Buy Dilaudid tablet online

Moderate-to-Severe Pain

Indicated for moderate-to-severe pain

PO

• Immediate-release: 2-4 mg q4-6hr PRN; a gradual increase in dose may be required
• Oral liquid (usual dose): 2.5-10 mg (2.5-10 mL) q3-6hr PRN

SC/IM

• 1-2 mg q2-3hr PRN; adjust dose according to pain and adverse effects
• IM dose not recommended for use as it may result in variable absorption and lag time to peak effect

IV

• Opioid naive: 0.2-1 mg IV q2-3hr PRN; may require higher doses in patients with prior opioid exposure
• Critically ill patients (opiate-naive patients): 0.2-0.6 mg q1-2hr PRN given slowly over 2-3 minutes; patients with previous opiate exposure may tolerate higher doses
• Continuous infusion: 0.5-3 mg/hr, titrated to response

Patient-controlled analgesia

• Usual concentration, 0.2 mg/mL; demand dose, 0.1-0.2 mg; dose range is 0.05-0.4 mg
• Lockout interval: 5-10 minutes

Rectal

• 3 mg PR q6-8hr

Chronic Severe Pain

Buy diladid tble onlne Long-acting (Exalgo) is indicated for the management of pain in opioid tolerant patients severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate

Opioid tolerant patients only (extended-release:) 8-64 mg PO qDay additionally may administer a starting dose equivalent to patient’s total daily oral hydromorphone dose administered once daily with or without food

Should address pain relief and adverse events frequently, also increase the dose no more frequently than q3-4days; may titrate with increases of 25-50% of current daily dose; consider increasing dose if more than 2 doses of rescue medications are needed within 24hr within 2 consecutive days

Extented-release tablets should be swallowed whole because crushing, dividing, or dissolving will release opioid content all at once and increase risk of respiratory depression and death

Converting to Exalgo

• Conversion from other oral hydromorphone formulations: Start with equivalent total daily dose of immediate release formulation and administer once daily; may titrate q3-4days until adequate pain relief with tolerable adverse effects achieved
• Conversion from other opioids: Start Exalgo dose at 50% of calculated daily dose q24hr furthermore, titrate until adequate pain relief with tolerable adverse effects achieved
• Conversion from transdermal fentanyl to Exalgo: Start Exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr; for a 25 mcg/hr fentanyl patch the equianalgesic dose is 12 mg PO q24hr
• Discontinuation of Exalgo therapy: Taper gradually by decreasing dose by 25-50% q2-3days to a dose of 8 mg PO q24hr before discontinuing

Opioid-tolerant definition

• Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression
• Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid

Limitations of use

• Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain
• Not indicated for acute pain or as a PRN analgesic

Cough (Off-label)

1 mg PO q3-4hr PRN

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