Morphine vs Dilaudid

[Wackie]

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Do you know what the concentration of morphine and dilaudid is for IV?

I know it sounds ridiculous, but I've got someone telling me morphine and dilaudid are just as potent and it's driving me crazy. I'm saying dilaudid is more potent. So now the question is, if you gave someone the drug straight, no fillers, which is more potent. Their argument, from what I'm gathering, is that you can't base it off of volume of what is actually injected because of the fillers.

 

[FoughtFyr]

Do you know what the concentration of morphine and dilaudid is for IV?

I know it sounds ridiculous, but I've got someone telling me morphine and dilaudid are just as potent and it's driving me crazy. I'm saying dilaudid is more potent. So now the question is, if you gave someone the drug straight, no fillers, which is more potent. Their argument, from what I'm gathering, is that you can't base it off of volume of what is actually injected because of the fillers.

Look here: http://www-users.med.cornell.edu/~spon/picu/referenc/analges.htm and here: http://www.fpnotebook.com/PHA30.htm. You are correct, Dilaudid is FAR more potent. In fact, the 2 mg common starting dose is equal to 16 mg of morphine according to some sources.

- H

 

[ERMudPhud]

So now the question is, if you gave someone the drug straight, no fillers, which is more potent. Their argument, from what I'm gathering, is that you can't base it off of volume of what is actually injected because of the fillers.

The more important point is that you should never dose IV drugs by volume. Many drugs come in multiple concentrations. Ketamine, brevital, epi are three that come readily to mind. If you start ordering or administering by volume you are bound to make a mistake and get in trouble. Epi is the best example of this with people forever arguing over how much 1:1000 or 1:10,000 to give in a specific situation and with I would bet at least 1 M&M case per year in most academic centers from someone giving the wrong dose.

 

[Wackie]

Look here: http://www-users.med.cornell.edu/~spon/picu/referenc/analges.htm and here: http://www.fpnotebook.com/PHA30.htm. You are correct, Dilaudid is FAR more potent. In fact, the 2 mg common starting dose is equal to 16 mg of morphine according to some sources.

- H

What I think they're trying to argue (and IMO it's pointless and semantics) is that if you have an X amount of mL of solution of which 10% is the active ingredient morphine and the same amount of mL of solution with 10% of it being the active ingredient dilaudid, then their potency would be the same.

To clarify, how much of 4mg of morphine is actually morphine? And the same question for dilaudid.

 

[ERMudPhud]

What I think they're trying to argue (and IMO it's pointless and semantics) is that if you have an X amount of mL of solution of which 10% is the active ingredient morphine and the same amount of mL of solution with 10% of it being the active ingredient dilaudid, then their potency would be the same.

To clarify, how much of 4mg of morphine is actually morphine? And the same question for dilaudid.

4mg of morphine is 4mg of morphine. 4mg of dilaudid is 4mg of dilaudid. Those are mass measurements and not volumes. I think the dilaudid we use is a 1mg/ml solution and the morphine we use is a 4mg/ml but both drugs can be found in solutions of varying concentrations. I don't worry about the concentration or the number of ml's to give. All I worry about is the number of mg of morphine or diluadid I want to give. The nurse decides how many ml's to give based on the concentration of the solution our hospital stocks.

Your question about how many mg's of a drug are actually that drug is mostly meaningless these days. Drugs are generally pure. Mixed isomers are an exception. Drugs like ofloxacin, albuterol, and prilosec are mixed isomers of which 50% is inactive. Thus, on a per weight basis they are half as potent as the pure isomers, levaquin, xopenex, and nexium. As near as I can tell neither dilaudid nor morphine are sold as mixed isomers.

Now if the person arguing with you is a complete chemistry nerd they might be basing their argument on the fact that morphine usually exists as a pentahydrate of the sulfate salt where hydromorphone(dilaudid) exists a hydrochloride salt. Thus the amount of "opiate" on a per mg basis is about 20% less in morphine than in hydromorphone. That doesn't really explain the 5-8 fold difference in the per mg potency of the two drugs and is clinically meaningless.

Somehow I don't think I made things any clearer

 

[docB]

Now if the person arguing with you is a complete chemistry nerd they might be basing their argument on the fact that morphine usually exists as a pentahydrate of the sulfate salt where hydromorphone(dilaudid) exists a hydrochloride salt. Thus the amount of "opiate" on a per mg basis is about 20% less in morphine than in hydromorphone. That doesn't really explain the 5-8 fold difference in the per mg potency of the two drugs and is clinically meaningless.

Somehow I don't think I made things any clearer

So basically if they're a complete nerd they might make the point the MudPhud just made😛. And you made one thing clear😛😛😛.

(I'm only teasing because I learned chemistry by reading a Cracker Jacks box)

 

[mikecwru]

So basically if they're a complete nerd they might make the point the MudPhud just made😛. And you made one thing clear😛😛😛.

(I'm only teasing because I learned chemistry by reading a Cracker Jacks box)

I would be careful. He might stab you with his compass.


mike

 

[kungfufishing]

I learned chemistry by reading a Cracker Jacks box)

That's where I got my medical license - Only 1 UPC left until I'm board eligible!

 

[ditch doctor]

4mg of morphine is 4mg of morphine. 4mg of dilaudid is 4mg of dilaudid. Those are mass measurements and not volumes. I think the dilaudid we use is a 1mg/ml solution and the morphine we use is a 4mg/ml but both drugs can be found in solutions of varying concentrations. I don't worry about the concentration or the number of ml's to give. All I worry about is the number of mg of morphine or diluadid I want to give. The nurse decides how many ml's to give based on the concentration of the solution our hospital stocks.

Your question about how many mg's of a drug are actually that drug is mostly meaningless these days. Drugs are generally pure. Mixed isomers are an exception. Drugs like ofloxacin, albuterol, and prilosec are mixed isomers of which 50% is inactive. Thus, on a per weight basis they are half as potent as the pure isomers, levaquin, xopenex, and nexium. As near as I can tell neither dilaudid nor morphine are sold as mixed isomers.

Now if the person arguing with you is a complete chemistry nerd they might be basing their argument on the fact that morphine usually exists as a pentahydrate of the sulfate salt where hydromorphone(dilaudid) exists a hydrochloride salt. Thus the amount of "opiate" on a per mg basis is about 20% less in morphine than in hydromorphone. That doesn't really explain the 5-8 fold difference in the per mg potency of the two drugs and is clinically meaningless.

Somehow I don't think I made things any clearer

Now, a clever man would put the Dilaudid into his own IV, because he would know that only a great fool would reach for what he was given. I'm not a great fool, so I can clearly not choose the Morphine in front of you. But you must have known I was not a great fool; you would have counted on it, so I can clearly not choose the Dilaudid in front of me. However, iocane powder comes from Australia, as everyone knows. And Australia is entirely peopled with criminals. And criminals are used to having people not trust them, as you are not trusted by me. So I can clearly not choose the Morphine in front of you, but you must have suspected I would have known the powder's origin, so I can clearly not choose the Dilaudid in front of me.

It's so simple, really.

 

[Wackie]

Now, a clever man would put the Dilaudid into his own IV, because he would know that only a great fool would reach for what he was given. I'm not a great fool, so I can clearly not choose the Morphine in front of you. But you must have known I was not a great fool; you would have counted on it, so I can clearly not choose the Dilaudid in front of me. However, iocane powder comes from Australia, as everyone knows. And Australia is entirely peopled with criminals. And criminals are used to having people not trust them, as you are not trusted by me. So I can clearly not choose the Morphine in front of you, but you must have suspected I would have known the powder's origin, so I can clearly not choose the Dilaudid in front of me.

It's so simple, really.

You get +10 Chuck Norris points.

 

[da8s0859q]

Now, a clever man would put the Dilaudid into his own IV, because he would know that only a great fool would reach for what he was given. I'm not a great fool, so I can clearly not choose the Morphine in front of you. But you must have known I was not a great fool; you would have counted on it, so I can clearly not choose the Dilaudid in front of me. However, iocane powder comes from Australia, as everyone knows. And Australia is entirely peopled with criminals. And criminals are used to having people not trust them, as you are not trusted by me. So I can clearly not choose the Morphine in front of you, but you must have suspected I would have known the powder's origin, so I can clearly not choose the Dilaudid in front of me.

It's so simple, really.

Nice.

 

[kungfufishing]

In-Con-Theevable!

 

[Jeff698]

You get +10 Chuck Norris points.

Seriously. WAY strong work.

Take care,
Jeff