Strong opioid (heroin)

Diamorphine hydrochloride

Brand names: various

Adult dose

Dose: Acute pain: 5mg IM/SC q4h; LV failure: 2.5–5mg slow IV; Palliative: SC infusion (typical 5–10mg/24h, titrate)

Route: SC / IM / IV / Intrathecal / Epidural

Frequency: q4h or continuous infusion

Clinical pearls

Schedule 2 CD
Standard parenteral opioid in UK palliative care — high water solubility ideal for SC syringe drivers
NICE NG31 end-of-life care; APM (Association for Palliative Medicine) guidance
More potent than morphine — IV/SC conversion ratio 1:3 (10mg morphine ≈ 3mg diamorphine)

Contraindications

Respiratory depression
Acute alcoholism
Head injury / raised ICP
Phaeochromocytoma
Concurrent or recent MAOI
Hypersensitivity

Side effects

Respiratory depression
Sedation
Nausea/vomiting
Constipation
Dependence
Hypotension
Histamine release

Interactions

CNS depressants
MAOIs
Other opioids

Monitoring

Pain score
Sedation
Respiratory rate
Bowel function

Reference: BNF; NICE NG31; APM Guidelines; FPM Opioids Aware; https://bnf.nice.org.uk/drugs/diamorphine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways