Hydromorphone

Common/Brand Names
Dilaudid, Palladone, Exalgo
Expected Screen Results
Opiates
Expected Confirmation Results
Hydromorphone
Confirmation Cutoff
20
ng/mL
Detection Time
Up to
3
Days
Notes
Hydromorphone is a drug and also the metabolite of hydrocodone
drug image

INTRODUCTION

Hydromorphone, a Schedule II semi-synthetic opiate, possesses a structure similar to that of morphine, which makes it part of phenanthrenes group1. Additionally, this drug is a µ receptor agonist and is 7-10 times more potent than morphine2. It is prescribed as an analgesic for moderate to moderately severe pain under the following trade names: Dilaudid, Exalgo and Palladone. Hydromorphone is widely prescribed with approximately 3.9 million prescriptions in 2012 and 972,000 in the first quarter of 2013.

PHARMACOLOGY                                            

ADMINISTRATION:

Hydromorphone is administered orally via a tablet with typical doses  of 2-8 mg. An extended release formulation is available, for patients who require around the clock pain relief, in tablet or capsule form with a dose of 8-32 mg. Furthermore, hydromorphone may be administered intravenously, subcutaneously or intramuscularly with typical doses ranging from 1-10 mg5. 

DISTRIBUTION:

Following an 8 mg oral dose of hydromorphone, peak plasma concentrations occurred around 0.8 hours with a half-life of 3-9 hours. Following a single extended release dose of 32 mg, peak plasma concentrations occurred around 16 hours with a half-life of 10-22 hours5. 

METABOLISM:

Hydromorphone is extensively metabolized via glucuronidation in the liver, with greater than 95% of the dose metabolized to hydromorphone-3-glucuronide along with minor amounts of 6-hydroxy reduction metabolites2,5.

EXCRETION:

Approximately 6% of parent drug, 36% of conjugated hydromorphone, and traces of minor metabolites are excreted in the 24 hour urine5.

METHODS OF ANALYSIS

For qualitative screening purposes, hydromorphone will significantly cross-react with the opiate Enzyme Immunoassay (EIA) at the 300 ng/mL cutoff 6. Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry (UPLC-MS/MS) is used to confirm and quantify hydromorphone, with a cutoff concentration of 20 ng/mL. The urine samples are hydrolyzed prior to analysis and the total hydromorphone concentration is reported. 

INTERPRETATION

The interpretation of patients prescribed hydromorphone should be conducted with caution since it is a prescription drug and a metabolite of hydrocodone. Patients prescribed only hydromorphone should not have hydrocodone in their urine. However, hydromorphone preparations may contain morphine and hydrocodone as impurities up to 0.025 % and hydromorphone is a known impurity in oxymorphone preparations up to 0.1 %8. Also, in a study conducted by Coneet al, patients chronically administered morphine had low concentrations of hydromorphone present7. Therefore, if other opiates are present in the urine at low concentrations in addition to hydromorphone, clinical interpretations should include the entire medical history of the patient and known contaminants in the medication.

References
  1. Ropero-Miller. J.D., Goldberger.B.A (2001) Opioids. In Shaw.L.M. (eds). The Clinical Toxicology Laboratory Contemporary Practice of Poisoning Evaluation, Chapter 6. AACC Press. Washington, D.C., 73-95.
  2. Stout, P. R.  (2009) Opioids. In Ropero-Miller J. D., Goldberger B.A. (eds.) Handbook of Workplace Drug Testing 2nd edition, Chapter 10.  AACC Press. Washington, D.C., 289-316.
  3. Drug Enforcement Administration. (2013) Hydromorphone. Retrieved from deadivision.gov. http://www.deadiversion.usdoj.gov/drug_chem_info/hydromorphone.pdf.
  4. Food and Drug Administration (2011) Dilaudid Injection. Retrieved from fda.gov. http://www.accessdata.fda.gov/drugsatfda/label/2011/019034s021lbl.pdf.
  5. Baselt, R. C. (2011) Disposition of Toxic Drugs and Chemicals in Man, 9th Edition. Biomedical Publications, Seal Beach, CA, 818-820.
  6. Emit II Plus Opiate Assay (2010) [Package Insert]. Newark, DE: Siemens Healthcare Diagnostics.
  7. Cone E.J, Heit H.A, Caplan Y.H, Gourlay, D., Evidence of Morphine Metabolism to Hydromorphone in Pain Patients Chronically Treated with Morphine. Journal of Analytical Toxicology. 2006 January/February; 30:1-5
  8. American Association of Medical Review Officers. (2010) Interpreting Test Results for Prescription Opiates. MRO Alert,3, 1-3.