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Hydromorphone is a more common synonym for dihydromorphinone, commonly a hydrochloride (brand names Palladone, Dilaudid, and numerous others). Not to be confused with dihydromorphine, which is a different derivative of the morphine family. It is a very potent centrally acting analgesic drug of the opioid class. It is a derivative of morphine; to be specific, it is a hydrogenated ketone thereof. Comparatively, hydromorphone is to morphine as hydrocodone is to codeine—that is, a semi-synthetic drug. In medical terms, it is an opioid analgesic and, in legal terms, a narcotic. Hydromorphone is commonly used in the hospital setting, mostly intravenously (IV) because its bioavailability is very low orally, rectally, and intranasally. Sublingual administration (under the tongue) is usually superior to swallowing for bioavailability and effects; however, hydromorphone is bitter and hydrophilic like most opiates, not lipophilic, so it is absorbed poorly and slowly through mouth membranes.〔http://www.drugs.com/pro/hydromorphone.html〕 Hydromorphone is much more soluble in water than morphine and, therefore, hydromorphone solutions can be produced to deliver the drug in a smaller volume of water. The hydrochloride salt is soluble in three parts of water, whereas a gram of morphine hydrochloride dissolves in 16 ml of water; for all common purposes, the pure powder for hospital use can be used to produce solutions of virtually arbitrary concentration. When the powder has appeared on the street, this very small volume of powder needed for a dose means that overdoses are likely for those who mistake it for heroin or other powdered narcotics, especially those that have been cut or 'stepped on' already.〔''Hydromorphone Hydrochloride''; MSDS No. 71681; Purdue Pharma L.P.: Stamford, CT, October 13, 2009. (http://www.purduepharma.com/msdss/Dilaudid_2_4_8mgTablets_OralLiquid_MSDS.pdf (accessed November 5, 2015) )〕 Very small quantities of hydromorphone are detected in assays of opium on rare occasions; it appears to be produced by the plant under circumstances and by processes which are not understood at this time, and may include the action of bacteria. A similar process or other metabolic processes in the plant may very well be responsible for the very low quantities of hydrocodone also found on rare occasions in opium and alkaloid mixtures derived from opium. Dihydrocodeine, oxymorphol, oxycodone, oxymorphone, metopon, and possibly other derivatives of morphine and hydromorphone also are found in trace amounts in opium. ==Side effects== Adverse effects of hydromorphone are similar to those of other potent opioid analgesics, such as morphine and heroin. The major hazards of hydromorphone include dose-related respiratory depression, urinary retention, bronchospasm and sometimes circulatory depression.〔(Hydromorphone Monograph ) (Side Effects & Drug Interactions)〕 More common side effects include light-headedness, dizziness, sedation, itching, constipation, nausea, vomiting, and sweating.〔 These symptoms are common in ambulatory patients and in those not experiencing severe pain. Simultaneous use of hydromorphone with other opioids, muscle relaxants, tranquilizers, sedatives, and general anesthetics can cause a significant increase in respiratory depression, progressing to coma or death. Taking benzodiazepines (such as diazepam) in conjunction with hydromorphone may increase side effects such as dizziness and difficulty concentrating.〔(【引用サイトリンク】title=Drug interactions between Dilaudid and Valium )〕 If simultaneous use of these drugs is required, dose adjustment can be done. A particular problem that may occur with hydromorphone is accidental administration in place of morphine due to a mix-up between the similar names, either at the time the prescription is written or when the drug is dispensed. This has led to several deaths and calls for hydromorphone to be distributed in distinctly different packaging from morphine to avoid confusion. Massive overdoses are rarely observed in opioid-tolerant individuals, but when they occur, they may lead to circulatory system collapse. Symptoms of overdose include respiratory depression, drowsiness leading to coma and sometimes to death, drooping of skeletal muscles, low heart rate and decreasing blood pressure. In the case of an overdose, take the patient to the Emergency Department or call 911. At the hospital, individuals with hydromorphone overdose are provided supportive care such as assisted ventilation to provide oxygen, gut decontamination using activated charcoal through a nasogastric tube. Opioid antagonist such as naloxone can also be administered concurrent with oxygen supplementation. It works by reversing the effects of hydromorphone. It is only administered in the presence of significant respiratory depression and circulatory depression.〔 The effects of overdose can be exaggerated by dose dumping if the medication is taken with alcohol.〔(Palladone Pain Drug Pulled Off the Market ).〕 Sugar cravings associated with hydromorphone use are the result of a glucose crash after transient hyperglycemia following injection or a less profound lowering of blood sugar over a period of hours, in common with morphine, heroin, codeine, and other opiates. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Hydromorphone」の詳細全文を読む スポンサード リンク
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