Palladone (Hydromorphone)

How does it work?

Palladone capsules contain the active ingredient hydromorphone hydrochloride, which is a type of medicine called an opioid analgesic (painkiller). The opioids are a group of very strong painkillers that are related to morphine.

Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.

Hydromorphone mimicks the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.

Hydromorphone is used to relieve severe pain caused by cancer.

Palladone capsules can be swallowed whole, or for people who have difficulty swallowing the capsules, they can be opened and their contents sprinkled on to cold soft food.

What is it used for?

  • Severe pain in cancer.


  • This medicine may cause drowsiness. If affected do not drive or operate machinery. Alcohol should be avoided as it will make any drowsiness worse.
  • Opioids such as hydromorphone frequently cause constipation. Constipation can often be eased by eating plenty of fibre, such as fruit, green leafy vegetables and bran and by drinking six to eight glasses of water each day. However, if this doesn't work or is not possible a laxative may be needed. Ask your doctor for advice if you get constipated while taking this medicine.
  • If this medicine is taken for prolonged periods of time, the body can become tolerant to it and it may become less effective at relieving pain. This means that with time, higher doses may be needed to control pain. With prolonged use the body may also become dependent on the medicine. As a result, withdrawal symptoms can occur if the medicine is stopped suddenly. For this reason, when a person no longer needs this medicine, it may be necessary to reduce treatment gradually to avoid withdrawal symptoms.

Use with caution in

  • Elderly people.
  • Weak or debilitated people.
  • Abnormal muscle weakness (myasthenia gravis).
  • Decreased kidney function.
  • People with severe breathing difficulties.
  • Chronic obstructive pulmonary disease (COPD).
  • Asthma.
  • People with mental and behavioural disorders caused by a toxic substance (toxic psychosis).
  • Serious medical condition caused by withdrawal from alcohol (delirium tremens).
  • Inflammation of the pancreas (pancreatitis).
  • Underactive thyroid gland (hypothyroidism).
  • Insufficient production of natural steroid hormones by the adrenal glands (adrenal insufficiency).
  • Enlarged prostate gland (prostatic hypertrophy).
  • Reduced blood flow to vital internal organs (shock).
  • Low blood pressure (hypotension) combined with low fluid volume in the body (hypovolaemia).
  • People who have recently had surgery, particularly abdominal surgery.
  • Constipation.
  • History of alcohol or drug abuse.

Not to be used in

  • The first 24 hours following surgery.
  • The four hours before surgery on the spinal cord (cordotomy) or other pain relieving surgical procedures.
  • People with slow, shallow breathing resulting in low levels of oxygen and high levels of carbon dioxide in the blood (respiratory depression).
  • Coma.
  • Sudden emergency conditions affecting one or more of the organs in the abdomen (acute abdomen, eg appendicitis).
  • Failure of function of part of the gut causing an obstruction in the intestines (paralytic ileus).
  • People with a head injury or raised pressure inside the skull (raised intracranial pressure).
  • Convulsive disorders such as epilepsy.
  • Alcoholism.
  • Decreased liver function.
  • People who have taken a monoamine-oxidase inhibitor (MAOI) in the last 14 days.
  • Pregnancy.
  • Breastfeeding.
  • This medicine is not recommended for children under 12 years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine should not be used during pregnancy, particularly during the third trimester, as it may have harmful effects on the baby. Seek medical advice from your doctor.
  • This medicine may pass into breast milk. The manufacturer recommends that it should not be used by women who are breastfeeding. Seek medical advice from your doctor.

Label warnings

  • This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Common (affect more than 1 in 100 people)

  • Constipation.
  • Feeling sick and vomiting.
  • Dry mouth.
  • Feeling weak or loss of strength (asthenia).
  • Low blood pressure (hypotension).
  • Dizziness.
  • Sleepiness.
  • Confusion.
  • Rash.
  • Itching.
  • Sweating.
  • Difficulty passing urine.

Uncommon (affect fewer than 1 in 100 people)

  • Blurred vision.
  • Contracted pupils.
  • Hallucinations.
  • Feeling of well-being (euphoria).
  • Feeling agitated, restless or unwell.
  • Headache.
  • Tremor.
  • Difficulty performing voluntary movements, resulting in jerky movements or muscle twitches (dyskinesia).
  • Convulsions.
  • Slow, shallow breathing (respiratory depression).
  • Paralysis or inactivity of the intestine that stops the movement of material through the gut (paralytic ileus).
  • Swollen ankles caused by fluid retention (peripheral oedema).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

This medicine should not be taken by people who are taking a type of medicine called a monoamine oxidase inhibitor (MAOI, for example the antidepressants phenelzine, tranylcypromine or isocarboxacid), or who have taken one of these medicines in the last 14 days.

There may be an increased risk of drowsiness and sedation if this medicine is taken with any of the following (which can also cause drowsiness):

  • alcohol
  • antipsychotic medicines, eg haloperidol, chlorpromazine
  • antisickness medicines, eg prochlorperazine, promethazine, nabilone
  • barbiturates, eg phenobarbital, amobarbital
  • benzodiazepines, eg diazepam, temazepam
  • other opioid painkillers, eg morphine, codeine
  • sedating antihistamines, eg chlorphenamine, hydroxyzine
  • sleeping tablets, eg zopiclone
  • tricyclic antidepressants, eg amitriptyline.

Hydromorphone may oppose the effects of the following medicines on the gut:

  • domperidone
  • metoclopramide.

Other medicines containing the same active ingredient

Palladone SR