Hydromorphine question

[bluemonkey]

Ok so I know this might sound weird but, last time I was in the hospital the only thing that worked for my pain for a while was dialudid IV. So, the pain management doc tried to switch it to oral and honestly all that seemed to do was make me feel weird. Hot, heavy feeling on my chest, no real pain relief. I am not recommending anyone do anything IV outside of a medical setting but, i have wondered for months now could it really be that big of a difference just by how it's given with the dose the same?

Btw, once they sorted out the underlying stomach problem i has not in that much pain anymore and was sent home with hydrocodone. At this point I am asking purely out of curiosity to know if it was all in my head or if the infection i had could have played in too or if difference is common with opiates

 

[Siccness909]

IV hydrmorphone is way more potent than orally. The BA of oral I think is like 30% with hydromorphone? Its pretty damn low...IV is the most effective ROA and you'd need a way bigger dose to feel it comparing oral to IV I'd assume. I only have experience with snorting hydromorphone but to get high of course. I can't really speak on effectiveness for actual pain relief.

But yes it does make a way bigger difference between the 2.

 

[DubiousDoctor]

In addition to the bioavailability of IV versus PO for hydromorphone which Siccness909 mentions above (which is right on the mark by the way), the subjective experience of the slower rate of absorption can't be ignored. When taken IV the effects (including pain relief) are immediate and the concentration of the drug will slowly drop over time until the next dose (obviously if it is a steady drip infusion this doesn't apply). When taken PO, even if the doctor properly scaled up the dose, it takes a while for the drug to be absorbed within the G.I. tract. Peak levels won't be reached until some time after administration and they will slowly build up to them at that.

From a subjective point of view it may not appear to do as much for pain as there is a less pronounced difference between in pain/not in pain. In other words you simply didn't notice that the pain was partially reduced as it happened gradually.

Finally your doctor might not have scaled the dose up properly because it is very difficult to. This is because hydromorphone is metabolized by the liver, and when taken orally it undergoes first pass metabolism (it goes through the liver before the brain). This means people with stronger enzymes will metabolize more than people with weaker enzymes, so the equivalent oral to IV dosage differs from person to person.

 

[drunken_etard]

IV hydromorphone is my favorite hit. two 30's in on shot. thats my dream i loved when I Did that. NOt recomending any IV60mg thwats alot i have tolerance. ANyway about your question what your missing is the rush from the IV hydromorphone . Oral is shit is like around 25 30 %bioavailability when IV is 100% bioavailability.. Thats what your missing the pain relleif from the IV hydromorphone you got at the hospital because of the hitgher bioavailability. Ask your doctor to raise your dose. Be straight wit him your not looking to get high you want pain relief.