Diamorphine pharmacokinetics and conversion factor estimates for intranasal diamorphine in paediatric breakthrough pain:systematic review.

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dc.contributor.author Gastine, Silke
dc.contributor.author Morse, James D
dc.contributor.author Leung, Miriam Ty
dc.contributor.author Wong, Ian Chi Kei
dc.contributor.author Howard, Richard F
dc.contributor.author Harrop, Emily
dc.contributor.author Liossi, Christina
dc.contributor.author Standing, Joseph F
dc.contributor.author Jassal, Satbir Singh
dc.contributor.author Hain, Richard D
dc.contributor.author Skene, Simon
dc.contributor.author Oulton, Kate
dc.contributor.author Law, Siew L
dc.contributor.author Quek, Wan T
dc.contributor.author Anderson, Brian J
dc.coverage.spatial England
dc.date.accessioned 2022-07-12T21:34:00Z
dc.date.available 2022-07-12T21:34:00Z
dc.date.issued 2022-02-19
dc.identifier.citation (2022). BMJ Supportive and Palliative Care, bmjspcare-2021-003461-.
dc.identifier.issn 2045-435X
dc.identifier.uri https://hdl.handle.net/2292/60371
dc.description.abstract Intranasal diamorphine is a potential treatment for breakthrough pain but few paediatric data are available to assist dose estimation. To determine an intranasal diamorphine dose in children through an understanding of pharmacokinetics. A systematic review of the literature was undertaken to seek diamorphine pharmacokinetic parameters in neonates, children and adults. Parenteral and enteral diamorphine bioavailability were reviewed with respect to formation of the major metabolite, morphine. Clinical data quantifying equianalgesic effects of diamorphine and morphine were reviewed. PubMed (1960-2020); EMBASE (1980-2020); IPA (1973-2020) and original human research studies that reported diacetylmorphine and metabolite after any dose or route of administration. The systematic review identified 19 studies: 16 in adults and 1 in children and 2 neonatal reports. Details of study participants were extracted. Age ranged from premature neonates to 67 years and weight 1.4-88 kg. Intranasal diamorphine bioavailability was predicted as 50%. The equianalgesic intravenous conversion ratio of morphine:diamorphine was 2:1. There was heterogeneity between pharmacokinetic parameter estimates attributed to routes of administration, lack of size standardisation, methodology and pharmacokinetic analysis. Estimates of the pharmacokinetic parameters clearance and volume of distribution were reduced in neonates. There were insufficient paediatric data to characterise clearance or volume maturation of either diamorphine or its metabolites. We estimate equianalgesic ratios of intravenous morphine:diamorphine 2:1, intravenous morphine:intranasal diamorphine 1:1 and oral morphine:intranasal diamorphine of 1:3. These ratios are based on adult literature, but are reasonable for deciding on an initial dose of 0.1 mg/kg in children 4-13 years.
dc.format.medium Print-Electronic
dc.language eng
dc.publisher BMJ
dc.relation.ispartofseries BMJ supportive & palliative care
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm
dc.subject chronic conditions
dc.subject clinical decisions
dc.subject paediatrics
dc.subject pain
dc.subject pharmacology
dc.subject Pediatric
dc.subject 6.1 Pharmaceuticals
dc.subject 6 Evaluation of treatments and therapeutic interventions
dc.subject Science & Technology
dc.subject Life Sciences & Biomedicine
dc.subject Health Care Sciences & Services
dc.subject PLASMA-CONCENTRATIONS
dc.subject ADMINISTERED DIACETYLMORPHINE
dc.subject CANCER PAIN
dc.subject MORPHINE
dc.subject HEROIN
dc.subject METABOLITES
dc.subject CHILDREN
dc.subject MORPHINE-6-GLUCURONIDE
dc.subject PHARMACODYNAMICS
dc.subject INFANTS
dc.subject 1110 Nursing
dc.subject 1117 Public Health and Health Services
dc.title Diamorphine pharmacokinetics and conversion factor estimates for intranasal diamorphine in paediatric breakthrough pain:systematic review.
dc.type Journal Article
dc.identifier.doi 10.1136/bmjspcare-2021-003461
pubs.begin-page bmjspcare-2021-003461
dc.date.updated 2022-06-15T03:44:30Z
dc.rights.holder Copyright: The author en
dc.identifier.pmid 35184039 (pubmed)
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/35184039
pubs.publication-status Published
dc.rights.accessrights http://purl.org/eprint/accessRights/RetrictedAccess en
pubs.subtype IM
pubs.subtype Journal Article
pubs.elements-id 884825
pubs.org-id Medical and Health Sciences
pubs.org-id Medical Sciences
pubs.org-id School of Medicine
pubs.org-id Anaesthesiology
dc.identifier.eissn 2045-4368
dc.identifier.pii bmjspcare-2021-003461
pubs.record-created-at-source-date 2022-06-15
pubs.online-publication-date 2022-02-19


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