV routes of the administration of hydromorphone. Moreover, we recommend establishing a policy to restrict the prescription of hydromorphone to avoid the overuse of hydromorphone and minimize the risk of adverse effects and medication errors.
Highlights
Hydromorphone is a semi-synthetic opioid that acts mainly on the μ-opioid receptor
Bradycardia was defined as a heart rate less than 60 beats per minute (HR < 60 b/m)[12], and hypotension was defined as a reduction in systolic blood pressure (SBP) to less than 90 mmHg or by ≥ 20 mmHg or a reduction in mean arterial pressure (MAP) to less than 65 mmHg or by ≥ 10 mmHg13
Cardiac adverse events were reported in 47.7% of the patients (n = 73)
Summary
Hydromorphone has a fast onset of action, usually within 5 min, and its effectiveness peaks at approximately 20 min, which makes it favourable in the postoperative setting It plays a role in the management of moderate to severe chronic pain. The mean age of patients who received naloxone was 56.2 years old (+/− 20.5), their mean weight was 75.9 kg (+/− 17.2), and 61.3% of them were male (n = 46). We recommend evaluating cardiac parameters, oxygen saturation, respiration rate, and pain severity before administering hydromorphone, in patients who have a high risk of cardiorespiratory adverse events, such as patients with cardiac disease, asthma, or chronic obstructive pulmonary disease. A recent systemic review included 38 studies that assessed the rates of opioid misuse, abuse, and addiction in patients with chronic pain. The prevalence of opioid abuse was reported in only one study, with averages rates of 0.08% and 0.81%4
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