Hydromorphone in palliative care: what the GP needs to know

Most patients with advanced cancer will suffer pain that requires opioid analgesia. The most widely prescribed opioid is morphine, and it has the greatest body of published information to support its use. Although most patients will achieve adequate analgesia with morphine, there is a small but significant number of patients who will suffer intolerable adverse effects without acceptable analgesia.

Hydromorphone (Dilaudid) is a strong opioid that is similar in action to morphine. In selected patients who have developed intolerable adverse effects from other opioids, switching to hydromorphone has been shown to be beneficial. For the benefit of these patients, understanding of the principles and practice of opioid switching is imperative.