Hydromorphone injection is currently on shortage due to increased demand, manufacturing delays, and shortage of an active ingredient. Estimated restock dates vary by manufacturer, ranging from mid-March to August 2025.
While some products remain available, they may be different concentrations than what is typically stocked in your clinic (e.g., 2 mg/mL hydromorphone vs. 10 mg/mL hydromorphone). If switching concentrations, ensure all staff are informed to prevent dosing errors. Update any dosing charts or calculators that use previous concentrations.
Additionally, verify whether new products are preservative-free or multi-dose vials. Preservative-free vials should be discarded after a single use, while multi-dose vials may be kept for 28 days (unless otherwise specified by the manufacturer).
If hydromorphone is unavailable, consider alternative injectable opioids such as methadone, morphine, or fentanyl. Always double-check concentration, dosing, and calculations when switching to less familiar opioids as their potency can vary greatly. Opioid equivalent charts are available but are based on human data and may not be useful in a veterinary setting.
Duration of action also varies between opioids. Other considerations when choosing an alternative include cost and vial type. Methadone and higher morphine concentrations are more expensive than hydromorphone. Many of the higher concentration morphine products are also on shortage. Fentanyl vials are currently available in a variety of sizes; however, they are all single dose vials.
Drug shortages will continue to be a challenge. Developing backup plans for existing pain and sedation protocols is a proactive approach to staying prepared. Consider adopting or maintaining multi-modal strategies to reduce the impact of shortages.
By Lauralei Fisher-Cronkhite, PharmD, DICVP, FSVHP, Clinical Staff Pharmacist
References
- American Society of Hospital Pharmacists. (March 10, 2025). Hydromorphone Hydrochloride Injection. ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=329&loginreturnUrl=SSOCheck-Only
- U.S. Food and Drug Administration. (2025). FDA Drug Shortages. dps.fda.gov/drugshortages/activeingredient/hydromorphone-hydrochloride-injection
