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Publication Type: Safety Notice
Single or Multiple Incident: Multiple
Date: 3/17/2021 12:00:00 AM
Country: Australia

This Safety Notice addresses the discontinuation of HYDROmorphone oral liquid 1 mg/mL and the necessary considerations when converting to an alternate analgesic. HYDROmorphone is a potent opioid (five to seven times more potent than morphine) used to treat severe, acute or chronic pain in patients for whom other opioid medicines were deemed inappropriate or not tolerated. All patients on HYDROmorphone oral liquid should be reviewed for continued need by a relevant speciality. For patients deemed appropriate and necessary to continue on HYDROmorphone, tablets are available in 2 mg, 4 mg and 8 mg strengths. Due to HYDROmorphone’s high potency, errors with this medication may result in serious adverse patient outcomes and switching patients from HYDROmorphone to another opioid can be complex. Clinicians should seek specialist advice and carefully consider individual patient factors to ensure the most appropriate alternative is selected. Opioid conversion tools should be used when determining a suitable dose. The notice provides alternatives for consideration and recommendations to prevent patient safety incidents in patients who require conversion from HYDROmorphone oral liquid 1 mg/mL.

Additional Details

Medication/Gas/Fluid:
opioid, HYDROmorphone (Dilaudid®) morphine, morphine oral liquid (Ordine®) oxycodone oral liquid (OXYNorm®) methadone, tapentadol
Medication/IV List:
narcotics/opiates, IV, transdermal, and oral (including liquid concentrates, immediate and sustained-release formulations)


HYDROmorphone (Dilaudid®) Oral Liquid 1 mg/mL – Discontinued