A patient taking hydromorphone may develop neuroexcitation as an adverse side effect.


Neuroexcitation includes:

(1) agitation and restlessness

(2) myoclonic activity

(3) seziures

(4) hyperalgesia

(5) tremor

(6) cognitive dysfunction


Hydromorphone is metabolized in the liver. The neuroexcitation is associated with accumulation of the metabolite hydromorphone-3-glucoronide.


Risk factors associated with neuroexcitation:

(1) high dose and/or continuous intravneous infusion for severe pain in palliative care

(2) impaired renal function

(3) older age


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