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Hydromorphone, a powerful opioid medication, carries significant safety concerns that must be understood before use. Below are essential warnings and precautions to consider:

• Risk of Abuse and Addiction: There is a potential for abuse and addiction with hydromorphone, which can lead to overdoses and fatal outcomes. Physicians should prescribe the lowest effective dose for the shortest necessary duration to mitigate these risks. A history of substance abuse or mental health conditions may further increase the likelihood of addiction.

• Severe Breathing Problems: Hydromorphone may cause dangerous breathing difficulties, particularly at the start of treatment or following a dosage increase. The risk is higher if combined with alcohol or other depressant drugs. Immediate medical attention is required if symptoms like slow or shallow breathing, extreme drowsiness, or difficulty waking occur.

• Emergency Overdose Response: Overdoses, even with prescribed doses, can be life-threatening. Naloxone should be available for emergency treatment, and family members should be trained to recognize overdose signs. Seek emergency help if ingestion occurs by someone not accustomed to opioids, especially children.

• Pregnancy and Newborn Risks: Use during pregnancy is advised only if absolutely necessary, as it can lead to neonatal opioid withdrawal syndrome, potentially causing severe withdrawal symptoms in newborns. Pregnant individuals should discuss risks with their healthcare provider.

• Interactions with Other Substances: Avoid mixing hydromorphone with alcohol or medications that depress the central nervous system, such as benzodiazepines and muscle relaxants, as this can exacerbate respiratory depression and sedation.

• Special Populations: Older adults, individuals with severe asthma, COPD, or other respiratory conditions, and those with a history of seizures should use caution. Hydromorphone may increase seizure frequency in susceptible individuals.

• Physical Dependence and Withdrawal: Long-term use can lead to physical dependence, with withdrawal symptoms occurring if the medication is suddenly reduced or stopped. Gradual dose reduction under medical supervision is recommended.

• Low Blood Pressure and Hormone Levels: The medication may cause low blood pressure, especially when changing positions, and can affect hormone levels if used for extended periods.

• Contraindications: Do not use hydromorphone in cases of severe respiratory depression, significant asthma, gastrointestinal blockages, or sulfite allergies. Extended-release tablets are not suitable for opioid-naïve individuals.

• Handling and Storage: Store hydromorphone securely to prevent theft, misuse, or accidental ingestion. Do not break, crush, dissolve, or chew extended-release tablets, as this can result in a potentially fatal overdose.

These precautions are vital to ensure safe usage, and any concerns should be discussed with a healthcare provider.

Common side effects:

• nausea
• vomiting
• constipation
• lightheadedness
• dizziness
• drowsiness
• sweating
• flushing
• euphoria
• distress
• dry mouth
• itchy skin

Less common but important to monitor:

• slowed breathing
• weakness
• headache
• fainting
• stomach pain
• low appetite
• mood changes
• anxiety
• depression
• nervousness
• unusual dreams
• changes in heartbeat
• blood pressure changes

Serious side effects:

• severe slowed breathing
• severe drowsiness
• difficulty waking up
• seizures
• overdose symptoms
• opioid withdrawal symptoms
• allergic reactions

Interactions with high risk of serious adverse effects and should be avoided:

• butorphanol
• nalbuphine
• pentazocine
• naltrexone
• samidorphan
• codeine
• hydrocodone
• alcohol
• marijuana (cannabis)
• alprazolam
• lorazepam
• zolpidem
• carisoprodol
• cyclobenzaprine
• cetirizine
• diphenhydramine