An uncontrolled retrospective study was conducted looking at the use of oral controlled-release
hydromorphone in
palliative care patients. Over a 2-year period 55 patients were switched to
hydromorphone therapy, and the efficacy and outcomes were assessed.
Urea and
electrolyte measurements were also recorded at the time of
opioid switch and renal impairment defined as
urea > 10.5 mmol/l and/or
creatinine > or = 101 mmol/l. This group of 29 patients with abnormal
urea and/or
creatinine (Group 1) was compared with the remaining 26 patients (Group 2) who had normal
urea and
creatinine. The major reasons for change to
hydromorphone were side-effects (cognitive/drowsiness/
nausea) on previous
therapy. Following a switch to
hydromorphone these side-effects improved in over 80% of patients (n = 55). Comparison between Group 1 and 2 demonstrated a significant difference in renal function but no significant differences in reasons for change, dose of
opioids or response to change (over 80% improvement following
opioid switch). We conclude that
hydromorphone is a flexible second-line alternative to
morphine that is particularly useful when intolerable side-effects are experienced with other
opioids. In renal impairment (including two patients with
end-stage renal failure) we found
hydromorphone to be safe and effective. Further clinical and pharmacokinetic studies are required.