Dilaudid dosing in L&D

  1. Does anyone have an existing protocol addressing the use of hydromorphone (dosing/frequency) for patients prior to delivery? I am a hospital pharmacist and I had a conversation with an OB/GYN nurse today regarding an order for 2mg IV every 3 hours prn. She was concerned that the dose may not have been appropriate in this setting.

    We talked about what we know: it cosses the placenta and thus can cause respiratory compromise in newborns. However, since hydromorphone is Category C and the manufacturer lists pregnancy as a contraindication, I can find very little published information regarding use in this specialty.

    Many thanks for your thoughts and/or experience with this med.
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  2. 6 Comments

  3. by   koolmaditz
    Quote from Daddybyrd
    Does anyone have an existing protocol addressing the use of hydromorphone (dosing/frequency) for patients prior to delivery? I am a hospital pharmacist and I had a conversation with an OB/GYN nurse today regarding an order for 2mg IV every 3 hours prn. She was concerned that the dose may not have been appropriate in this setting.

    We talked about what we know: it cosses the placenta and thus can cause respiratory compromise in newborns. However, since hydromorphone is Category C and the manufacturer lists pregnancy as a contraindication, I can find very little published information regarding use in this specialty.

    Many thanks for your thoughts and/or experience with this med.
    We use 0.4mg IV for break through pain and that seems to be enough for section patients, we only give 2mg as PO
  4. by   Elvish
    I had an antepartum (read: not laboring, delivery not imminent) getting 1mg q2h for pain. She had kidney stones. It worked.
  5. by   anggelRN
    I have only given dialaudid 2mg IV push for a pt right after delivery. We do not routinely use dialaudid. This was also a one time dose. I would be weary about giving it during labor.
  6. by   Fyreflie
    I wouldn't be any more comfortable with it than I am giving IV morphine in labour. I'm way more comfortable giving fentanyl just because of how fast it wears off.
    Ante partum I'm not sure about.
  7. by   PinkNBlue
    Same as Elvish... I had an antepartum with hyperemesis gravidarum on TPN and lipids getting 1mg Q 2h and it worked.
  8. by   Daddybyrd
    Thanks so much for all your comments - very helpful as usual.

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