Alerts & Corrections

Update Alert: Pediatric Hydromorphone Dosage

Alert:  The Editors of AHFS Drug Information® (AHFS® DI) wish to inform you of a change in dosage of hydromorphone hydrochloride for off-label use in pediatric patients in the hydromorphone hydrochloride monograph 28:08.08.  Although the existing dosages accurately reflect the expert recommendations cited in the monograph, lower dosages are now being recommended for children and adolescents who weigh 50 kg or more.  The monograph content has been updated accordingly.

The dosage information appears in the first column on page 2220 of the printed edition of AHFS® DI™ 2018.

In the final paragraph under the subhead Parenteral Dosage, in Dosage and Administration: Dosage, the newer lower dosage (in bold) for children and adolescents weighing 50 kg or more is as follows:

Although safety and efficacy of parenteral hydromorphone hydrochloride have not been established in pediatric patients†, some clinicians recommend an initial parenteral dosage of 0.015 mg/kg every 3−6 hours as needed in children who weigh less than 50 kg and an initial parenteral dosage of 0.2−0.6 mg IV every 2−4 hours or 0.8−1 mg by IM or subcutaneous injection every 4−6 hours as needed in children and adolescents who weigh 50 kg or more.

In the final paragraph under the subhead Conventional Preparations under Dosage: Oral Dosage, in Dosage and Administration, the newer lower dosage (in bold) for children and adolescents weighing 50 kg or more is as follows:

Although safety and efficacy of conventional oral preparations of hydromorphone hydrochloride have not been established in pediatric patients†, some clinicians recommend an initial oral hydromorphone hydrochloride dosage of 0.03−0.08 mg/kg every 3−4 hours as needed in children who weigh less than 50 kg and a usual initial oral dosage of 1−2 mg every 3−4 hours as needed in children and adolescents who weigh 50 kg or more.  For children with severe pain, initial oral doses of 0.06 mg/kg have been used.

For purchasers of print copies of AHFS® DI:
If you have a print copy of AHFS® DI™ 2018, please keep this alert with your copy and inform all others who may refer to the book.

For purchasers of AHFS® Clinical Drug Information™ (AHFS® CDI™):
Please note that the dosage change has already been made.

For other electronic users of AHFS® DI:
Please note that an updated version of the monograph has been supplied to all vendors.