Question on diluadid

[ED50]

Hey all, sorry to start a thread for a question but I have exhausted the resources at my local hospital. I'm attempting to find out why IV hydromorphone has a wide variable morphine equivalent range of 4-7 while other opioids do not. Initially I thought it was due to tolerance but I can't find much data to back this up. Any help or suggestions on where to look would be appreciated... and before we go there I don't prescribe the stuff, just looking for information. Thanks so much

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[willabeast]

my anecdotal experience with parenteral dilaudid is that it as predictable as anything else. the "problem" with it is the formulation it comes in is not intuitive to dosing.
for example with morphine, 5- 10 mg IM is a common dose. so it is easy to split it IV into 1-3 mg IV doses. dilaudid equivalent to 10 mg morphine is 1 mg. so to cut the dosing for IV or even IM it is going to be 0.1-0.3 mg IV or 0.5 to 1 mg IM. this is confusing to a lot of people. i used to get around this by diluting 1 mg of dilaudid into 10 ml of normal saline, but one could also get a TB syringe and give 0.1 ml IV injections of a 1 mg/ml dose.
bottom line - dilaudid is "unpredictable" because of a problem with the people administrating it, from the prescribers to the nursing staff.
my two cents - your experience may be different.