Generally the drug should be avoided by persons suffering from asthma, urinary retention, enlarged prostate, deficient adrenal or thyroid glands, gallbladder trouble, or epilepsy.

Abuse factors. Dependence can develop after hydromorphone has been taken regularly for several weeks. Although tolerance is unusual for medical effects of drugs, tolerance has been observed when hydromorphone is used for pain relief, with patients needing more of the drug for the same amount of relief.

Heroin addicts find hydromorphone to be a satisfactory substitute. Through cross-tolerance hydromorphone can reduce opiate withdrawal symptoms, and the drug has been used as an experimental medication in programs trying to switch opiate addicts to methadone or buprenorphine.

Drug interactions. Normally hydromorphone should not be taken along with antihistamines or various tranquilizers and antidepressants, including monoamine oxidase inhibitors (MAOIs, found in some antidepressants and in other medicine). Taking hydromorphone and cocaine together can increase each drug's effects.

Cancer. Hydromorphone does not seem to cause cancer.

Pregnancy. In general the drug fails to produce birth defects, but some did appear when pregnant hamsters received 600 times the normal human dose. The potential for malformations is unknown among infants from pregnant women who use the drug in a medical context. Infants can be born with dependence if the mother has used hydromorphone during pregnancy. The drug is used to ease childbirth. Whether the substance passes into a nursing mother's milk is unknown but is considered safe for the infant.

Additional information. The cough syrup form of Dilaudid may contain tartrazine (FD&C Yellow No. 5) to which some persons are allergic, particularly if they are allergic to aspirin.

Additional scientific information may be found in:

Hill, J.L., and J.P. Zacny. "Comparing the Subjective, Psychomotor, and Physiological Effects of Intravenous Hydromorphone and Morphine in Healthy Volunteers." Psychopharmacology 152 (2000): 31-39. "Hydromorphone HCl." In Therapeutic Drugs, ed. C. Dollery. 2d ed. New York: Churchill Livingstone, 1999. H69-H71. McBride, D.C., et al. "Dilaudid Use: Trends and Characteristics of Users." Chemical

Dependencies 4 (1980): 85-100. Walker, D.J., and J.P. Zacny. "Subjective, Psychomotor, and Physiological Effects of Cumulative Doses of Opioid Mu Agonists in Healthy Volunteers." Journal of Pharmacology and Experimental Therapeutics 289 (1999): 1454-64.

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