Insight on Dilaudid?

TheCommuter, BSN, RN · Apr 25, 2016

What exactly is the history with Dilaudid in nursing?

It's an opioid with a high potential for addiction. That's the history.

Yes, yes, I know...pain is whatever the patient says it is. However, when you receive the umpteenth patient who insists he is allergic to all pain medications except Dilaudid, it is one of those things that makes you go, "Hmmm..."

Lev, MSN, RN, NP · Apr 25, 2016

Strong narcotic analgesic- stronger than morphine but doesnt last quite as long and supposedly less respiratory depression with a big initial high/sense of euphoria. Which is why you may get requests to "push it fast. " 1mg dilaudid = 5mg morphine.

akulahawkRN, ADN, RN, EMT-P · Apr 25, 2016

Strong narcotic analgesic- stronger than morphine but doesnt last quite as long and supposedly less respiratory depression with a big initial high/sense of euphoria. Which is why you may get requests to "push it fast. " 1mg dilaudid = 5mg morphine.

I have gotten more than a request or two to do exactly this. Since I know Dilaudid does this and why patients ask for it to be pushed fast, I do not do as asked. I usually dilute it in at least 5 mL of normal saline (yes, it's compatible). Since most of the time I'm giving IV pain meds through a short extension tube, if I give it undiluted, it can take just a little while before it actually reaches the patient and when I flush the med, the patient gets a small bolus of the drug pretty quickly. I generally actually dilute it in 10 mL as the 10 mL flushes are quite convenient to use.

nutella, MSN, RN · Apr 25, 2016

Some providers will order dilaudid to be diluted into 50 ml of NS and to be given over 15 min (via pump) if "getting high" and "addiction potential" is a problem.

Pat will still get pain relief but the "high/euphoria" usually does not develop that way or not as strong, which is why pat craving exactly this effect will complain about the infusion.

The other day somebody said that they did not feel it was "right" and that they prefer it undiluted push together with benadryl (also push fast for the high)... .

TheCommuter, BSN, RN · Apr 25, 2016

The other day somebody said that they did not feel it was "right" and that they prefer it undiluted push together with benadryl (also push fast for the high)... .

I've also had patients request a dose of Phenergan IV immediately after having received the Dilauded. Apparently the combo of Dilaudid and Phenergan create an enhanced 'feel good' feeling in many people.

Since my last workplace disallowed Phenergan from being administered IV push unless it was given very slowly (over five minutes) and diluted in 10mL of normal saline, many of these patients were never quite able to achieve that 'feel good' feeling of the two medications working together.

LifeIsBeachy, BSN, RN · Apr 25, 2016

Wow, yes I knew it was stronger than morphine and that it was an opioid but I guess all I was missing was the fact that people who want the "high" know their desired cocktail. :lol2:

plinky · Apr 25, 2016

I understand that you are all talking about drug seeking patients who want Dilaudid. I'd like to add my two cents about the drug when used as it should be. I was given Dilaudid after my third surgery for spinal fusions. I'd never had it before. I guess whoever ordered it thought they were doing me a favor by giving me strong medication. However, I never knew if I had pain or not because I began to have hallucinations from the Dilaudid. I was supposed to be in the hospital for 2 days but ended up staying 7 days. I had hallucinations all during that time. I have memories of my time in the hospital, but I know they weren't real. I was blessed by a nurse who came to me the night before I was discharged. She said her mother had had a similar problem. The hallucinations continued for several days even the drug was discontinued. She sat with me until I was calmed and had a clear understanding of what was happening to me, where I was, the day and time, as well as reminding me of my husband who was staying with me. She made it possible for me to be discharged. Not only did I continue to have occasional hallucinations when I first got home, I also had PTSD for several months. I couldn't talk about what happened without crying. This is just a reminder that 13% of patients will have hallucinations just as I did. If you have a patients who seems off the wall after Dilaudid, remember that this is a serious drug reaction and needs to be addressed. Now I'll shut my mouth.

Kyrshamarks, BSN, RN · Apr 25, 2016

Give me dialudid over morphine any day. Morphine gets me as high as a kite but does not stop my pain at all. I Will be flying 20 feet off the ground but hurt like crazy still. Give me 2 MG of dialudid and my pain will be gone for up to 12 hours. I know this from personal experience. As for fentanyl, it just makes me sick. I get pain relief but I get sick to my stomach from it.

Cook26 · Apr 25, 2016

Dilaudid is probably closer to 8 times as strong, not 5. Morphine is the standard opioid against which all others are measured. An easy way to remember is make everything a factor of 10:

Demerol 1/10

Morphine 1

Dilaudid 10x

Fentanyl 100x

There are other drugs (remifentanil, sufenta, etc) but those won't be used in the floor hospital setting.

Long Term Care Columnist / Guide · Apr 26, 2016

The one time I had morphine, I almost clawed my skin off---the itching was so severe. Fortunately it's now on my allergies list so I'm usually given Dilaudid. Honestly, though, I'd rather have Toradol because it's great for pain and doesn't make me stupid.

Twinmom06, ASN, APN · Apr 26, 2016

the one and only time I had Dilaudid was for a gallbladder attack - 0.5 mg and I slept for 6 hours....