Hydromorphone is a potent μ opioid receptor agonist, belonging to the class of opioid painkillers.

It is a derivative of morphine but, compared to the latter, it is about eight times more powerful.

Hydromorphone - Chemical Structure

Hydromorphone is used in the treatment of intense pain and is available in pharmaceutical formulations suitable for oral administration.

Examples of medicinal specialties containing hydromorphone

  • Jurnista ®


For what it uses

The use of hydromorphone is indicated for the treatment of intense pain in adult patients.


Due to the side effects that may occur, before starting hydromorphone treatment, you need to tell your doctor if you have any of the following conditions:

  • Respiratory difficulties or chronic obstructive pulmonary disease (or COPD);
  • Chronic constipation;
  • Headache or head injury;
  • Sudden diarrhea;
  • Intestinal disorders of any kind;
  • Pancreatitis;
  • Hepatic, renal, adrenal and / or cardiac disorders;
  • Hypothyroidism;
  • Prostatic hypertrophy;
  • Alcoholism or drug addiction;
  • Depression of the central nervous system;
  • Epilepsy or convulsive disorders;
  • Toxic psychosis;
  • Kyphoscoliosis.

Furthermore, before taking hydromorphone, patients who have to undergo surgery to reduce pain (such as cordotomy) should inform their doctor.

Concomitant intake of hydromorphone and alcohol causes an increase in side effects induced by the hydromorphone itself, therefore, this association must be avoided.

Hydromorphone may alter the ability to drive and / or use machinery, therefore, these activities should be avoided.

For those who play sports, the use of hydromorphone without therapeutic necessity is doping and in any case can determine positivity to doping tests even when the drug is taken for therapeutic purposes.


Hydromorphone should not be given to patients who are taking - or have taken in the last two weeks - monoamine oxidase inhibitors (or MAOIs, drugs used to treat Parkinson's disease and depression).

Concomitant intake of hydromorphone and other opioid analgesics should be avoided due to side effects that may occur.

Furthermore, before taking hydromorphone it is necessary to inform your doctor if you are already taking drugs such as muscle relaxants, hypnotic sedatives and anxiolytics .

However, it is always good to inform your doctor if you are taking - or if you have recently been - medications of any kind, including prescription free medicines and herbal and homeopathic products.

Side effects

Hydromorphone can cause different types of side effects, but not all patients experience them. This depends on the different sensitivity that each individual has towards the drug.

Listed below are some of the major adverse effects that can occur during treatment with the drug.

Allergic reactions

Hydromorphone can trigger allergic reactions in sensitive individuals. These reactions can occur in the form of:

  • Angioedema with consequent difficulty in breathing and swallowing;
  • Itchy skin eruptions.

Gastrointestinal disorders

Hydromorphone therapy can cause nausea, vomiting, constipation or diarrhea, stomach pain, gastrointestinal inflammation, dyspepsia, heartburn, intestinal blockage, hemorrhoids, flatulence, belching and swelling.

Nervous system disorders

Hydromorphone treatment can cause:

  • Drowsiness;
  • Headache;
  • dizziness;
  • Weakness;
  • Abnormal dreams;
  • Memory disorders;
  • Confusion;
  • Muscle tremors or spasms;
  • Tingling or numbness of the skin;
  • Decreased sense of touch;
  • Dizziness;
  • Convulsions.

Psychiatric disorders

Hydromorphone therapy can promote the onset of:

  • Euphoria;
  • agitation;
  • Anxiety;
  • Onset of depression or exacerbation of depression in patients who are already suffering from it;
  • Mood changes;
  • Hallucinations;
  • Insomnia;
  • Abnormal dreams;
  • Panic attacks;
  • Paranoia;
  • Apathy.

Lung and respiratory tract disorders

Hydromorphone treatment can cause:

  • Respiratory depression;
  • Wheezing due to narrowing of the airways;
  • A runny nose;
  • hyperventilation;
  • Sneezing;
  • Respiratory block.

Cardiovascular disorders

In the course of hydromorphone therapy, the following may occur:

  • Hypertension or hypotension;
  • bradycardia;
  • Cardiac rhythm disorders;
  • Palpitations.

Other side effects

Other side effects that may occur during treatment with hydromorphone are:

  • Tolerance and dependence;
  • Dehydration;
  • Increase or decrease in appetite;
  • Weight gain or loss;
  • Changes in vision;
  • Miosi;
  • Tinnitus;
  • Pain during urination, difficulty with urination and increased frequency of urination;
  • Fluid retention;
  • Temperature;
  • Flu-like symptoms;
  • Bruises;
  • Decreased libido;
  • Redness of the skin;
  • Hypokalemia;
  • Increased blood levels of liver transaminases.


The symptoms that may appear when taking excessive doses of the drug are:

  • Excessive sleepiness;
  • Respiratory depression;
  • Sweating;
  • Miosi;
  • Hypotension;
  • Coma.

In severe cases respiratory arrest, cardiac arrest and death may also occur.

Therefore, if hydromorphone overdose is suspected, contact your doctor immediately or go to the nearest hospital.

Action mechanism

Hydromorphone exerts its analgesic activity by interacting with μ-opioid receptors. These receptors are located along the pain pathways of our body and their task is precisely to modulate the neurotransmission of painful stimuli. More in detail, when these receptors are stimulated, analgesia is induced.

Hydromorphone - as a selective agonist of the aforementioned opioid receptors μ - is able to activate them and thus exert its remarkable pain-relieving action.

Mode of Use - Posology

Hydromorphone is available for oral administration in the form of prolonged-release tablets.

To avoid the occurrence of serious adverse reactions, it is very important to strictly adhere to the indications provided by the doctor, both as regards the amount of drug to be taken, and as regards the duration of the treatment.

In patients who are not taking other opioid painkillers for the treatment of pain, the dose of hydromorphone usually used is 8 mg a day.

However, the amount of drug to be taken must be established by the doctor on an individual basis for each patient.

Pregnancy and breastfeeding

The use of the drug by pregnant women and by breast-feeding mothers is not recommended.

In any case, this category of patients should always seek medical advice before taking any type of medicine.


The use of hydromorphone is contraindicated in the following cases:

  • In patients with hypersensitivity known to the same hydromorphone;
  • In patients with severe stenosis or blockage of the intestine and / or stomach;
  • In patients who have undergone surgery that caused a blind loop in the intestine;
  • In patients who have severe abdominal pain whose cause is unknown;
  • In patients with severe hepatic impairment;
  • In patients suffering from respiratory diseases or severe acute asthma;
  • In patients who are taking - or have recently taken - MAOIs;
  • In patients receiving buprenorphine, nalbuphine or pentazocine;
  • In children and adolescents under 18 years of age;
  • Pregnant;
  • During breastfeeding.