When This Medicine Should Not Be Used:
This medicine is not right for everyone. You should not receive it if you had an allergic reaction to hydromorphone or sulfites.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin, into a muscle, or into a vein.
• A nurse or other health provider will give you this medicine.
• You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
• You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.
• Use a new needle and syringe each time you inject your medicine.
• Missed dose: Call your doctor or pharmacist for instructions.
• If you store this medicine at home, keep it at room temperature, away from heat and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine, containers, and other supplies. Throw away old medicine after the expiration date has passed. Ask your pharmacist about the best way to dispose of medicine you do not use.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some foods and drugs can affect how hydromorphone works. Tell your doctor if you have used an MAO inhibitor (MAOI) within the past 14 days. Also, tell your doctor if you are using any of the following:
  
  • Buprenorphine, butorphanol, nalbuphine, or pentazocine
  • Phenothiazine medicine, including chlorpromazine, perphenazine, promethazine, prochlorperazine, thioridazine
• Do not drink alcohol while you are using this medicine. Do not take any medicine with alcohol in it.
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, lung disease or breathing problems, low blood pressure, Addison disease or other thyroid disorder, or a head injury. Tell you doctor if you have an enlarged prostate, problems with urination, or digestion problems, including gallbladder or pancreas disorders. Also, tell your doctor if you have a history of seizures, depression, or drug or alcohol abuse.
• This medicine may cause severe breathing problems.
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• Too much of this medicine can cause death. Symptoms of an overdose include extreme dizziness or weakness, trouble breathing, slow heartbeat, seizure, and cold, clammy skin.
• This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
• This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
• Long-term use: Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Extreme weakness, shallow breathing, slow heartbeat, sweating, cold or clammy skin
• Lightheadedness, dizziness, or fainting
• Severe constipation or stomach pain
• Slow or uneven heartbeat
• Trouble breathing

If you notice these less serious side effects, talk with your doctor:

• Feelings of extreme happiness or sadness
• Mild tiredness or sleepiness
• Nausea or vomiting
• Pain, itching, or rash where the needle is placed
• Warmth or redness in your face, neck, arms, or upper chest

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088