Hydromorphone for cancer pain - Palladone

Hydromorphone eases severe pain associated with cancer.

The capsules can be swallowed whole with a drink of water, or opened and the contents sprinkled on to some soft food such as yoghurt.

The most common side-effects are constipation, drowsiness and feeling sick. Your doctor may prescribe medicines for you to take with hydromorphone to help with some of these side-effects.
Type of medicine Strong opioid painkiller
Used for Pain relief in adults with cancer
Also called Palladone®
Available as Capsules, and modified-release capsules

Strong opioids are medicines used to treat severe pain. Hydromorphone is a type of strong opioid (sometimes called an opiate) used to treat pain caused by cancer. It works on your nervous system and brain to reduce the way you feel pain.

Hydromorphone is taken by mouth as a capsule. There are two types of capsule available: quick-acting capsules (Palladone®) and modified-release capsules (Palladone® SR). Modified-release capsules release the hydromorphone they contain more slowly than the quick-acting capsules do. This provides longer and more even pain relief.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking hydromorphone it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have liver or kidney problems.
  • If you have prostate problems or any difficulties passing urine.
  • If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).
  • If you have been told you have low blood pressure.
  • If you have any problems with your thyroid, pancreas, or adrenal glands.
  • If you have epilepsy.
  • If you have a problem with your bile duct.
  • If you have been constipated for more than a week or have an inflammatory bowel problem.
  • If you have a condition causing muscle weakness, called myasthenia gravis.
  • If you have a mental health problem called toxic psychosis.
  • If you have recently had a severe head injury.
  • If you have ever been dependent on drugs or alcohol.
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • Before you start taking the capsules, read the manufacturer's printed information leaflet from inside the pack. The manufacturer's leaflet will give you more information about hydromorphone and a full list of the side-effects which you may experience from taking it.
  • Take hydromorphone exactly as your doctor tells you to. If you have been prescribed the quick-acting capsules (Palladone®), you will be asked to take a dose every four hours. The modified-release capsules (Palladone® SR) are taken twice a day, 12 hours apart.
  • There are different strengths of both types of hydromorphone capsule, so each time you collect a prescription check to make sure it is the strength you are expecting.
  • You can swallow the capsules whole with a drink of water, or alternatively, open them and sprinkle the contents on to some soft food, such as yogurt.
  • You can take hydromorphone before or after food.
  • If you forget to take a dose, take the next dose when it is due and then continue as before. Do not take two doses together to make up for a forgotten dose.
  • Ask your doctor for advice before drinking alcohol while you are on this medicine. Your doctor may recommend you do not drink alcohol while you are on hydromorphone because it increases the possibility of side-effects such as feeling dizzy and sleepy.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking hydromorphone as a painkiller.
  • If you buy any medicines, check with a pharmacist that they are suitable for you to take with hydromorphone. Many other medicines have similar side-effects to hydromorphone, and taking them together will increase the risk of these.
  • If you are planning a trip abroad, you are advised to carry a letter with you from your doctor to explain that you have been prescribed hydromorphone. This is because hydromorphone is classed as a 'controlled drug' and is subject to certain restrictions.
  • Continue to take hydromorphone unless your doctor tells you otherwise. Stopping suddenly will cause your pain to return, and it can also cause you to feel agitated, anxious, and sweaty. If you need to stop taking hydromorphone your doctor will prescribe an alternative painkiller for you, or reduce your dose gradually.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with hydromorphone. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common hydromorphone side-effects What can I do if I experience this?
Feeling or being sick Stick to simple meals - avoid rich or spicy foods. Also, try taking your doses after food, as this may help to protect your stomach
Shallow breathing Let your doctor know about this
Feeling dizzy, sleepy or drowsy If this happens, do not drive or use tools or machines. Do not drink alcohol
Constipation Try to eat a well-balanced diet and drink plenty of water each day. If this continues to be a problem, speak with your doctor who will prescribe a laxative for you
Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
Other common side-effects include: feeling confused or disorientated, itching, sweating, mood changes, disturbed sleep, headache, difficulties passing urine, flushing, and rash If any of these become troublesome, speak with your doctor

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Helen Huins
Last Checked:
15/10/2013
Document ID:
611 (v24)
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