Table 7

Diamorphine intranasal or sublingual

Diamorphine intranasal or sublingual
What is it?Strong opioid - CD schedule 2
Mechanism of actionMu agonist
Starting dose1.25–2.5 mg 4 hourly prn (equivalent to 3.75–7.5 mg morphine PO)
Time to onset of effect<5 min17
FormulationNasal spray (Ayendi(R))
OR
Injection (powder for reconstitution) intranasal or sublingual routes
IndicationModerate to severe pain
Common adverse effectsVomiting; opioid adverse effects; constipation; dizziness; drowsiness; dry mouth16
ContraindicationsAcute respiratory depression, comatose, head injury, raised intracranial pressure16
CautionThose at risk of aspiration
Severe hepatic and renal impairment
LicencingOff license route of licensed injections
Nasal spray (Ayendi(R)) licensed but not available in the UK at time of writing
BenefitsRapidity of onset of action
Ease of nasal administration
RisksPrescribing/administration error
Lack of familiarity with drug
Lay carer administration and difficulty making up the drug
Cost£12.81 for 5×5 mg ampoules for injection;
Ayendi (R) price of application
  • CD - Controlled Drug