Talk:Hydromorphone

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Contents

[edit] Seizures

high doeses of dilaudid can cause seizures.

As well as all other opioids do. Hydromorphone is not particulary pro-convulsive, compared e.g. to tramadol and meperidine.--84.163.114.217 03:11, 22 April 2007 (UTC)

[edit] Strength

The article states hydromorphone is the strongest prescription narcotic. Is there any source for this? I thought there were more potent drugs, such as fentanyl. —The preceding unsigned comment was added by 71.75.170.119 (talk) 05:29, 11 March 2007 (UTC).

You are quite right to question this. Many other prescribed opioids are stronger eg. fentanyl and alfentanyl.
--Claud Regnard 23:17, 15 March 2007 (UTC)

Yes, I saw that also and thought "what the heck"?! There is a list of opioids that are more potent than hydromorphone ie. oxymorphone, and as you've mentioned, fentanyl and its analogues. —The preceding unsigned comment was added by 69.14.241.151 (talk) 18:40, 18 March 2007 (UTC).

For reference for anyone who would like to include this in the article, 1.5 mg of hydromorphone is equivalent to 10 mg of morphine/1.5 mg oxymorphone/0.1 mg (100 mcg) fentanyl/0.02 mg sufentanyl (used in anesthesia, not pain management). These doses are for the parenteral route (IV,IM,SC) ONLY, and do not take into account cross-tolerance to other opioids. It's also important to distinguish between potency and efficacy. Some opioids are more potent (meaning it requires a lower dose to produce the desired effect) than others, but may not be more efficacious at relieving physical and psychological symptoms of pain (i.e. suffering). Selecting one of these words is better for pharmacology related articles because they are more specific and sound more professional, as "strong" is a very vague term that is hard to quantify. This info was taken from Basic and Clinical Pharmacology, 10th Ed. by Bertram Katzung,MD, Ph.D, copyright 2007. It was double checked against an opioid dose equivalency calculator from www.paindr.com, the website of a clinical pharmacist/pain specialist friend of mine, with the cross-tolerance meter set to 0%. 24.228.48.163 17:33, 7 October 2007 (UTC)

[edit] Synthesis add to Chemistry section?

I know this shouldn't be too detailled in the chemistry of the drug, but what do you think of adding the proposed (semi)synthesis routes from morphine to hydromorphone in structures?:
http://img144.imageshack.us/img144/1285/knollprocessbp6.png , Catalytic rearrangement (Knoll Process)
and
http://img84.imageshack.us/img84/4361/morphinetohydromorphonesb1.png , Subsequent hydrogenation and oxidation of morphine
these sketches are not copyright-protected, I drew them myself. Is it too much chemistry for the article, what do you think?--84.163.114.217 02:54, 22 April 2007 (UTC)

[edit] Available forms

The available forms section is needlessly long. Fuzzform 03:49, 3 May 2007 (UTC)

[edit] Dilaudid

What a poetic, arcane name. —Preceding unsigned comment added by 68.194.117.136 (talk) 23:46, 24 September 2007 (UTC)

[edit] Alternative to Acetaminophen-Based Narcotics

A family member was recently presecribed this medication as an alternative to acetaminophen-based medications which were apparently having an adverse affect on the liver.


NOTE: APAP (acetaminophen) is extremely toxic to the liver. APAP should be avoided in high doses (more than 2000 mg per day) at all costs - even pain. Get the MD to prescribe non-compounded pain medicine such as Dilaudid, Demerol, oxycodone, pure codiene or oxymorphone.

[edit] Which creates much suffering?

Found under the Side effects heading:

"A common side effect associated with taking hydromorphone is euphoria. This effect makes hydromorphone quite desirable to both patients with severe health problems, which creates much suffering, and their doctors and caretakers, due to its high potency."

Can somebody edit the bolded sentence? It makes no sense, only I don't know enough about the topic to change it.--Edgewise (talk) 23:00, 14 February 2008 (UTC)

I think what they were trying to say is: "A common side effect associated with taking hydromorphone is euphoria, which can lead to abuse and dependence."

Ive been on dilaudid for chronic back pain (3 herniated disks) for 3-4 years and have not suffered from any form of depression or dependance. I have taken breaks when I was able to but am able to only use them for pain. I am 22 years old. No mood changes or any signs of depression. I wouldnt worry about the side effects if you are physically/mentally healthy and stable person to begin with. -Wes —Preceding unsigned comment added by 70.55.100.126 (talk) 23:46, 24 September 2007 (UTC)

I agree. I've personally been prescribed Duragesic fentanyl patches (started at 25μg/h) since 2004, started with morphine sulfate since 2003. Since August 2004 it's been a mixture of Duragesic fentanyl patches (current dose is 2 * 100μg/h patches, since I've been able to reduce my tolerance actively for personal preference) and morphine sulfate to handle breakthrough pain, for those who have used the patches and know how the intermittent doses feel, according to how it's absorbed. Anyways, I've never felt any "depression" or "much suffering" from opioids of any kind, nor have I felt the very-much overstated addiction and dependency "issues" mis-informed throughout this article, apparently attributed to a single writer with an improper and self-researched experience with Hydromorhpone and, more importantly, opioids in general (concerning the relationship between quite a few classes of opioids and their effects, positive and [far less] negative).
Fentanyl and morphine sulfate (for a CNS condition I have) have been fantastic for treatment, and I've never really felt any strong side-effects. Although I've never personally used hydromorphone, I can personally speak about opioids as definitely positive, and have felt little to no "seeking-effects" for fentanyl or morphine, particularly since I use them for pain; even at higher doses any possible addiction effects are minimal to non-existent, and depression and other related effects are pretty much non-existent.-TAz69x (talk) 08:57, 3 March 2008 (UTC)
This is a talk page for the Wikipedia article on hydromorphone. It is not a forum to post about your own personal experiences (see Wikipedia:Talk_page). Personal experience is not a source of research that can be used for inclusion in Wikipedia. It is original research (see WP:NOR). It is also unverfiable (see WP:VER) and does not maintain a neutral point of view (see WP:NPOV). While I appreciate your comments and realize most patients do not become addicted to hydromorphone, please try to keep the dialogue here focused on improving the article Hydromorphone. Thank you! Dgf32 (talk) 18:21, 3 March 2008 (UTC)
I was just making a point, and have personally attributed a large portion of information to selective opioid articles, including writing much of the fentanyl and opioids articles myself. I'm a student of organic chemistry and pharmacology, as well as having opioids adjunct to my life, and have personal experience relaying positive proof, and more so, citeable studies compounding concrete relational resources to attribute information to this (and these) articles. My information was to relay experiencial primary, and resource information secondary to the hydromorphone article, to provide a foundational constituent to the concept that, what the first user provided was information basing hydromorphone as non-depression-inducing, and I secondarily supporting that information with additional information, committing the first user's information as unconfined to a single user, which was also pertinent.-TAz69x (talk) 21:57, 3 March 2008 (UTC)
I've updated the sentence in the article. Dgf32 (talk) 23:24, 24 February 2008 (UTC)