Diamorphine intranasal or sublingual | |
What is it? | Strong opioid - CD schedule 2 |
Mechanism of action | Mu agonist |
Starting dose | 1.25–2.5 mg 4 hourly prn (equivalent to 3.75–7.5 mg morphine PO) |
Time to onset of effect | <5 min17 |
Formulation | Nasal spray (Ayendi(R)) OR Injection (powder for reconstitution) intranasal or sublingual routes |
Indication | Moderate to severe pain |
Common adverse effects | Vomiting; opioid adverse effects; constipation; dizziness; drowsiness; dry mouth16 |
Contraindications | Acute respiratory depression, comatose, head injury, raised intracranial pressure16 |
Caution | Those at risk of aspiration Severe hepatic and renal impairment |
Licencing | Off license route of licensed injections Nasal spray (Ayendi(R)) licensed but not available in the UK at time of writing |
Benefits | Rapidity of onset of action Ease of nasal administration |
Risks | Prescribing/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