Dilaudid dosing in L&D

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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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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

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Specializes in Community, OB, Nursery.

I had an antepartum (read: not laboring, delivery not imminent) getting 1mg q2h for pain. She had kidney stones. It worked.

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Specializes in OB.

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.

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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.

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Specializes in Obstetrics.

Same as Elvish... I had an antepartum with hyperemesis gravidarum on TPN and lipids getting 1mg Q 2h and it worked.

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Thanks so much for all your comments - very helpful as usual.

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