Palladone-Sr (Hydromorphone Hydrochloride)

Hydromorphone hydrochloride acts on the central nervous system to provide analgesia for several painful conditions.

• Post‑operative pain: delivers rapid relief of acute pain following surgery.
• Cancer‑related pain: helps control persistent severe pain in oncology patients.
• Severe chronic pain: used when other opioids are insufficient for managing chronic nociceptive pain.

• Hydromorphone hydrochloride is a full agonist at the µ‑opioid receptors in the central nervous system. Binding activates inhibitory G‑protein pathways, reducing neuronal excitability, decreasing the perception of pain, and altering pain‑modulating neurotransmitter release.

Adverse reactions may occur with hydromorphone use and should be monitored.

Common Side Effects

• Nausea and vomiting: mild to moderate gastrointestinal upset.
• Constipation: reduced bowel motility leading to hard stools.
• Drowsiness or sedation: increased sleepiness or reduced alertness.
• Dizziness: sensation of light‑headedness or imbalance.
• Pruritus: itching without rash.
• Dry mouth: reduced salivation causing oral discomfort.

Serious or Rare Side Effects

• Respiratory depression: slowed or shallow breathing that can be life‑threatening.
• Severe hypotension: marked drop in blood pressure.
• Cardiac arrhythmias: abnormal heart rhythms.
• Anaphylaxis: acute allergic reaction with hives, swelling, and airway compromise.
• Dependence and withdrawal: physical dependence with withdrawal symptoms on abrupt cessation.

Hydromorphone should be prescribed and monitored carefully to minimise risks.

• Assess pain severity: confirm that opioid therapy is appropriate for the level of pain.
• Evaluate respiratory function: monitor for signs of respiratory depression, especially after dose changes.
• Review patient history: consider prior opioid use, substance abuse, or tolerance.
• Adjust for organ impairment: modify dosing in renal or hepatic dysfunction.
• Educate on side‑effects: inform patients about constipation, sedation and the need to avoid driving if impaired.
• Store at ambient temperature: keep in original container, protect from light and moisture.

Hydromorphone may interact with other medications, altering its safety or effectiveness.

Major Interactions (Avoid)

• CNS depressants: concurrent use with benzodiazepines or barbiturates can cause profound respiratory depression.
• MAO inhibitors: may precipitate severe hypertension or serotonin syndrome.
• Opioid antagonists: naloxone or naltrexone can reverse analgesia and precipitate withdrawal.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors: ketoconazole, erythromycin may increase hydromorphone plasma levels.
• CYP3A4 inducers: rifampicin, carbamazepine may reduce effectiveness.
• Anticholinergics: may worsen constipation.
• Diuretics: can enhance hypotensive effects.
• Alcohol: additive central nervous system depression.