Consumer medicine information

Dilaudid and Dilaudid-HP injections

Hydromorphone hydrochloride

BRAND INFORMATION

Brand name

Dilaudid, Dilaudid-HP injections

Active ingredient

Hydromorphone hydrochloride

Schedule

S8

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Dilaudid and Dilaudid-HP injections.

DILAUDID® / DILAUDID®-HP Injection

DILAUDID® / DILAUDID®-HP Injection


 Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.


WARNING: Important safety information is provided in a boxed warning in the full CMI. Read before using this medicine.

 1. Why am I using DILAUDID / DILAUDID-HP?

DILAUDID / DILAUDID-HP contains the active ingredient hydromorphone hydrochloride. DILAUDID / DILAUDID-HP is used for the short-term relief of severe pain for which other treatment options have failed or otherwise unsuitable to provide sufficient management of pain.

For more information, see Section 1. Why am I using DILAUDID / DILAUDID-HP? in the full CMI.

 2. What should I know before I use DILAUDID / DILAUDID-HP?

Do not use if you have ever had an allergic reaction to hydromorphone or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.

For more information, see Section 2. What should I know before I use DILAUDID / DILAUDID-HP? in the full CMI.

 3. What if I am taking other medicines?

Some medicines may interfere with DILAUDID / DILAUDID-HP and affect how it works.

A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

 4. How do I use DILAUDID / DILAUDID-HP?
  • Your doctor will tell you exactly how much to take.
  • Follow the instructions given to you by your doctor or pharmacist exactly.
  • You must only take DILAUDID / DILAUDID-HP Injection..

More instructions can be found in Section 4. How do I use DILAUDID / DILAUDID-HP? in the full CMI.

 5. What should I know while using DILAUDID / DILAUDID-HP?

Things you should do
  • Remind any doctor, dentist or pharmacist you visit that you are using DILAUDID / DILAUDID-HP
  • Tell your doctor or pharmacist if you are taking any other medicines that you use to help you relax, anything that contains alcohol (like cough syrup) or other medicines that treat pain.
Things you should not do
  • Do not stop using this medicine suddenly.
  • Do not take more than your doctor tells you to
Driving or using machines
  • DILAUDID / DILAUDID-HP may cause drowsiness, if affected do not drive a vehicle or operate machinery
Drinking alcohol
  • Avoid alcohol
  • Alcohol may make you feel more sleepy, and could increase the risk of serious side effects, such as shallow breathing with the risk of stopping breathing and loss of consciousness.
Looking after your medicine
  • Store below 30°C. Protect from light
  • Keep it where young children cannot reach it.

For more information, see Section 5. What should I know while using DILAUDID / DILAUDID-HP? in the full CMI.

 6. Are there any side effects?

DILAUDID / DILAUDID-HP Injection may cause constipation, nausea, dizziness, drowsiness and be habit forming if taken frequently or over long periods.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.


WARNING:

Limitations of use

DILAUDID / DILAUDID-HP should only be used when your doctor decides that other treatment options are not able to effectively manage your pain or you cannot tolerate them.

Hazardous and harmful use

DILAUDID / DILAUDID-HP poses risks of abuse, misuse and addiction which can lead to overdose and death. Your doctor will monitor you regularly during treatment.

Life threatening respiratory depression

DILAUDID / DILAUDID-HP can cause life-threatening or fatal breathing problems (slow, shallow, unusual or no breathing) even when used as recommended. These problems can occur at any time during use, but the risk is higher when first starting DILAUDID / DILAUDID-HP and after a dose increase, if you are older, or have an existing problem with your lungs. Your doctor will monitor you and change the dose as appropriate.

Use of other medicines while using DILAUDID / DILAUDID-HP

Using DILAUDID / DILAUDID-HP with other medicines that can make you feel drowsy such as sleeping Injection (e.g. benzodiazepines), other pain relievers, antihistamines, antidepressants, antipsychotics, gabapentinoids (e.g. gabapentin and pregabalin), cannabis and alcohol may result in severe drowsiness, decreased awareness, breathing problems, coma and death. Your doctor will minimise the dose and duration of use; and monitor you for signs and symptoms of breathing difficulties and sedation. You must not drink alcohol while using DILAUDID / DILAUDID-HP.

DILAUDID® / DILAUDID®-HP Injection

Active ingredient(s): Hydromorphone Hydrochloride


 Consumer Medicine Information (CMI)

This leaflet provides important information about using DILAUDID / DILAUDID-HP. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using DILAUDID / DILAUDID-HP.

Where to find information in this leaflet:

1. Why am I using DILAUDID / DILAUDID-HP?
2. What should I know before I use DILAUDID / DILAUDID-HP?
3. What if I am taking other medicines?
4. How do I use DILAUDID / DILAUDID-HP?
5. What should I know while using DILAUDID / DILAUDID-HP?
6. Are there any side effects?
7. Product details

1. Why am I using DILAUDID / DILAUDID-HP?

DILAUDID / DILAUDID-HP contains the active ingredient hydromorphone hydrochloride. Hydromorphone belongs to a group of medicines called opioid analgesics.

DILAUDID / DILAUDID-HP is used to provide the short-term management of severe pain for which other treatment options have failed or are otherwise inappropriate to provide sufficient management of pain.

2. What should I know before I use DILAUDID / DILAUDID-HP?

Warnings

Do not use DILAUDID / DILAUDID-HP if:

  • you are allergic to hydromorphone hydrochloride, or any of the ingredients listed at the end of this leaflet.
    Always check the ingredients to make sure you can use this medicine.
  • you have acute breathing difficulties such as bronchitis or asthma
  • you have severe abdominal pain with bloating, cramps or vomiting
  • you have a condition where your small bowel does not work properly
  • you take medicine for depression called a 'monoamine oxidase inhibitor' or have taken any in the last two weeks.
  • you are pregnant or in labour

Check with your doctor if you:

  • are severely drowsy, have a reduced level of consciousness or are feeling faint or dizzy upon standing
  • have heart problems or heart disease
  • have low blood pressure
  • have chronic lung disease
  • suffer from sleep apnoea (temporarily stopping breathing while you sleep)
  • have just drunk a large amount of alcohol, regularly drink large amounts of alcohol or have confusion and shaking due to stopping drinking alcohol
  • suffer from convulsions, fits or seizures
  • have a head injury, brain tumour or increased pressure in your head
  • are about to have surgery, had recent gastrointestinal surgery or have had other surgery in the last 24 hours,
  • have chronic liver or kidney disease
  • have increased prostate size or difficulty passing urine
  • have problems with your gall bladder
  • have problems with or recent surgery of your bile duct
  • have inflammation of the pancreas
  • have adrenal glands which are not working properly
  • have an underactive thyroid gland
  • have a severe mental condition involving losing contact with reality or an inability to think clearly
  • suffer from major depression, anxiety or a personality disorder
  • have an addiction or history of abuse of alcohol, opioids or other drugs.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed. Low levels of opioid analgesics have been detected in human milk.

DILAUDID / DILAUDID-HP given to the mother during labour can cause breathing problems and signs of withdrawal in the newborn.

Addiction

You can become addicted to DILAUDID / DILAUDID-HP even if you take it exactly as prescribed. DILAUDID / DILAUDID-HP may become habit forming causing mental and physical dependence. If abused it may become less able to reduce pain.

Dependence

As with all other opioid containing products, your body may become used to you taking DILAUDID / DILAUDID-HP. Taking it may result in physical dependence. Physical dependence means that you may experience withdrawal symptoms if you stop taking DILAUDID / DILAUDID-HP suddenly, so it is important to take it exactly as directed by your doctor.

Tolerance

Tolerance to DILAUDID / DILAUDID-HP may develop, which means that the effect of the medicine may decrease. If this happens, more may be needed to maintain the same effect.

Withdrawal

Continue taking your medicine for as long as your doctor tells you. If you stop having this medicine suddenly, your pain may worsen and you may experience some or all of the following withdrawal symptoms:

  • nervousness, restlessness, agitation, trouble sleeping or anxiety
  • body aches, weakness or stomach cramps
  • loss of appetite, nausea, vomiting or diarrhoea
  • increased heart rate, breathing rate or pupil size
  • watery eyes, runny nose, chills or yawning
  • increased sweating.
3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may interfere with DILAUDID / DILAUDID-HP and affect how it works.

  • Using DILAUDID / DILAUDID-HP with medicines that can make you feel drowsy may result in severe drowsiness, decreased awareness, breathing problems, coma and death. These medicines include:
  • sleeping tablets and other sedatives (including benzodiazepines and barbiturates)
  • gabapentinoids
  • cannabis
  • antihistamines
  • anxiolytics
  • general anaesthetics
  • antiemetics
  • antidepressants (including tricyclic antidepressants),
  • antipsychotics (including phenothozines)
  • other opioids
  • alcohol

DILAUDID / DILAUDID-HP may enhance the action of neuromuscular blocking agents and affect your breathing

DILAUDID / DILAUDID-HP should not be used if you are taking non-selective monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping such treatment

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect DILAUDID / DILAUDID-HP.

4. How do I use DILAUDID / DILAUDID-HP?

How much to take

  • Your doctor will decide the appropriate dose for you

When to take DILAUDID / DILAUDID-HP

You should be given DILAUDID or DILAUDID-HP injections as directed by your doctor.

If you begin to experience pain, tell your doctor as your dosage may have to be reviewed.

How to take DILAUDID / DILAUDID-HP

A doctor or nurse will usually prepare and administer the injection or infusion.

DILAUDID and DILAUDID-HP injections can be given as a single injection or infusion into the vein. It can also be administered through a fine needle into the tissue under the skin or into the muscle.

Your doctor will decide the most appropriate way for you to have DILAUDID / DILAUDID-HP. Using this medicine in a manner other than that prescribed by your doctor can be harmful to your health.

If you forget to use DILAUDID / DILAUDID-HP

If you forget to have a dose, contact your doctor or pharmacist for advice.

Do not take a double dose to make up for the dose you missed.

This may increase the chance of getting unwanted side effects including severe drowsiness, decreased awareness, breathing problems, coma and death.

If you use too much DILAUDID / DILAUDID-HP

If you or someone else receive too much (overdose), and experience one or more of the symptoms below, call triple zero (000) for an ambulance. Keep the person awake by talking to them or gently shaking them every now and then. You should follow the above steps even if someone other than you have accidentally used DILAUDID / DILAUDID-HP that was prescribed for you. If someone takes an overdose, they may experience one or more of the following symptoms:

  • slow, unusual or difficult breathing
  • drowsiness, dizziness or unconsciousness
  • slow or weak heartbeat
  • nausea or vomiting
  • convulsions or fits

If you think you or someone else may have used too much DILAUDID / DILAUDID-HP you should immediately:

  • phone the Poisons Information Centre (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

When seeking medical attention, take this leaflet and remaining medicine with you to show the doctor. Also tell them about any other medicines or alcohol which have been taken.

5. What should I know while using DILAUDID / DILAUDID-HP?

Things you should do

Call your doctor straight away if you:

  • become pregnant
  • feel your pain is getting worse.

Remind any doctor, dentist or pharmacist you visit that you are using DILAUDID / DILAUDID-HP.

If you are going to have surgery, tell the surgeon or anaesthetist that you are taking this medicine

Things you should not do

Do not stop using this medicine suddenly. If you stop taking this medicine suddenly, your pain may worsen and you may experience withdrawal symptoms.

Do not take DILAUDID / DILAUDID-HP Injection to treat any other complaint unless your doctor tells you to.

Do not give this medicine to anyone else, even if they have the same condition as you.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how DILAUDID / DILAUDID-HP affects you.

DILAUDID / DILAUDID-HP may cause drowsiness or impair mental and/or physical ability in some people.

Drinking alcohol

Tell your doctor if you drink alcohol.

Alcohol may make you feel more sleepy, and could increase the risk of serious side effects, such as shallow breathing with the risk of stopping breathing and loss of consciousness.

Looking after your medicine

  • Store below 30°C

Follow the instructions in the carton on how to take care of your medicine properly.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do not store it:

  • in the bathroom or near a sink, or
  • in the car or on windowsills.

Keep it where young children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

Do not use this medicine after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Less serious side effects

Less serious side effectsWhat to do
Gastrointestinal and urinary related:
  • constipation
  • nausea or vomiting
  • difficulty urinating
Neurological and behavior related:
  • dizziness
  • drowsiness
  • headache
Allergy related
  • sweating
Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
Breathing related
  • difficulty breathing or shallow breathing
Neurological and behavior related:
  • light-headedness, fainting or dizziness especially when standing up
  • changes in mood
  • drowsiness or feeling extremely sedated
  • feeling disorientated and having nightmares
Heart related:
  • slow or noticeable heartbeats
Gastrointestinal and urinary related:
  • severe stomach pain with nausea or vomiting
  • difficulty urinating
Allergy related
  • shortness of breath, swelling of the face, lips, tongue or other parts of the body
Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What DILAUDID / DILAUDID-HP contains

Active ingredient
(main ingredient)
Hydromorphone hydrochloride
Other ingredients
(inactive ingredients)
sodium citrate dihydrate
citric acid
sodium chloride
hydrochloric acid or sodium hydroxide
water for injections

Do not take this medicine if you are allergic to any of these ingredients.

What DILAUDID / DILAUDID-HP looks like

DILAUDID / DILAUDID-HP Injections are clear, colourless to pale yellow solution packed in a clear glass ampoule

DILAUDID hydromorphone hydrochloride 2mg/1mL injection ampoule (Aust R 272632)

DILAUDID-HP hydromorphone hydrochloride 10mg/1mL injection ampoule (Aust R 272633)

DILAUDID-HP hydromorphone hydrochloride 50mg/1mL injection ampoule (Aust R 272634)

Who distributes DILAUDID / DILAUDID-HP

Mundipharma Pty Limited
ABN 87 081 322 509
10 Carrington Street
SYDNEY NSW 2000
Phone: 1800 188 009

This leaflet was prepared in July 2023

® DILAUDID is a trademark of MUNDIPHARMA.

DILAUDID INJ-CMI-v1-(CCDSv20)

Published by MIMS October 2023

BRAND INFORMATION

Brand name

Dilaudid, Dilaudid-HP injections

Active ingredient

Hydromorphone hydrochloride

Schedule

S8

 

Boxed Warnings

Limitations of use. Because of the risks associated with the use of opioids, Dilaudid, Dilaudid-HP injections should only be used in patients for whom other treatment options, including non-opioid analgesics, are ineffective, not tolerated or otherwise inadequate to provide appropriate management of pain (see Section 4.4 Special Warnings and Precautions for Use).
Hazardous and harmful use. Dilaudid, Dilaudid-HP injections pose risks of hazardous and harmful use which can lead to overdose and death. Assess the patient's risk of hazardous and harmful use before prescribing and monitor the patient regularly during treatment (see Section 4.4 Special Warnings and Precautions for Use).
Life threatening respiratory depression. Serious, life-threatening or fatal respiratory depression may occur with the use of Dilaudid, Dilaudid-HP injections. Be aware of situations which increase the risk of respiratory depression, modify dosing in patients at risk and monitor patients closely, especially on initiation or following a dose increase (see Section 4.4 Special Warnings and Precautions for Use).
Concomitant use of benzodiazepines and other central nervous system (CNS) depressants, including alcohol. Concomitant use of opioids with benzodiazepines, gabapentinoids, antihistamines, tricyclic antidepressants, antipsychotics, cannabis or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Limit dosages and durations to the minimum required; and monitor patients for signs and symptoms of respiratory depression and sedation. Caution patients not to drink alcohol while taking Dilaudid, Dilaudid-HP injections.

1 Name of Medicine

Hydromorphone hydrochloride.

2 Qualitative and Quantitative Composition

Dilaudid 2 mg injection contains 2 mg hydromorphone hydrochloride in 1 mL solution.
Dilaudid-HP 10 mg injection contains 10 mg hydromorphone hydrochloride in 1 mL solution.
Dilaudid-HP 50 mg concentrated injection contains 50 mg hydromorphone hydrochloride in 1 mL solution.

3 Pharmaceutical Form

Clear, colourless to pale yellow solution for injection in a clear glass ampoule.

4 Clinical Particulars

4.9 Overdose

For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).
Symptoms. Serious overdosage with hydromorphone is characterised by respiratory depression (reduced respiratory rate and/or tidal volume, cyanosis), extreme somnolence, progressing to stupor, coma or pneumonia aspiration, skeletal muscle flaccidity, cold and/or clammy skin, pupillary constriction, and possibly bradycardia, hypotension and death. Severe overdose may result in apnoea, pulmonary oedema, circulatory collapse and death.
Treatment. The primary concern in the treatment of opioid overdose is immediate supportive therapy with the establishment of adequate respiratory exchanges through the provision of, and maintenance of, adequate ventilation - patients may need ventilatory support up to and including endotracheal intubation and controlled ventilation. Adequate body temperature and fluid balance should be maintained. Oxygen, intravenous fluids, vasopressors and other supportive measures should be used as indicated.
Tolerance to the respiratory and CNS-depressant effects of opioids develops concomitantly with tolerance to the analgesic effects, therefore making respiratory depression unlikely in an opioid-tolerant patient taking the usual therapeutic doses of hydromorphone. Activated charcoal may reduce absorption of the drug if given within one to two hours after ingestion. A potentially serious recent oral ingestion of hydromorphone, if suspected, may be treated with activated charcoal in a patient who is fully conscious with an intact gag reflex or a secured airway. Initial dose of charcoal is 30 to 100 g in adults and 1-2 g/kg in children and is given as a slurry via nasogastric tube. In patients who are not fully conscious or have an impaired gag reflex, consideration should be given to administering activated charcoal via a nasogastric tube, once the airway is protected.
If there are signs of clinically significant respiratory or cardiovascular depression, the use of an opioid antagonist such as naloxone should be considered (please refer to naloxone product information for further information).
Caution should always be observed when using an opioid antagonist for the treatment of suspected hydromorphone overdose as the duration of action of hydromorphone may exceed that of the antagonist. Continuing surveillance is mandatory to prevent recurrence of respiratory depression and supportive care, including ventilatory and circulatory resuscitation/support when indicated, should always be provided. Additional doses of antagonist may be given as indicated by the clinical situation.
Opioid antagonists such as naloxone may precipitate withdrawal in opioid-dependent patients and should be carefully titrated to the desired degree of reversal. The severity of the withdrawal precipitated by administration of an opioid antagonist is contingent upon the degree of dependence and the dose of antagonist given. Too rapid or complete reversal may induce nausea, vomiting, sweating and circulatory stress and may reverse the desirable therapeutic effects (analgesia) as well.
Toxicity. Toxicity may result from overdosage but because of the great interindividual variation in sensitivity to opioids it is difficult to determine an exact dose of any opioid that is toxic or lethal. The toxic effects and signs of overdosage may be less pronounced than expected, when pain and/or tolerance are manifest.

5 Pharmacological Properties

5.3 Preclinical Safety Data

Genotoxicity. Hydromorphone was non-genotoxic in the Ames test and the in vivo mouse micronucleus assay but positive in mouse lymphoma assay with metabolic activation. Similar findings have been reported with other opioid analgesics such as codeine and oxycodone.
Carcinogenicity. Long term carcinogenicity studies have not been performed.

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Hydromorphone hydrochloride, a hydrogenated ketone of morphine, is an opioid analgesic.
Hydromorphone hydrochloride is a fine, white or practically white, odourless, crystalline powder. It is freely soluble in water, sparingly soluble in ethanol and practically insoluble in ether.
Chemical name: 4,5α-epoxy-3-hydroxy-17-methylmorphinan-6-one hydrochloride.
Molecular weight: 321.81.
Chemical structure. The structural formula of hydromorphone hydrochloride is:
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSHYDHYD.gif CAS number. 71-68-1.

7 Medicine Schedule (Poisons Standard)

S8.

Summary Table of Changes

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