Talk:Hydromorphone/Archive 1

milligrams or micrograms?

The withdrawl section refers to patients taking more than 40 milligrams per day. Is this accurate or should it be micrograms? A typical dose of oral hydromorphone is 4 micrograms. —Preceding unsigned comment added by 67.167.242.89 (talk) 23:02, 18 December 2010 (UTC)

What leads you to think that a typical dose is 4mcg? You must have this opioid confused with something else, hydromorphone comes in (instant release) doses of 0.5-8mg. DubiousIrony ^yell 07:03, 13 January 2011 (UTC)

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)

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)

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)

Available forms

The available forms section is needlessly long. Fuzzform 03:49, 3 May 2007 (UTC) You are not kidding. The whole article is too long. I suspect, and not in jest, that the writers were becoming personally educated with hydromorphone when they wrote about it.Nehmo (talk) 07:04, 10 November 2011 (UTC)

Dilaudid

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

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.

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 asociated 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)

I have been on Dilaudid for about 3 years now and I can say without a doubt this drug has devastating side-effects and is highly addictive. I crave it when I haven't had it for about 6 hours and when I do not use any for over 24 hours I experience more pain than I could ever imagine along with some of the other withdrawal symptoms listed. My pain was chronic for years but over the past few months it has declined in pain but sadly my need for the dilaudid has only increased. I have come to think of my situation as bittersweet because my pain is decreasing but my need for the little white pill that has helped me for so many years has increased both mentally and physically causing me to be afraid of the future of my life because I know there is no easy way to end my use of this drug and my future holds nights and days of extreme body pain as well as other terrifying withdrawal symptoms I must experience as I go through the process of detoxification and it will be more painful than anything I have ever experienced in my life because most family doctors and dentists haven't heard of this drug and because of this lack of information I will have to detox my body as well as my mind off of a dosage of 8mg pills every 4 to 6 hours, I have to put my body through the god awful pain caused by the process of detoxification off of the highest allowed dose of a very very powerful drug prescribed to me without my knowledge of its dangers or the knowledge of its dangers by my dentist who prescribed me the drug. In order for this process of addiction and detoxification to stop being so drastic, painful and possibly deadly there needs to be a nationwide law informing any and all physicians with a prescription pad and DEA number how dangerous, powerful and addictive these drugs are because if people out there are being given these drugs without knowing the risks that these drugs pose addiction rates will continue to rise, rehab clinics will continue to be filled with normal people who didn't choose their path to hell unlike illegal drug users do at least they know what lies ahead of them when they choose to abuse illegal drugs unlike regular people like me who had no idea that what I thought I was taking to help me would end up destroying my life. SO MUCH FOR THE WAR ON DRUGS. — Preceding unsigned comment added by 71.199.19.251 (talk) 10:53, 30 August 2011 (UTC)

Price

"On the street, it is usually rather expensive, upwards of $50 USD for a 2 mg tablet" also you can shoot them for a shitty felling so dont DO DRUGS THEY ARE BAD OK

50$ for 2 mg!? I'd say 5$... Illicit drug prices vary widely, but still, this is ridiculous. Please find a source... —Preceding unsigned comment added by 76.71.251.187 (talk) 04:59, 19 September 2008 (UTC)

Cultural references

The Folk-rock band The Mountain Goats have recorded a single named Dilaudid

Breat Easton Ellis made a reference to Dilaudid in his book Lunar Park —Preceding unsigned comment added by 217.211.193.63 (talk) 02:47, 29 January 2009 (UTC)

Addition

I added an animated .gif I created to the page. It looks correct to me, but if it's wrong remove it, let me know, and I will correct it and upload it again. Ζρς ι'β' ^¡hábleme! 01:16, 4 February 2009 (UTC)

Quality of this article....

This article is tagged as "High Importance" Portal Medicine article. Yet, one can find e.g. this:

"In 2005, one still encountered capsules of Dilaudid sized 18 mg and 30 mg on the street in British Columbia, and there is no reason to suppose that should have changed. I do not know the manufacturer. Despite this large dose, they are not highly sought after when there is a choice between them and the traditional 2, 4, and 8 milligram tablets. The capsules are large and brightly colored (yellow for 18 mg, red for 30 mg), and within they contain tiny beads which are maddeningly hard, which no amount of cooking will break apart. The only way to break them to a powder is by brute force, with a heavy mortar, stories are heard of coffee grinders. The beads are not like those found in many pharmaceuticals which melt or break apart easily, but are closer to those found in Kadian brand 100 mg morphine capsules. Although this prevents easy injection, it seems likely that the true intent of the manufacturer was to ensure the slow dissolution of a large dose of narcotics in the patients stomach."

Is this compatible with a "high importance" article? Sorry, but do we really need such junkyard trivia?--84.163.117.123 (talk) 15:18, 12 March 2009 (UTC)

"This article may need to be rewritten entirely to comply with Wikipedia's quality standards, as having too many overly long blocks of text." Don't waste your time counting peanuts! -- Robodoc.at (talk) 12:30, 7 March 2010 (UTC)

Hydromorphone and its implementation

Hydromorphone is typically implemented by surgeons when drugs such as percocet and other narcotics are innefective. I myself have used Hydromorphone for my past 2 surgeries due to the fact that other narcotic pain relievers have had little to no effect. This drug does have it's share of side effects so people should be wary about using it however it is an effective drug for treating moderate to severe pain post-op. —Preceding unsigned comment added by Glopus14 (talk • contribs) 22:04, 25 March 2009 (UTC)

Hydromorphone and other opioid classes

"Like all opioids used for analgesia, hydromorphone is potentially habit-forming and is listed in Schedule II of the United States' Controlled Substances Act of 1970 as well as in similar levels under the drugs laws of practically all other countries and is listed in the Single Convention On Narcotic Drugs." (emphasis mine)

This is not true, as Vicodin (hydrocodone APAP) is one example of a schedule III opioid analgesic, and I'm sure there are others. It just depends on the likelihood of severe addiction/abuse vs the benefit when it comes to scheduling. Cocaine is still a scheduled drug--schedule I. —Preceding unsigned comment added by 68.83.191.65 (talk) 14:24, 15 June 2009 (UTC)

extracting the active ingredients

Just dissolve in warm water for several hours then filter through cotton? —Preceding unsigned comment added by 99.189.108.108 (talk) 23:21, 2 September 2009 (UTC)

Shortening article lead

The article lead is a bit too long. I've shortened it. Any problems with the new lead? --PhuckOMatik (talk) 18:56, 7 June 2011 (UTC)

Year of discovery

Hydromorphone was first synthesized and researched in Germany in 1567 and introduced to the mass market by Knoll in 1926 under the brand name Dilaudid indicating its derivation and degree of similarity to morphine - from article which would mean that it was discovered before morphine but introduced afterwards. 86.44.79.87 (talk) 21:52, 16 November 2011 (UTC)