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/RestrictedAccess |
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 |
|