Use of oral hydromorphone in a patient with stage D heart failure

Abstract

Patients with advanced heart failure often experience dyspnea, fatigue, edema, and appetite loss. If these symptoms are refractory to treatment, palliative care via a team approach is necessary. We describe a patient with stage D heart failure whose dyspnea and overall condition improved with comprehensive medical treatments including conventional medications for heart failure, continuous infusions of catecholamine and diuretic, and oral hydromorphone. A 67-year-old man with a 12-year history of dilated cardiomyopathy was admitted to our hospital due to exacerbation of heart failure. Despite continuous infusion of catecholamine and diuretic, his dyspnea and liver and renal function continued to worsen. Oral hydromorphone was administered to relieve his refractory dyspnea, which also improved his conditions, continuous infusion of the catecholamine and diuretic could withdraw. Oral low-dose hydromorphone used in the present case might be a helpful agent for treating dyspnea in stage D heart failure patients with renal dysfunction.

Analysis of cardiohemodynamic and electrophysiological effects of morphine along with its toxicokinetic profile using the halothane-anesthetized dogs

“…European and Japanese heart failure guidelines recommend morphine therapy for refractory dyspnea in advanced heart failure patients (Anzai et al, 2021;McDonagh et al, 2021), which may offer hope for refractory dyspnea in advanced heart failure patients like in cancer patients. However, real-world data on morphine administration for refractory dyspnea in non-cancer diseases including heart fail-ure are still limited (Kawaguchi et al, 2020;Nakamura et al, 2023). More importantly, the cardiovascular actions of morphine by themselves have not been well characterized due to the limited role of opioid receptors in the regulation of cardiovascular system (Johnson et al, 2002;Pugsley, 2002;McDonagh et al, 2021).…”