Short-acting: Hydromorphone HCL (e.g., Dilaudid) tablets and liquid with no analgesic additive. Per milligram potency for hydromorphone is far greater than oxycodone and hydrocodone.
Dosing: usual starting dose for tablets is 2 mg to 4 mg, orally, every 4 to 6 hours.
Comes in tablets 2,4,8 mg and 5mg/5ml liquid form.
A gradual increase in dose may be required if analgesia is inadequate, as tolerance develops, or if pain severity increases.
The first sign of tolerance is usually a reduced duration of effect.
Since the pharmacokinetics of hydromorphone are affected in hepatic and renal impairment with a consequent increase in exposure, patients with hepatic and renal impairment should be started on a lower starting dose.
With regular daily dosing, strongly consider Senna laxative for constipation (not bulk products). Generally, constipation is a chronic effect of opioids.