Hydromorphone: uses and side effects

Hydromorphone It is a semisynthetic morphine derivative analgesic drug which presents an activity 5 times more powerful, although with a shorter action.

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

It can be administered both enterally and parenterally. The binding to μ receptors is the cause of both analgesic effects as of the 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 show that This medicine has an 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 observed that It is a morphine equivalent drug in terms of analgesic efficacy and side effects.

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

A little history of hydromorphone

Hydromorphone, as we have seen, is a semi-synthetic drug derived from 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 medicine marketed under different brands and in different pharmaceutical forms With different doses. Preparations for immediate release are not marketed in Spain.

How does hydromorphone exert its effect on the body?

Hydromorphone is a potent agonist of opioid receptors μ. These receptors, like the other types of opioid 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 the peripheral nerves.

The analgesia it produces It is due to the changes that occur in the perception of pain at the spinal level by joining these receptors. This medicine, like other opiates, has a very high analgesic ceiling.

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Adverse reactions of hydromorphone

Hydromorphone, like all medicines marketed in the market, It is not exempt from producing a series of adverse effects.

We understand as adverse effects all those events produced undesirably and unintentionally that are expected in treatment with a drug.

In this regard, among most common adverse effects which have been observed in patients treated with this medicine, we can mention the following:

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

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

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Although hydromorphone has a pharmacological profile, analgesic and morphine side effects, there are still controversies regarding the equianalgesic doses between these two medications 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 that originate in an oncological disease. Thus, further research in this area and further clinical trials should be carried out.To study the use of hydromorphone in this type of patients.