Dilaudid Dosage

Generic name: hydromorphone (oral)
Brand names: Dilaudid, Exalgo, Hydrostat IR
Drug class: Narcotic analgesics

Medically reviewed by  A Ras MD.

Recommended Adult Dosing

Dosage forms:  TAB: 2 mg, 4 mg, 8 mg; SOL: 1 mg per mL; INJ (pre-filled syringe): 0.5 mg per 0.5 mL, 1 mg per mL, 2 mg per mL, 4 mg per mL

Dosage Forms Discontinued in US

[3 mg supp not avail. as brand; see generic]

Special Note

[prescribing info]

Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion

Pain, mod-severe

[PO route, tablet]

Dose: individualize dose PO q3-6h prn; Start: 2-4 mg PO q4-6h; Info: in pts converting from other opioids, consider starting 1-2 mg PO q4-6h; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use

[PO route, oral solution]

Dose: individualize dose PO q3-6h prn; Start: 2.5-10 mg PO q3-6h; Info: in pts converting from other opioids, consider starting 1.25-5 mg PO q3-6h; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use

[parenteral route]

Dose: 1-4 mg SC/IM/IV q3-6h; Start: 0.2-1 mg IV q2-3h; 1-2 mg SC/IM q2-3h; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; taper dose by 25-50% q2-4 days to D/C if prolonged or long-term use

[rectal route]

Dose: 3 mg PR q6-8h; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[*PCA route]

Dose: 0.05-0.4 mg IV q6-20min prn; Start: 0.1-0.5 mg IV x1; Info: basal rate for opioid-experienced pts is up to 0.5 mg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

Renal dosing

[PO route]

CrCl <80: decr. usual start dose by 50-75%

HD: start 0.5-1 mg q6h; no supplement after dialysis; PD: start 0.5-1 mg q6h; no supplement

[parenteral route]

CrCl <80: decr. usual start dose by 50-75%

HD: decr. usual start dose, amount not defined; no supplement after dialysis; PD: decr. usual start dose, amount not defined; no supplement

[rectal route]

renal impairment: not defined, caution advised

HD/PD: not defined, caution advised

Hepatic dosing

[PO route]

Child-Pugh Class B: decr. usual start dose by 50-75%; Child-Pugh Class C: decr. usual start dose, amount not defined, titrate slowly

[parenteral route]

Child-Pugh Class B: decr. usual start dose by 50-75%; Child-Pugh Class C: decr. usual start dose, amount not defined, titrate slowly

[rectal route]

hepatic impairment: not defined, caution advised

Recommended Peds Dosing

Dosage forms:  TAB: 2 mg, 4 mg, 8 mg; SOL: 1 mg per mL; INJ (pre-filled syringe): 0.5 mg per 0.5 mL, 1 mg per mL, 2 mg per mL, 4 mg per mL

Pain, mod-severe

[PO route, 6 mo and older, <50 kg]

Dose: 30-80 mcg/kg/dose PO q3-6h; Start: 30-80 mcg/kg/dose PO q4-6h; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[PO route, 6 mo and older, >50 kg]

Dose: 2-4 mg PO q3-6h; Start: 1-2 mg PO q4-6h; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[parenteral route, <6 mo]

Dose: 5 mcg/kg/dose SC/IV q2-6h; Start: 5 mcg/kg/dose SC/IV q4-6h; Alt: 1.5 mcg/kg/h IV; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[parenteral route, 6 mo and older, <50 kg]

Dose: 15-20 mcg/kg/dose SC/IV q2-6h; Start: 15-20 mcg/kg/dose SC/IV q4-6h; Alt: 6 mcg/kg/h IV; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[parenteral route, 6 mo and older, >50 kg]

Dose: 1-2 mg SC/IV q3-6h; Start: 1 mg SC q4-6h; 0.2-0.6 mg IV q2-4h; Alt: 0.3 mg/h IV; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[PCA route, <50 kg]

Dose: 2-5 mcg/kg/dose IV q6-20min prn; Start: 8 mcg/kg/dose IV x1; Max: 20 mcg/kg/h; Info: basal rate for opioid-experienced pts is up to 3 mcg/kg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

[PCA route, >50 kg]

Dose: 0.05-0.4 mg IV q6-20min prn; Start: 0.1-0.5 mg IV x1; Info: basal rate for opioid-experienced pts is up to 0.5 mg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use

Renal dosing

[see below]

renal impairment: decr. usual dose, amount not defined

HD/PD: not defined, caution advised

Hepatic dosing

[not defined]

hepatic impairment: consider adult hepatic dosing for guidance

SRC: NLM .