Hydromorphone: Uses And Side Effects
Hydromorphone is a semi-synthetic opioid drug derived from morphine, with five times more potent, albeit shorter, action. As we will see, it owes its analgesic action to the interaction with the μ opioid receptors, present in the central nervous system and in smooth muscles.
It can be administered enterally or parenterally. The bonds with μ receptors are the basis of the analgesic effect, but also of the adverse reactions.
The opioid analgesic group is a mainstay in the treatment of moderate to severe pain, especially in acute cases or those derived from an oncological disease. In the field of acute pain treatment, clinical studies show that hydromorphone has analgesic equivalence similar to that of other opioids.
Regarding the treatment of cancer pain, compared to other opioids and with different formulations, it has been observed that it is equivalent to morphine in terms of analgesic efficacy and side effects. Finally, in the treatment of chronic pain, there are currently no official clinical studies confirming its efficacy.
A brief history of hydromorphone
Hydromorphone, as we have said, is a semi-synthetic drug derived from morphine. It was first synthesized in 1921, in Germany. The first results on the clinical efficacy of hydromorphone were made public in 1926. But it was not until 1981 that the pharmaco-kinetic and pharmaco-dynamic properties of this molecule began to be studied. It is a drug marketed under different names and dosages.
Action of hydromorphone on our body
Hydromorphone is a potent μ-opiate receptor agonist. These receptors, as with other types of opiate receptors, are coupled to G proteins and act as both positive and negative modulators of the synaptic transmission that occurs through this protein.
This drug does not alter the pain threshold of nerve endings, nor does it affect the transmission of impulses through peripheral nerves.
The analgesia it produces is due to changes in the perception of pain at the spinal level as it joins the receptors. It has, like other opioid medicines, a very high analgesic ceiling effect.
Side effects
Hydromorphone, like all drugs, is not exempt from producing a number of side effects. The term “side effects” refers to a series of events that could occur in an undesirable and unexpected way during treatment. In this sense, among the most common adverse effects we can mention:
- Nausea and vomiting.
- Constipation.
- Drowsiness.
- Euphoria.
- Dry mouth.
- Dizziness.
Severe adverse reactions associated with hydromorphone treatment include respiratory failure, apnea or respiratory arrest, circulatory failure, shock and cardiac arrest.
Conclusions
Although hydromorphone has a similar pharmacological, analgesic and side effects profile to morphine, there is still controversy about the equianalgesic doses between these two drugs and between oral and parenteral doses.
There are currently not many studies on the quality of the role of hydromorphone in the treatment of chronic pain in cancer patients. Research in this area must therefore continue.
