Textbook and Publication Errata

Error in Lexi-Comp publications within the monograph for hydromorphone dosing

Lexi-Comp has noted an error in their publications within the monograph for the dosing of hydromorphone.

The current field reads:
Pain:
Adults:

Oral, I.M., I.V., S.C.: 1-4 mg/dose every 4-6 hours as needed; usual adult dose: 2 mg/dose

Rectal: 3 mg every 6-8 hours

It should read:
Acute pain (moderate to severe): Adults: Note: These are guidelines and do not represent the maximum doses that may be required in all patients. Doses should be titrated to pain relief/prevention.

Oral:

Initial: Opiate-naive: 2-4 mg every 3-4 hours as needed; patients with prior opiate exposure may require higher initial doses

Usual dosage range: 2-8 mg every 3-4 hours as needed

I.V.: Initial: Opiate-naive: 0.2-0.6 mg every 2-3 hours as needed; patients with prior opiate exposure may tolerate higher initial doses

Note: More frequent dosing may be needed.

Mechanically-ventilated patients (based on 70 kg patient): 0.7-2 mg every 1-2 hours as needed; infusion (based on 70 kg patient): 0.5-1 mg/hour

Patient-controlled analgesia (PCA): Initial: Opiate-naive: Consider lower end of dosing range; after loading: 0.05-0.4 mg/dose; usual lockout range: 5-10 minutes

Epidural: Initial: 0.8-1.5 mg/dose; infusion: 0.15-0.3 mg/hour

I.M., S.C.: Note: I.M. use may result in variable absorption and a lag time to peak effect.

Initial: Opiate-naive: 0.8-1 mg every 4-6 hours; patients with prior opiate exposure may require higher initial doses

Usual dosage range: 1-2 mg every 3-6 hours as needed

Rectal: 3 mg every 4-8 hours as needed

Chronic pain: Patients taking opioids chronically may become tolerant and require doses higher than the usual dosage range to maintain the desired effect. Tolerance can be managed by appropriate dose titration. There is no optimal or maximal dose for hydromorphone in chronic pain. The appropriate dose is one that relieves pain throughout its dosing interval without causing unmanageable side effects.