Hydromorphone:
Intravenous opioid
ECMO Dose Adjustment:
NONE
Renal Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
CRRT Dose Adjustment:
YES—a decreased dose may be warranted in some patients.
Hepatic Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
Adult Starting Dose^:
Adult Intermittent: 10-20 mcg/kg IV every 1-2 hrs (0.2-1 mg IV every 1-2 hrs)
Adult Continuous Infusion: 7-8 mcg/kg/hr (0.3-0.5 mg/hr)
Pediatric Starting Dose^:
Pediatric Intermittent: 10-15 mcg/kg IV every 30-60 min
Pediatric Continuous Infusion: 10-15 mcg/kg/hr
Neonatal Starting Dose^:
Neonatal Intermittent: 10-15 mcg/kg IV every 30-60 min
Neonatal Continuous Infusion: 10-15 mcg/kg/hr
*Dose adjustment will be dependent on acuity and severity of impairment.
^Always use the lowest-effect dose to an objective endpoint (e.g., pain).
Intravenous opioid physicochemical and pharmacokinetic characteristics
Drug Hydromorphone
   
Onset (min) 5-10
Log P 1.7
Protein Binding (%) 8-19
Metabolism / Elimination Hepatic
Dose Adjustment on ECMO -
Dose Range*
Adult: 7-15 mcg/kg/hr (0.5-2 mg/hr)
Pediatric: 10-100 mcg/kg/hr
Neonatal: 10-100 mcg/kg/hr
- Minimal sequestration; no need for dose adjustment
++ Moderate sequestration; may require dose adjustment
+++ Significant sequestration; need for dose adjustment
*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.