Dilaudid What it is and why a Dr. would prescribe it
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Dilaudid
Dilaudid is the brand name of a strong analgesic prescribed for relief from pain and sometimes from cough. The generic name is Hydromorphone, which belongs to the family of narcotic pain relievers. Also known as opioids, this narcotic pain reliever has effects similar to morphine. Dilaudid is available as an injection, in tablet, rectal suppository, as well as liquid forms. Taken in any of the mentioned forms, Dilaudid needs to be administered with caution, as overdoses may prove hazardous.
The dosage of opioid analgesics is individualized for each patient, as complete relief may not take place when adverse events occur. After comprehensive assessment of the nature of the pain -its severity, etiology, frequency, and pathophysiology- the doctor decides on a dosage in concurrence to the medical status of the patient.
Usually prescribed for immediate relief from continuous pain, the drug is injected into the buttock, hip or any large muscle, into an intravenous fluid that will enter the vein dripping through a needle or through a catheter placed under your skin or in the vein. The oral form of Dilaudid contains hydromorphone hydrochloride, plus other ingredients such as purified water, propylparaben, methylparaben, glycerin, and sucrose.
Oral dosage of Dilaudid for adults ranges from 2.5 ml to two teaspoonfuls every 3 to 6 hours. However, higher dosages may be prescribed by the doctor depending on the patient’s clinical condition. In the tablet form, Dilaudid 2 mg, 4 mg and 8 mg. The usual starting dose is 2 mg to 4 mg tablet taken orally once every 4 to 6 hours. Caution and careful clinical evaluation is required when 8 mg tablets are prescribed. If the analgesia proves to be inadequate, the doctor may suggest a gradual increase in dosage. Inadequacy of analgesia can occur due to increase in the severity of pain or as tolerance develops.
For patients who are non-opioid-tolerant, hydromorphone therapy is typically initiated with 2-4 mg tablet, every four hours with an exception to elderly patients who require lower doses. Patients receiving opioids need varied doses of analgesia and the duration also varies according to the patient’s opioid tolerance. Since hydromorphone affects patients with hepatic and renal impairment, a very low dose should be started on and increased, depending on the severity of the problem.
Frequently observed side effects in patients taking Dilaudid include light-headedness, sedation, nausea, vomiting, dizziness, sweating, flushing, dry mouth, dysphoria, euphoria, and pruritus. Other side effects seen are respiratory depression, apnea, shock, circulatory depression, respiratory arrest, and sometimes cardiac arrest. There have also been reports of CNS such as agitation, weakness, headache, uncoordinated muscle movements, tremor, mood swings; cardiovascular effects such as bradycardia, palpitation, chills, tachycardia, faintness, hypertension, syncope and hypotension; gastrointestinal adverse effects like diarrhea, constipation, biliary tract spasm, cramps, ileus, anorexia, and taste alteration. Respiratory depression is a common side effect among the elderly, the incapacitated, and those suffering from conditions linked with hypoxia and hypercapnia.
Before taking Dilaudid, patients must inform the doctor about any present or planned pregnancy or surgery. Even in the case of a dental surgery or sterilization, the patient must inform the doctor about his use of Dilaudid. The patient’s nature of job should be known to the doctor, as the drowsiness caused by the drug could prove risky for car drivers and operators of large and heavy machinery. Also inform the doctor about:
Any prescription and nonprescription medications the patient may be taking Any kidney, liver, thyroid or heart disease Seizures, asthma, or bronchitis Prostatic hypertrophy; or urinary problems. Pregnant- present or planned Nursing infants
Patients receiving Dilaudid need to look out and inform the doctor, for the following symptoms of catheter-related infection:
tenderness warmth irritation drainage redness swelling pain
Dilaudid belongs to the family of opioid analgesics and can cause psychological and physical dependence. In patients who abruptly discontinue the drug, withdrawal symptoms are common. Similar to other opioid agonists, Dilaudid can also be abused or misused. This morphine-type drug is sought by people with addiction disorders, drug abusers and those subject to criminal diversion. Prescribers of Dilaudid should monitor patients for signs of abuse, addiction and misuse. Though administration of Dilaudid is allowed in people with a personal or family history of alchohol or drug abuse and mental illness, intensive monitoring is required to detect signs of misuse or abuse.
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July 25th, 2010
Tramadol…safe and Effective
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In the wake of growing concerns over the fatal effects of some pain relievers in the market, pain specialists continue developed recommendations for alternatives – as effective yet not as dangerous.
News on the rising deaths of patients using COX-2 inhibitors and traditional NSAIDS (Nonsteroidal Antiinflammatory Drugs) has prompted medical experts to recommend the ban or withdrawal of drugs with these ingredients from the market.
After discussing the safety data for both NSAIDs and the COX-2 inhibitors, the group endorsed an expanded role for weak opioids, which are more effective in moderate-to-severe pain than NSAIDs. At the same time these possess other significant advantages included titratability, reversibility and lack of prostaglandin-associated side effects.
The role of combinations of weak opioids and other analgesic agents – in particular, tramadol plus paracetamol – merits particular attention.
A group of international pain specialists considered that tramadol and tramadol combinations offered a useful advantage in that they were ‘NSAID-sparing’. The drug could be used in combination with lower-than-usual doses of NSAIDs. Use of tramadol is recommended by medical societies.
The panel also recommended the proper utilization of weak opioids. Side-effects, they stressed, are a common reason given for non-compliance.
The panel agreed that a policy of ‘go low, go slow’ – starting with a low dose and increasing it gradually – should be used to achieve good analgesia without intolerable side-effects.
After thorough deliberations, the group concluded that it is very important to communicate clear guidance to physicians on appropriate prescribing of analgesics in this new climate of uncertainty regarding the continuing use of COX-2 inhibitors.
Way back in 2004, there was a move for the global withdrawal of rofecoxib (Vioxx), which and concerns regarding use of other COX-2 inhibitors. Rofecoxib is used to relieve pain, tenderness and stiffness caused by arthritis. It is in a class of COX-2 exhibitors.
This then raised concerns for the need of prompt and clear guidance to physicians regarding prescription of drugs with these compositions.
NSAIDS and Cox-2
There actually are two Cox enzymes, Cox 1 and Cox-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only Cox-1 produces prostaglandins that support platelets and protect the stomach.
NSAIDs block the Cox enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.
Since the prostaglandins that protect the stomach and support the platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.
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WHat is Arthritis and how can I prevent it and cure it
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Arthritis is inflammation of one or more of your joints, such as one or both knees or wrists, or a part of your spinal column. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Joint pain and stiffness are the main symptoms of arthritis.
Less common types of arthritis may be associated with conditions that also affect other parts of your body. For example, lupus can affect the kidneys and lungs, in addition to joints, while psoriasis is primarily a skin disease that sometimes also affects joints.
Symptoms
The most common signs and symptoms of arthritis involve the joints. Depending on the type of arthritis you have, your joint symptoms may include:
- Pain
- Stiffness
- Swelling
- Redness
- Decreased range of motion
Some types of arthritis are accompanied by signs and symptoms involving other parts of your body. These symptoms may include:
- Fever
- Fatigue
- Rash
- Weight loss
- Breathing problems
- Dry eyes and mouth
- Night sweats
Causes
The pain associated with arthritis is caused by joint damage. Joints are made up of the following parts:
- Cartilage. A hard, but slick, coating on the ends of bones, cartilage allows bones of the joint to slide smoothly over each other.
- Joint capsule. This tough membrane encloses all the joint parts.
- Synovium. This thin membrane lines the joint capsule and secretes synovial fluid, which lubricates the joint.
How arthritis damages joints
The two main types of arthritis damage joints in different ways.
- Osteoarthritis. In osteoarthritis, wear-and-tear damage to cartilage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.
- Rheumatoid arthritis. In rheumatoid arthritis, the body’s immune system attacks joints and inflames the synovium, causing swelling, redness and pain. The disease can eventually destroy cartilage and bone within the joint.
Risk factors
Risk factors for arthritis include:
- Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. While your genes don’t actually cause arthritis, they can make you more susceptible to environmental factors that may trigger arthritis.
- Age. The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout — increases with age.
- Sex. Women are more likely than are men to develop rheumatoid arthritis, while most of the people who have gout are men.
- Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
- Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. Obese people have a higher risk of developing arthritis.
Complications
Severe arthritis, particularly if it affects your hands or arms, can make it difficult for you to take care of daily tasks. Arthritis of weight-bearing joints can keep you from walking comfortably or sitting up straight. In some cases, joints may become twisted and deformed.
Preparing for your appointment
While you might first discuss your symptoms with your family doctor, he or she may refer you to a rheumatologist — a doctor who specializes in the treatment of arthritis and other inflammatory conditions — for further evaluation.
What you can do
Because appointments can be brief, plan ahead and write a list that includes:
- Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse
- Information about medical problems you’ve had in the past
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints.
Tests and diagnosis
Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.
Laboratory tests
The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include:
- Blood
- Urine
- Joint fluid
To obtain a sample of your joint fluid, your doctor will cleanse and numb your skin, and then insert a needle into your joint space to withdraw some fluid.
Imaging
These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:
- X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but are often used to track progression of the disease.
- Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can visualize soft tissues such as cartilage, tendons and ligaments as well as bone.
Arthroscopy
In some cases, your doctor may look for damage in your joint by inserting a small, flexible tube — called an arthroscope — through an incision near your joint. The arthroscope transmits images from inside the joint to a video screen.
Treatments and drugs
Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you.
Medications
The medications used to treat arthritis vary, depending on the type of arthritis. Commonly used arthritis medications include:
- Analgesics. These types of medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram) and narcotics like oxycodone (Percocet) and hydrocodone (Vicodin).
- Counterirritants. Some varieties of creams and ointments contain a substance such as menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include aspirin, ibuprofen and naproxen. Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.
- Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
- Biologics. Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that suppress the immune system. Examples include TNF blockers such as etanercept (Enbrel) and infliximab (Remicade).
- Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.
Therapy
Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.
Surgery
If more-conservative measures don’t help, your doctor may suggest surgery, such as:
- Synovium removal (synovectomy). Rheumatoid arthritis causes the joint capsule’s lining, called the synovium, to swell — particularly in the wrists, hands and fingers. Removing the synovium may slow joint deterioration.
- Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.
- Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit.
Lifestyle and home remedies
- Weight loss. If you’re obese, losing weight will reduce the stress on your weight-bearing joints. This may increase your mobility and limit future joint injury.
- Exercise. Regular exercise can help keep your joints flexible. Swimming or water aerobics is often a good choice because the buoyancy of the water reduces stress on weight-bearing joints.
- Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
- Assistive devices. Using canes, walkers, raised toilet seats and other assistive devices can help protect your joints and improve your ability to perform daily tasks.
Alternative medicine
Many people use alternative remedies for arthritis, but there is little reliable evidence to support the use of many of these products. Some alternative remedies appear to reduce the symptoms of some types of arthritis but not others. The most promising alternative remedies for arthritis include:
- Glucosamine. Although study results have been mixed, many experts now recommend this nutritional supplement as a first-line treatment for osteoarthritis.
- Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
- Transcutaneous electrical nerve stimulation (TENS). Using a small device that produces mild electrical pulses, TENS therapy stimulates nerves near the aching joint and may interfere with the transmission of pain signals to the brain.
Coping and support
The pain and disability associated with arthritis can be frustrating and depressing. In many cases, it may help to talk about your feelings with people who are facing the same problems.
Prevention
While there is no proven way to prevent arthritis, maintaining a healthy weight and exercising regularly may help reduce your risk.
People who have gout should avoid:
- Alcohol
- Organ meats, such as liver and kidney
- Sardines
- Anchovies
- Gravy