Hydromorphone controlled-release belongs to the family of medications known as opioid analgesics (narcotic pain relievers). It is used to treat chronic, severe pain. Hydromorphone works on the brain to increase the ability to tolerate pain. Hydromorphone controlled-release works by gradually releasing the medication into the body to help control pain that requires the prolonged or continuous use of an opioid pain killer.

Hydromorphone is a strong pain reliever that can be fatal if it is taken by someone for whom it has not been prescribed.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

For people who are not currently taking other opioid pain medications or are taking low doses of weak opioid medications, the usual adult dose of hydromorphone controlled-release capsules is 3 mg every 12 hours.

For people who are receiving other formulations of hydromorphone or other opioid medications, the dose depends on the dose of these medications that you are currently taking. Your doctor will determine the dose that is appropriate for you.

Your doctor can adjust your dose every 48 hours until a dose that controls your pain with tolerable side effects is reached.

Your daily dose should be taken in two equally divided doses every 12 hours. Swallow hydromorphone controlled-release capsules whole, or open them and sprinkle the contents on cold or warm (not hot), soft food. Rinse your mouth with liquid to make sure that you have swallowed the entire contents of the capsule. Do not chew, crush, dissolve, or break the contents of the capsule, as this could result in too much hydromorphone being released rapidly and could be fatal. It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature in a dry place and keep it out of the reach of children.

Do not take this medication if you:

• are allergic to hydromorphone, or any ingredients of the medication
• are allergic to other opioid (narcotic) pain medications (e.g., morphine, codeine, oxycodone)
• are taking or have taken (within the last 14 days) MAO inhibitors (e.g., phenelzine, tranylcypromine)
• have had surgery or have an underlying condition that may cause narrowing or obstruction of the intestines
• have acute alcoholism
• have acute asthma or other obstructive lung disease
• have acute pain, or pain following surgery
• have acute respiratory depression (slowed breathing)
• have convulsions or seizure disorders
• have cor pulmonale (heart failure caused by chronic high blood pressure in the arteries of the lungs)
• have delirium tremens (e.g., confusion, diarrhea, shaking, fever, hallucinations, disorientation) associated with alcohol withdrawal
• have increased carbon dioxide levels in the blood
• have increased intracranial pressure (increased pressure inside the head), cerebrospinal pressure (increased pressure inside the head and spine), or head injury
• have mild or intermittent pain that can be managed with other pain medications
• have severe central nervous system (CNS) depression (slowed nervous system)
• have or may have surgical abdomen (e.g., acute appendicitis)
• are pregnant, in labour or delivering, or breastfeeding

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• confusion
• constipation
• decreased appetite
• decreased sexual ability or interest
• dizziness, lightheadedness, or feeling faint
• drowsiness
• dry mouth
• headache
• increased sweating
• itchiness
• nausea
• trouble sleeping
• vomiting
• weakness, lack of muscle strength

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abdominal pain
• anxiety
• decreased coordination
• fast, slow, or pounding heartbeat
• symptoms of withdrawal
  • anxiety
  • body aches
  • cold and clammy skin
  • diarrhea
  • loss of appetite
  • nausea
  • sweating
  • vomiting
• symptoms of a bowel blockage (e.g., abdominal pain, severe constipation, nausea)
• vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• slow, shallow, or weak breathing
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
• symptoms of too much medication:
  • cold, clammy skin
  • confusion
  • difficulty walking normally
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • "pinpoint" pupils of eyes
  • seizure
  • severe drowsiness
  • slow or troubled breathing
  • slow heartbeat
  • signs of a severe allergic reaction (hives, difficulty breathing, swelling of the face, throat, or tongue)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Accidental use: Accidental ingestion or use of as little as one dose of hydromorphone by someone for whom it has not been prescribed can lead to a fatal overdose. Children are especially at risk. Keep this medication out of sight and reach of children.

Alcohol and other medications that cause drowsiness: Do not combine this medication with alcohol or other medications (e.g., antidepressants, sleeping pills, anxiety medications) that cause drowsiness or slowed breathing since additional drowsiness or suppressed breathing can occur and be dangerous and possibly life-threatening.

Asthma and other respiratory conditions: Hydromorphone may cause increased breathing difficulty for people having an acute asthma attack, or those with chronic obstructive pulmonary disease (chronic bronchitis, emphysema) or other conditions that affect breathing. If you have asthma or another breathing disorder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence: As with other opioid medications (narcotics), this medication may become habit-forming if taken for long periods of time. Misuse of hydromorphone is usually not a problem when it is used appropriately for pain relief. Withdrawal symptoms (e.g., body aches, diarrhea, nausea, nervousness, restlessness, runny nose, sneezing, goose bumps, shaking, shivering, nausea, stomach cramps, fast heart rate, fever, sweating) may occur if hydromorphone is stopped suddenly. People who are taking this medication for a long time and no longer require it for pain control should stop the medication gradually as directed by their doctor.

Difficulty breathing: Hydromorphone can cause serious, possibly life-threatening breathing problems. Do not drink alcohol while taking this medication as this will make breathing problems caused by this medication worse. If you experience slowed breathing or difficulty breathing, seek immediate medical attention. People with lung problems, sleep apnea, or head injury, and those who are taking other medications that can slow breathing are more at risk for experiencing this. Make sure you follow the instructions on how to properly use this medication. If you have any questions, contact your doctor or pharmacist.

If you have a chronic lung condition (e.g., bronchitis, emphysema, asthma), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Hydromorphone may reduce the mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Do not drive or operate dangerous machinery while using this medication unless you have determined that the medication does not affect your ability to do so.

Head injury: People with head injuries or increased pressure in the head may have a higher risk of experiencing side effects (breathing problems) or worsening of their condition while taking this medication. If this you have a head injury or increased pressure in your head, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood pressure: Hydromorphone can cause low blood pressure, which may be severe. If you experience severe dizziness, especially when standing from a lying or sitting position, contact your doctor.

Medical conditions: People with abnormal heart rhythms, reduced adrenal function (e.g., Addison's disease), low thyroid, inflammation of the pancreas, enlarged prostate, gallbladder disease, alcoholism, or urethral strictures should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizures: Hydromorphone may cause seizures at high doses and increase the frequency of seizures for people who have a history of seizures. If you have a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when hydromorphone is taken when other medications that act on serotonin, such as antidepressants or lithium are also being taken. These combinations should be avoided if possible. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. If not treated, coma and death are possible.

Stopping the medication: Do not suddenly stop taking this medication since withdrawal symptoms may occur. These symptoms include body aches, diarrhea, nausea, nervousness, restlessness, runny nose, sneezing, goose bumps, shaking, shivering, nausea, stomach cramps, fast heart rate, fever, and sweating. Your doctor will advise you on how to safely stop taking this medication if you no longer require it for pain control.

Tablet form: The tablet form of hydromorphone controlled-release should not be used by people who have narrowing of the intestines (e.g., small bowel inflammatory disease, history of peritonitis, cystic fibrosis). Talk to your doctor if you have any questions.

Tolerance: Hydromorphone may lead to tolerance when used for a long period of time. Tolerance means that your body gets used to the medication so that more medication may be needed to produce the same pain relief. Your doctor will recommend the dose of hydromorphone that is most appropriate for you. Do not change your dose or the way you are using the medication on your own. Speak to your doctor if you have any questions.

Pregnancy: This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately. Infants born to parents who have been taking hydromorphone for long periods of time or who are physically dependent on hydromorphone will also be physically dependent on the medication and may experience breathing difficulties as well as withdrawal symptoms.

Breast-feeding: Hydromorphone passes into breast milk. If you are breast-feeding and are using hydromorphone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using hydromorphone have not been established for children less than 18 years of age. Accidental ingestion of this medication by children may lead to severe and even fatal consequences. Keep this medication out of the reach of children.

Seniors: Seniors may be more sensitive to the effects of hydromorphone.

For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.

If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.