Related Experiment Videos
Hydromorphone neuroexcitation.
Daniel Thwaites1, Shawn McCann, Peter Broderick
1Community Hospice, Inc., University of California, Davis, Stanislaus Family Practice Residency, Modesto, CA 95350-5443, USA. Dan.Thwaites@hospiceheart.org
Journal of Palliative Medicine
|September 9, 2004
Summary
Continuous parenteral hydromorphone can cause neuroexcitatory symptoms like agitation and seizures. Higher doses and longer durations of this pain medication increase the risk of these adverse events in palliative care patients.
Area of Science:
- Palliative Care
- Neuropharmacology
- Oncology
Background:
- Continuous parenteral hydromorphone is a common pain management strategy in palliative care.
- Neuroexcitatory symptoms (agitation, myoclonus, seizures) have been anecdotally linked to hydromorphone.
- Limited data exists on the incidence and dose-response relationship of these side effects.
Purpose of the Study:
- To investigate the incidence of neuroexcitatory symptoms during continuous parenteral hydromorphone administration.
- To determine the relationship between these symptoms and the dose or duration of hydromorphone therapy.
- To explore potential associations with patient characteristics and diagnosis.
Main Methods:
- Retrospective chart review of 48 terminally ill hospice patients.
- Systematic search for agitation, myoclonus, and seizures.
- Statistical comparison of symptom incidence with maximal hydromorphone dose and treatment duration.
Main Results:
- Agitation was significantly associated with known metastatic disease (p < 0.01).
- Agitation, myoclonus, and seizures were independently associated with higher maximal hydromorphone doses (p < 0.05 to p < 0.001).
- These neuroexcitatory symptoms also correlated with longer durations of hydromorphone treatment (p < 0.01 to p < 0.05).
Conclusions:
- Increased dose and duration of continuous parenteral hydromorphone are linked to neuroexcitatory side effects.
- Hydromorphone-3-glucuronide may be a contributing factor to these adverse events.
- These findings highlight the importance of monitoring for neurotoxicity in patients receiving high-dose or long-term hydromorphone.