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Hydromorphone injection now authorized in the UK

22nd November 2016

Hydromorphone solution for injection or infusion is now available as an authorized product (Palladone, Napp) in the UK as 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL. It is authorized for the relief of severe cancer pain in patients >12 years old by either intravenous injection/infusion or by subcutaneous injection/infusion.

When converting from oral hydromorphone to parenteral hydromorphone, the SPC recommends a 3:1 conversion ratio, i.e. dividing the total daily oral dose by 3 to give the total daily parenteral dose. (Note. This is a more conservative estimate than the traditional 2:1 dose conversion ratio as recommended in PCF).

The formulation can be diluted with WFI or 0.9% saline. The SPC states that no evidence of incompatibility was observed between Palladone injection and representative brands of the following drugs, when stored in high and low dose combinations in polypropylene syringes over a 24 hour period at ambient temperature:

  • dexamethasone sodium phosphate
  • glycopyrronium bromide
  • haloperidol
  • hyoscine butylbromide
  • hyoscine hydrobromide
  • ketamine hydrochloride
  • levomepromazine hydrochloride
  • metoclopramide hydrochloride
  • midazolam hydrochloride

(Note. Incompatibilty has been observed with dexamethasone or haloperidol at some higher concentrations, see PCF Appendix 3 compatibility charts and the SDSD for more details).

The NHS cost per 1mL ampoule of 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL is £1.60, £13.20, £26 and £34 respectively. (Note. Hydromorphone injection is ≤5 times more expensive than the equivalent dose of morphine injection.)

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