What is Hydromorphone?

Hydromorphone is a medication for managing pain and shortness of breath. Your child’s medical team may choose hydromorphone if your child experienced intolerable side effects to morphine (for example, itching), or if one of the other pain medications is no longer providing optimal symptom relief at increasing doses.

How is Hyrdomorphone given?

Children can take hydromorphone as tablets or liquid. Depending on their symptoms, they can take it when needed for symptom relief, or they might need to take it regularly every few hours. Sometimes in these cases, if their pain and hydromorphone dose is stable, they can be changed to a longer-acting, “controlled release” form of hydromorphone that does not need to be taken as often. Controlled release capsules should not be crushed or chewed – they must be swallowed whole. In some cases, capsules can be opened and the beads contained inside can be mixed with soft foods and swallowed whole – talk to the team first.

Children who cannot take medication by mouth can have hydromorphone administered through an IV or under the skin (subcutaneous catheter).

What is the dose?

Our team will work out a starting dose based on your child’s weight. This dose may need to be increased or decreased depending on how your child responds. The amount of hydromorphone needed varies between children. If your child is receiving regular doses of the medication, do not stop the medication without consulting your child’s doctor. Any dose changes (increases or decreases) need to be monitored carefully with the help of your child’s medical team.

The optimal dose of hydromorphone is the amount that eases your child’s pain or shortness of breath. To provide your child with optimal symptom control with minimal side effects, tell the team if you think your child is still experiencing pain or shortness of breath, or if they are too sleepy.

Your child’s body may get used to a certain dose of hydromorphone, and so the dose may need to be increased over time. This is called “tolerance”. A dose increase does not mean your child’s condition is getting worse or your child is becoming addicted.

Do they really need it?

Children can move about, participate in activities, and interact with family if their pain or shortness of breath is well controlled. This improves their quality of life.

What are the side effects of hydromorphone?

  • Constipation: Children taking hydromorphone will often need to take a laxative.
  • Nausea and vomiting: Nausea (feeling sick) or vomiting happens in some children, but usually gets better in a few days. Some children may need to take extra medication to help with nausea.
  • Drowsiness: Many children are drowsy in the first few days after hydromorphone is started or after the dose is increased, but this improves with time. If your child is too drowsy, notify Canuck Place.
  • Slowed breathing: If the first dose is too high or the dose is increased too quickly, a child’s breathing might slow down more than is wanted. As a result, the team will monitor changes in dose.
  • Itching: Some children get itchy when taking hydromorphone. Your child’s team may consider treating this with another medicine, or changing to a different pain reliever.
  • Headache: Sometimes hydromorphone can cause headaches and tired feelings. If they are severe or persistent, please notify Canuck Place.
  • Flushing: Your child may experience some warmth, redness or tingly feelings. Speak with your child’s team if it becomes problematic or bothersome.
  • Dry Mouth: Chewing on ice chips and sugar free candy may help. If your child is unable to take food by mouth, then swab their mouth with a small amount of water.

Sometimes, the side effects may become uncomfortable or intolerable, or not well managed by using other medications. If this happens, your child may need to change to another similar medication instead.

If you have any questions call a Canuck Place Nurse at 604-742-3478 and for immediate assistance call the Kid’s Counter at 604-742-3475

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