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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)

Communication
  1. Verbally inform patients/carers affected by the discontinuation of potential changes to their treatment. Provide written information of alternatives including dosing and adverse effects.
Rules / Policies / Procedures
  1. Alternative oral opioid liquid formulations available include: • Oxycodone (OxyNorm®) oral liquid 1 mg/mL, 250 mL bottle • Morphine (Ordine®) oral liquid 1 mg/mL, 2 mg/mL, 5 mg/mL and 10 mg/mL; 200 mL bottle There are other alternatives available (e.g. methadone oral liquid, tapentadol tablets and opioids delivered via an alternative route e.g. patches), which could be considered after specialist consultation.
  2. Develop a local plan to manage the unavailability which should include – a. an assessment of the current status of HYDROmorphone (Dilaudid®) oral liquid available in each facility b. when converting patients to an alternative opioid: i. ensuring the availability of locally approved opioid conversion tools and implementing strategies to minimise conversion errors e.g. independent second person check, obtaining specialist advice if limited experience with opioid conversions ii. ensuring the alternative opioid is commenced at a lower dose than the calculated equianalgesic dose considering patient factors, including age, renal impairment and opioid characteristics (refer to Therapeutic Guidelines3 ) and then titrated to effect. c. clear communication of any changes to the patient’s opioid therapy in the patient notes, to nursing, pharmacy staff and to primary healthcare providers d. in facilities utilising eMM systems, liaison with local eMeds/ICT teams to review and modify available order sentences

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