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Topic: Diamorphine

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	Diamorphine (PIM 261F, French)
		Diamorphine hydrochloride is used as an analgesic: it is a more potent analgesic than morphine but has a shorter duration of action.
		In those countries where diamorphine is used therapeutically it is indicated for treating chronic pain in terminal illness, the acute pain of myocardial infarction and in obstetric epidural anaesthesia (Reynolds, 1989; Smith et al.
		Diamorphine hydrochloride is used in doses of 5 to 10 mg orally, intramuscularly, subcutaneously or intravenously, repeated four hourly (Reynolds, 1989; Clarke, 1986).
	www.inchem.org /documents/pims/pharm/pim261f.htm (5617 words)

	Diamorphine Injection BP 30mg , SPC from the eMC
		Diamorphine may be used in the treatment of severe pain associated with surgical procedures, myocardial infarction or pain in the terminally ill and for the relief of dyspnoea in acute pulmonary oedema.
		Diamorphine should be administered with care to patients with head injuries as there is an increased risk of respiratory depression which may lead to elevation of CSF pressure.
		Diamorphine is a potent opiate analgesic which has a more rapid onset of activity than morphine as the first metabolite, monoacetylmorphine, more readily crosses the blood brain barrier.
	emc.medicines.org.uk /emc/assets/c/html/displaydoc.asp?DocumentID=7032 (928 words)

	Abstract Summary: Intranasal Benzodiazepines for seizure control
		OBJECTIVE: To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray.
		CONCLUSION: Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures.
		CONCLUSIONS: Intranasal diamorphine is an effective, safe, and acceptable method of analgesia for children requiring opiates in the A andamp; E department.
	www.wolfetory.com /education/intranasal_opiates.htm (3602 words)

	News - Nasal Diamorphine Preferred For Children With Limb Fractures (Site not responding. Last check: 2007-11-03)
		Nasal diamorphine spray is safe and effective and preferable to intramuscular morphine in controlling pain among young people who suffer a fractured limb.
		In the study a dose of 0.1 mg/kg was used for diamorphine nasal drops compared with the standard treatment of 0.2 mg/kg for intramuscular morphine.
		Nasal diamorphine spray is a safe and effective method of pain relief for young people presenting to emergency departments in acute pain with clinical fractures, and it should be preferred to intramuscular morphine, the clinicians conclude.
	www.docguide.com /news/content.nsf/news/8BBEA305C6158665852569E7004F053D (688 words)

	Heroin - Wikipedia, the free encyclopedia
		Heroin, diamorphine (BAN) or diacetylmorphine (INN) is a semi-synthetic opioid.
		It is illegal to manufacture, possess, or sell heroin in the United States but, under the name diamorphine, heroin is a legal prescription drug in the United Kingdom.
		According to the British National Formulary (BNF) edition 50, diamorphine hydrochloride may be used in the treatment of acute pain, myocardial infarction, acute pulmonary edema, and chronic pain.
	en.wikipedia.org /wiki/Heroin (4926 words)

	Diamorphine shortage: UKHRA statement on the UK diamorphine shortage
		Since the beginning of 2005 there has been a shortage of diamorphine affecting all patients requiring this drug, including those who are prescribed diamorphine maintenance treatment for the treatment of their drug dependence.
		The only licensed form in which diamorphine can be sold in the UK is the most expensive one namely, freeze-dried amps; in both Holland and Switzerland, however, diamorphine is provided as powder, which can be dissolved for injection as required.
		When we consider that there is currently a glut in the world market of licit diamorphine such that prices have fallen by 12% in the last year, the government's failure to resolve the current crisis is particularly worthy of condemnation.
	www.ukhra.org /statements/diamorphine_shortage_uk.html (643 words)

	Guidance on use and supply of diamorphine : The Department of Health - Pubs and stats: Press releases (Site not responding. Last check: 2007-11-03)
		The Department of Health today advised the NHS that there is a supply problem with the opiate painkiller, diamorphine, and that stocks may rapidly reach a critical level in the next few weeks.
		Diamorphine is used for the treatment of acute and chronic pain, for example in cancer patients and patients in intensive care and accident and emergency departments. It is also used in the treatment of people who are opioid dependant.
		Diamorphine is available from two manufacturers, Chiron and Wockhardt UK. Chiron have told the Department of Health that they currently have limited supplies. It is unlikely that further supplies will be available from Chiron before the end of March.
	www.dh.gov.uk /PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4099536&chk=gFKSYg (445 words)

	The Shipman Inquiry - Fourth Report - Pethidine and Diamorphine
		The Inquiry has focussed mainly on diamorphine, the controlled drug used by Shipman to kill his patients, and pethidine, the controlled drug to which Shipman was addicted in the 1970s.
		Diamorphine, in particular, is dangerous for that reason.
		Diamorphine is widely used for the relief of severe pain in cases of terminal cancer.
	www.the-shipman-inquiry.org.uk /4r_page.asp?ID=3074 (309 words)

	Exchange Supplies - Articles: Report of lab study looking at the effect of acids on heroin injections by Jenny Scott (Site not responding. Last check: 2007-11-03)
		The diamorphine content in the herion used for this work was found to be 56%, which means 140 mg of diamorphine was present in the 250 mg quantities used.
		When this calculation is performed using the 140mg of diamorphine base that was in each 250mg quantity of heroin, it can be calculated that the amount of citric acid needed to fully dissolve all the diamorphine would be 24.3 mg.
		Diamorphine was detected in the filters, on the tip of the needle sheath used to stir the mixture, in the residue left on the spoon after preparation and in the vapour which evaporated from the spoon on heating.
	www.exchangesupplies.org /publications/articles/jscott1.html (2704 words)

	The Shipman Inquiry - First Report - Morphine and Diamorphine
		Diamorphine is twice as potent as morphine, when given by intravenous injection; however, once introduced into the body, diamorphine is very rapidly changed into morphine.
		Although it has the same chemical constituents as morphine, diamorphine's different structure means that it cannot bind to the receptors and has to break down into morphine in order to be able to do so.
		Whether administered as morphine or diamorphine, the morphine has to be transported in the bloodstream to the brain and the spinal cord, where the receptors are situated.
	www.the-shipman-inquiry.org.uk /fr_page.asp?id=96 (331 words)

	Drug Policy Alliance: They Don't Become Angels: Part II
		Diamorphine is available as ampoules of a freeze dried powder which is designed to be injected intravenously.
		In relation to diamorphine prescribing this study finds that there is leakage, albeit minimal, to people who were not prescribed the drug or a particular dosage.
		Because it is not uncommon for addicts on diamorphine to want to kick the habit, they should be guaranteed the return of their prescription if they try detoxification and fail.
	www.lindesmith.org /library/become_partii.cfm (6003 words)

	BBC NEWS \| In Depth \| The Shipman murders \| The Shipman files \| Diamorphine factfile
		Diamorphine, or heroin, is used in medicine as a very effective and powerful painkiller.
		Diamorphine is an opiate, a type of drug extracted from the unripe seed capsules of the Asian poppy.
		Diamorphine resembles morphine, another opiate, in its actions and uses, but produces better pain relief with less severe side effects when given intravenously.
	news.bbc.co.uk /2/hi/in_depth/uk/2000/the_shipman_murders/the_shipman_files/610787.stm (490 words)

	OnMedica - Guidance on use and supply of diamorphine
		The Department of Health has advised the NHS that there is a supply problem with the opiate painkiller, diamorphine, and that stocks may rapidly reach a critical level in the next few weeks.
		The Department of Health (DoH) has advised the NHS that there is a supply problem with the opiate painkiller, diamorphine, and that stocks may rapidly reach a critical level in the next few weeks.
		Diamorphine is used for the treatment of acute and chronic pain, for example in cancer patients and patients in intensive care and accident and emergency (AandE) departments.
	www.onmedica.net /content.asp?t=1&c=36858 (407 words)

	Guidance on use and supply of diamorphine, Supply problem, UK
		The UK Department of Health today advised the NHS that there is a supply problem with the opiate painkiller, diamorphine, and that stocks may rapidly reach a critical level in the next few weeks.
		Diamorphine is used for the treatment of acute and chronic pain, for example in cancer patients and patients in intensive care and accident and emergency departments.
		Diamorphine is available from two manufacturers, Chiron and Wockhardt UK.
	www.medicalnewstoday.com /medicalnews.php?newsid=18303&nfid=rssfeeds (446 words)

	BBC News \| UK \| GP prescribed drug 'after patients' deaths'
		GP Harold Shipman, who is on trial for the murder of 15 women patients, prescribed diamorphine for five of them after their deaths, his trial has heard.
		He said the cases, between December 1990 and July last year, showed the doctor had diamorphine available to him at the time he was alleged to have committed the murders in Hyde, Greater Manchester.
		Another patient Lilyan Ibbotson, who was recorded as having been prescribed 30mg of diamorphine by Shipman in February, 1993, said he had never given her the drug.
	news.bbc.co.uk /1/hi/uk/525296.stm (524 words)

	Guardian Unlimited \| Special reports \| Killer GP gave drug at 6 times the limit
		But an authority on the control of pain gave evidence in the context of trial reports that Shipman had regularly injected his elderly victims with 30mg of diamorphine, which was twice as potent as morphine.
		He said 30mg of diamorphine was a potentially lethal dose and that his professional colleagues would not let him go near them with a syringe loaded with more than 10mg.
		The effect of diamorphine would be stronger on older people and on those not suffering acute pain - a category into which most of Shipman's known victims can be grouped.
	www.guardian.co.uk /shipman/Story/0,2763,510798,00.html (358 words)

	Mumsnet Discussions - Pain relief in labour - Pethidine or Diamorphine? (Childbirth)
		I had diamorphine on a pump I controlled, and it felt so much better than the pethidine -I'd been dreading it as I assumed it would be the same, but although it made me a bit drowsy I didn't feel out of control, and it helped the pain enormously.
		I have had both pethidine and diamorphine and am happy to write about it if it would be useful, but one was in a "normal" delivery and the other a C section, so it's not a very scientific comparison.
		During my first labour I was given Diamorphine, I felt more or less pushed into having it by the Midwife, all I can remember her repeating was 'we can give you little injection that will help'.
	www.mumsnet.com /Talk?topicid=1365&threadid=4291&stamp=030905151526 (7736 words)

	Article Of The Month October 2005
		To evaluate the efficacy and tolerability of diamorphine in the treatment of dyspnea, the authors carried out an open observational study in 11 elderly, opioid naïve, distressed patients (mean age 86 years, range 78-92, there were eight females and 3 males).
		Among the opioids, diamorphine via the subcutaneous route was chosen because it was habitually used in the hospital and because of its absorption characteristics and its predictable peak effects within 30 minutes.
		This observational study may be considered a pilot study on the efficacy and tolerability of diamorphine and oral morphine in a population of very frail elderly patients with dyspnea, anxiety, and agitation due to end-stage a “non-malignant” condition such as IPF.
	www.hospicecare.com /AOM/2005/oct2005article.htm (717 words)

	Controlling breakthrough pain in palliative care
		Diamorphine is given subcutaneously, and it is three times stronger than oral morphine (Hanks and Hoskins 1987).
		Diamorphine ampoules are dispensed in 5mg, 10mg, 30mg, 100mg or 500mg measures.
		The doctor must prescribe the amount of diamorphine required in the syringe driver over 24 hours, and must prescribe the rescue dose of diamorphine on the PRN side of the medication chart.
	www.nursing-standard.co.uk /archives/ns/vol13-07/research.htm (1677 words)

	Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical ...
		Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures -- Kendall et al.
		Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures
		Use of nasal diamorphine for analgesia in children and teenagers
	bmj.bmjjournals.com /cgi/content/abstract/322/7281/261 (565 words)

	ESRA: Diamorphine/Bupivacine Combination Best Anesthetic Bet for Patients Undergoing Cardiac Surgery (Site not responding. Last check: 2007-11-03)
		The two ropivacaine mixtures were associated with a much greater degree of motor blockade (p=0.004) while those patients receiving the ropivacaine/fentanyl mixture had the highest pain scores (4.6 as compared with 2.9 in the bupivacaine/fentanyl cohort, and 0.8 and 0.2 in the ropivacaine/diamorphine and bupivacaine/diamorphine groups, respectively).
		The greater muscle relaxation seen in the ripovacaine group could not be explained by the dose of the local anaesthetic, the investigators said, because the same responses were not seen in the bupivacaine/fentanyl groups, despite the higher infusion rate in that group.
		The lower infusion rates observed in the two groups receiving diamorphine could be explained by its metabolism to morphine inside the spinal cord, and could illustrate the importance of using opiates that are lipid soluable to minimize rostral spread, the researcher said.
	www.pslgroup.com /dg/206AA2.htm (607 words)

	DIAMORPHINE
		Diamorphine (di-acetylmorphine, heroin) is generally considered to be a pro-drug without intrinsic activity.
		The explanation for this apparent paradox probably lies in the need for diamorphine to be converted into an active metabolite and differences in plasma protein binding (diamorphine 40%, morphine 20%).
		Diamorphine hydrochloride is much more soluble than morphine sulphate/hydrochloride and is the strong opioid of choice for parenteral use in the UK because large amounts can be given in very small volumes (Table 5.14).
	www.palliativedrugs.com /content/monographs/DIAMORPHINE.html (540 words)

	4 [501]
		A was convicted of trafficking in 33.71g of diamorphine and sentenced to death.
		The accused's defence was that the 85 sachets of diamorphine recovered were not for sale and were for his own consumption because he was a severe drug addict consuming a sachet of heroin a day.
		Amendments to s 17 of the MDA tightened that presumption in that more than 2mg of diamorphine by an accused was presumed to be an act of trafficking and not just having it in his possession for the purpose of trafficking.
	www.geocities.com /CapitolHill/1161/4v750.html (16276 words)

	Medical Dictionary: Heroin - WrongDiagnosis.com
		Diamorphine Hydrochloride BP for Injection 500mg, SPC from the eMC
		Diamorphine Hydrochloride BP for Injection 5mg, SPC from the eMC
		Diamorphine Hydrochloride BP for Injection 30mg, SPC from the eMC
	www.wrongdiagnosis.com /medical/heroin.htm (379 words)

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