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Diamorphine pharmacokinetics and conversion factor estimates for intranasal diamorphine in paediatric breakthrough

Silke Gastine1, James D Morse2, Miriam Ty Leung3

  • 1Great Ormond St Institute of Child Health, University College London, London, UK.

BMJ Supportive & Palliative Care
|February 20, 2022
PubMed

Insights

Intranasal diamorphine offers a potential breakthrough pain treatment for children. Based on adult data, an initial dose of 0.1 mg/kg is suggested for children aged 4-13 years.

Area of Science:

  • Pharmacology
  • Paediatric Medicine
  • Pain Management

Background:

  • Intranasal diamorphine is a promising treatment for breakthrough pain.
  • Limited pediatric data hinders accurate dose estimation.

Approach:

  • Systematic literature review of diamorphine pharmacokinetics in neonates, children, and adults.
  • Analysis of parenteral and enteral bioavailability, focusing on morphine metabolite formation.
  • Review of clinical data on equianalgesic effects of diamorphine and morphine.

Key Points:

  • Intranasal diamorphine bioavailability estimated at 50%.
  • Equianalgesic ratio of intravenous morphine to diamorphine is 2:1.
  • Pharmacokinetic parameters show reduced clearance and volume of distribution in neonates, with insufficient pediatric data for maturation characterization.

Conclusions:

  • Estimated equianalgesic ratios: IV morphine:diamorphine 2:1, IV morphine:intranasal diamorphine 1:1, oral morphine:intranasal diamorphine 1:3.
  • These ratios, derived from adult data, support an initial intranasal diamorphine dose of 0.1 mg/kg for children aged 4-13 years.
Abstract

Keywords:
chronic conditionsclinical decisionspaediatricspainpharmacology

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