Diamorphine is a semi-synthetic opiate that has been in use since the late 1800s to treat severe acute and chronic pain. The drug predates FDA approval. Diamorphine works by binding to the opioid receptors in the brain, similar to the body's naturally occurring pain killers, known as endorphins. It is about two and one-half times more potent than morphine and about 200 times more soluble. When used medically, diamorphine is an invaluable tool for relieving pain; however, illicit use and manufacture of diamorphine, more commonly known as heroin, often leads to serious medical and social consequences. Under medical supervision, diamorphine is generally safe and effective, but can also result in several side effects.
Sedation and Psychomotor Impairment
Diamorphine can cause several impairments of the central nervous system. According to the prescribing information from Wockhardt UK, one of the most common side effects from diamorphine injections is a feeling of drowsiness. The drug is a central nervous system depressant, and opioid mediated pain relief commonly results in a dose-dependent sedating effect. The prescribing label also states that patients may experience dizziness, feelings of faintness, double vision, confusion, headache and vertigo. Although these effects are dose dependent, they are also quickly tolerated and most patients become adjusted to the psychomotor effects of opiates in a short time.
Gastrointestinal Upsets
Diamorphine can also cause several gastrointestinal upsets. According to the Auralis prescribing label, some of the most common experienced side effects include nausea, vomiting and constipation. According to Dr. David Weismann, opioids cause gastrointestinal disturbances for several reasons. Opioids cause nausea by alerting the chemo-receptive trigger zone, a port that samples blood for noxious chemicals. Large doses of opioids can set off the trigger zone, sending a message to the vomiting center in the brain. Opioids may also cause nausea by affecting the vestibular apparatus, which controls balance and coordination. Lastly, constipation occurs because opioid receptors in the intestinal tract cause a reduction in movement and increased fluid absorption, leading to dry, hardened stools.
Respiratory Depression
Patients treated with diamorphine may also experience varying degrees of respiratory depression. In high doses, this effect can lead to respiratory failure, and patients new to this medication should be monitored by a medical professional. According to the International Programme on Chemical Safety, 21 percent of diamorphine overdoses affect the lungs with complications such as respiratory arrest, pneumonia and pulmonary inflammation and swelling. Patients may also experience asthma attacks and pulmonary hypertension. Patients usually become quickly adjusted to the effects of pharmaceutical diamorphine, but doses should be adjusted to adequately treat pain without risking respiratory impairment in higher doses.
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