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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Hydromorphone, a ketone congener of morphine (dihydromorphinone), has ~5–7.5 times morphine’s potency [85]. Hydromorphone is used for chronic cancer pain and for post-operative analgesia, but it does not convincingly demonstrate clinical superiority in adults over other strong opioid analgesics [86]. Its intermediate hydrophilic and lipophilic activity, lying between that of morphine and fentanyl (Tables 1 and 2), may offer advantages for epidural use [87–92]. Patient-controlled analgesia with hydromorphone results in similar analgesia and side effects compared to morphine in children for the management of mucositis pain after bone marrow transplantation. Effective plasma concentrations of around 4.7 ng/ml (range 1.9–8.9 ng/ml) were in these children [85].
Palliative care
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This is another alternative strong opioid. It has for many years been available as a suppository, but is now also produced as an oral drug in both immediate-release and controlled-release formulations. With hydromorphone it represents a suitable alternative to morphine for patients who cannot tolerate morphine because of limiting side effects, although since it is also a strong opioid a similar spectrum of unwanted effects are to be expected with both these drugs, in particular nausea and constipation. The use of these drugs should therefore follow guidelines similar to those for morphine with the accompanying use of regular prophylactic laxatives and anti-emetics.
Acetaminophen and Hydrocodone Levels in Chronic Pain Patients
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
The potential value of therapeutic monitoring is well recognized for many medications, including anticonvulsants, amitriptyline, digoxin, lithium, and others. There has been limited use of this technique for opioids, however. A blood level of 150–600 ng/ml has been found necessary to prevent recidivism in methadone maintenance patients (Dole, 1988). A study of some chronic pain patients demonstrated that hydromorphone concentrations of more than 4 ng/ml were required for pain control (Reidenberg et al., 1988). The latter study identified some patients where hydromorphone concentrations were low even at high doses, and the authors concluded that the wide variation in pharmacokinetics probably adds to reports of poor analgesic control in chronic cancer pain using opioids. This observation has been made by others (Tennant et al., 1988). These findings are consistent with the large pharmacokinetic/pharmacodynamic variability observed in numerous studies of short-term opioid administration for acute painful conditions.
Pharmacological approaches to treat intestinal pain
Published in Expert Review of Clinical Pharmacology, 2023
Mikolaj Swierczynski, Adam Makaro, Agata Grochowska, Maciej Salaga
The third step includes the use of strong opioids such as morphine, fentanyl, buprenorphine, tapentadol, methadone and hydromorphone. Morphine and its metabolic products are direct agonists of the μ and κ opioid receptors (ORs) whose activation provides anesthesia. Fentanyl gives a better analgesic effect, even 50 to 100 times more potent than morphine [16]. Buprenorphine is also a solid working agent, available in transdermal patches. It has a binding capacity to the three ORs, μ, δ, and κ. Compared to parenteral morphine, parenteral buprenorphine is 30–40 times more potent [17]. Methadone’s way of action is comparable to that of morphine and due to its low cost it is commonly used in developing countries. Hydromorphone is also a useful opioid derived from morphine, mainly applied for cancerous pain.
Implementation of an enhanced recovery after surgery program in the treatment of uterine fibroids with focused ultrasound ablation surgery
Published in International Journal of Hyperthermia, 2022
Guowei Sang, Xin Zhang, Huamin Fan, Xing Ao, Yushan Chen, Qiuling Shi
Hydromorphone, an opioid, was administered as an analgesic before leaving the operating room. The use of hydromorphone in the post-ERAS group was less than that in the pre-ERAS group, suggesting that ERAS reduced the use of opioids. The number of NSAIDs used in the post-ERAS group was more than that in the pre-ERAS group, with the exception of tramadol. Although tramadol has rarely been administered as a primary drug of choice, a review of physician health program records illustrated that tramadol was the third most frequently mentioned opioid and that it exceeded the abuse liability of fentanyl, oxycodone, and hydromorphone [40]. As with other opioids, the expansion of the worldwide availability of tramadol has resulted in an increase in abuse and diversion [41]. Furthermore, the analgesic activity of tramadol has been reported to be higher than that of diclofenac in other pain conditions such as moderate to severe traumatic musculoskeletal pain [42]. Therefore, the use of multimodal analgesia in ERAS and the reduction in the use of non-opioid central analgesics indicate that postoperative pain levels may be reduced with the implementation of ERAS.
Ending the War on Drugs Requires Decriminalization. Does It Also Require Legalization?
Published in The American Journal of Bioethics, 2021
What all of this makes clear is that it is not obvious “how legal” drugs need to be in order to achieve the goal of reducing harm through a safe supply. The authors sometimes seem to imply that legalization requires a publicly-accessible market—even if regulated and restricted somewhat, as in the case of tobacco and alcohol. However, the inclusion of prescription medications under the descriptor of legal and regulated substances, suggests another—less radical—option, which is liberalized prescribing laws. Hydromorphone, for instance, is already a Schedule II medication, legal to prescribe for severe pain; revising health law could make it permissible to prescribe to those with an active addiction, providing a form of safe supply akin to what heroin-assisted treatment provides in other countries.2 In short: an expanded harm reduction view that advocates for safe supply interventions does not require that all recreational drugs be legalized in the colloquial sense, since good health law and policy could make pharmaceutical grade drugs available to those with an addiction without full legalization.