Patient leaflet - Diamorphine Hydrochloride 5 mg for injection
1. What Diamorphine Injection is and what it is used for
Diamorphine Injection is available in five different strengths. Each ampoule contains either 5mg, 10mg, 30mg, 100mg or 500mg of diamorphine hydrochloride. Before being used the powder in the ampoules is mixed with water to make a solution which will be given to you by injection. Diamorphine hydrochloride belongs to a class of medicines known as opioids, which are ‘pain relievers’. They help to relieve severe pain.
Diamorphine Hydrochloride for Injection 5mg and 10mg can be used to:
- relieve severe pain such as that associated with surgical procedures, cancer or other terminal illnesses, or a heart attack, or
- relieve breathlessness caused by fluid in the lungs.
Diamorphine Hydrochloride for Injection 30mg, 100mg and 500mg are used to relieve severe pain as part of terminal care.
Opioids can cause addiction, and you may get withdrawal symptoms if you stop taking it suddenly. Your prescriber should have explained how long you will be taking it for and when it is appropriate to stop, how to do this safely.
2. What you need to know before you are given Diamorphine injection
Diamorphine Injection should not be given if you:
- have ever had a reaction to or been told that you are allergic to diamorphine or morphine
- have been told you have a tumour of the adrenal gland near your kidney called phaeochromocytoma
- have severe problems with breathing
- have increased pressure on the brain, have just had a head injury or if you are unconscious
- are suffering from acute alcoholism
- are at risk from a blocked intestine
- have severe stomach cramps caused by a condition known as biliary colic
- are suffering from severe diarrhoea
- are pregnant or breast-feeding.
Warnings and precautions
Talk to your doctor before Diamorphine Injection is given if you:
- suffer from asthma (your doctor may decide to administer Diamorphine Injection if your asthma is controlled. However, you should not be given this medicine if you are having an acute asthma attack)
- suffer from bronchitis (an inflammation of the lining of the tubes in the lungs, resulting in coughing spells accompanied by thick phlegm and breathlessness) or emphysema (a lung condition which leaves you struggling for breath)
- suffer from cor-pulmonale (a type of heart failure)
- are severely obese
- have a severely deformed spine
- are suffering from mental illness brought on by an infection
- have liver problems
- have kidney problems
- have problems with your bile duct
- suffer from an enlarged prostate gland (in men) or have difficulty passing urine
- have an under-active thyroid or adrenal gland
- have low blood pressure
- are in a state of severe shock
- are very run down
- have bowel disease, such as Crohn’s disease or ulcerative colitis
- suffer from convulsions (fits)
- are a child or elderly
- are feeling weak and feeble
- are or have ever been addicted to opioids, alcohol, prescription medicines, or illegal drugs
- have previously suffered from withdrawal symptoms such as agitation, anxiety, shaking or sweating, when you have stopped taking alcohol or drugs
- feel you need to take more of Diamorphine Injection to get the same level of pain relief, this may mean you are becoming tolerant to the effects of this medicine or are becoming addicted to it. Speak to your prescriber who will discuss your treatment and may change your dose or switch you to an alternative pain reliever
Taking this medicine regularly, particularly for a long time, can lead to addiction. Your prescriber should have explained how long you will be taking it for and when it is appropriate to stop, how to do this safely. Rarely, increasing the dose of this medicine can make you more sensitive to pain. If this happens, you need to speak to your prescriber about your treatment.
Addiction can cause withdrawal symptoms when you stop taking this medicine. Withdrawal symptoms can include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, loss of appetite, shaking, shivering or sweating. Your prescriber will discuss with you how to gradually reduce your dose before stopping the medicine. It is important that you do not stop taking the medicine suddenly as you will be more likely to experience withdrawal symptoms.
Opioids should only be used by those they are prescribed for. Do not give your medicine to anyone else. Taking higher doses or more frequent doses of opioid, may increase the risk of addiction. Overuse and misuse can lead to overdose and/or death.
If any of the above apply to you, speak to your doctor or nurse before Diamorphine Injection is given to you.
Tolerance, dependence, and addiction
This medicine contains diamorphine, which is an opioid. It can cause dependence and/or addiction.
This medicine contains diamorphine which is an opioid medicine. Repeated use of opioids can result in the drug being less effective (you become accustomed to it, known as tolerance). Repeated use of Diamorphine Injection can also lead to dependence, abuse, and addiction, which may result in life-threatening overdose. The risk of these side effects can increase with a higher dose and longer duration of use.
Dependence or addiction can make you feel that you are no longer in control of how much medicine you need to use or how often you need to use it.
The risk of becoming dependent or addicted varies from person to person. You may have a greater risk of becoming dependent on or addicted to Diamorphine Injection if:
- You or anyone in your family have ever abused or been dependent on alcohol, prescription medicines or illegal drugs (“addiction”).
- You are a smoker.
- You have ever had problems with your mood (depression, anxiety, or a personality disorder) or have been treated by a psychiatrist for other mental illnesses.
If you notice any of the following signs whilst using Diamorphine Injection, it could be a sign that you have become dependent or addicted:
- You need to use the medicine for longer than advised by your doctor
- You need to use more than the recommended dose
- You might feel that you need to carry on using your medicine, even when it doesn’t help to relieve your pain. • You are using the medicine for reasons other than prescribed, for instance, ‘to stay calm’ or ‘help you sleep’
- You have made repeated, unsuccessful attempts to quit or control the use of the medicine
- When you stop using the medicine you feel unwell, and you feel better once using the medicine again (‘withdrawal effects’)
If you notice any of these signs, speak to your doctor to discuss the best treatment pathway for you, including when it is appropriate to stop and how to stop safely (see section 3, If you stop using Diamorphine Injection).
Sleep-related breathing disorders
Diamorphine Injection can cause sleep-related breathing disorders such as sleep apnoea (breathing pauses during sleep) and sleep related hypoxemia (low oxygen level in the blood). The symptoms can include breathing pauses during sleep, night awakening due to shortness of breath, difficulties to maintain sleep or excessive drowsiness during the day. If you or another person observe these symptoms, contact your doctor. A dose reduction may be considered by your doctor.
Other medicines and Diamorphine Injection
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
In particular, tell your doctor if you are taking any of the following:
- Gabapentin or pregabalin to treat epilepsy or pain due to nerve problems (neuropathic pain).
- monoamine oxidase inhibitors (MAOIs) such as moclobemide or phenelzine used in the treatment of depression. You must also tell your doctor if you have stopped taking any of these or related medicines in the last two weeks.
- tricyclic antidepressants, which are used in the treatment of depression
- tranquillising drugs or sleeping tablets such as diazepam, nitrazepam and temazepam.
- medicines used to treat mental illnesses, including schizophrenia (e.g. chlorpromazine, haloperidol).
- medicines used for diarrhoea (e.g. loperamide, kaolin).
- medicines which are used as premedication before operations and after heart attacks such as atropine.
- medicines used to treat nausea and vomiting, such as metoclopramide or domperidone
- mexiletine, used to control heart rhythm.
- cimetidine, used to treat stomach ulcers and indigestion
- ritonavir, used to treat HIV (a viral infection)
- medicines to treat depression;
- medicines used to treat allergies, travel sickness or nausea (antihistamines or antiemetics);
- medicines to treat psychiatric disorders (antipsychotics or neuroleptics);
- muscle relaxants;
- medicines to treat Parkinson’s disease;
Diamorphine Injection with alcohol
You should not drink alcohol whilst being given Diamorphine Injection as it will increase its effects.
Pregnancy, breast-feeding and fertility
Pregnancy Do not take Diamorphine Injection if you are pregnant or think you might be pregnant unless you have discussed this with your prescriber and the benefits of treatment are considered to outweigh the potential harm to the baby.
If you use Diamorphine Injection during pregnancy, your baby may become dependent and experience withdrawal symptoms after the birth which may need to be treated.
Do not take Diamorphine Injection while you are breastfeeding as diamorphine hydrochloride passes into breast milk and will affect your baby.
Fertility Diamorphine may reduce fertility.
Driving and using machines
You may feel drowsy and confused when you are being given Diamorphine Injection so you should not drive or operate machinery.
This medicine can affect your ability to drive.
Do not drive whilst taking this medicine until you know how this medicine affects you.
It may be an offence to drive if your ability to drive safely is affected.
There is further information for patients who are intending to drive in Great Britain - go to http://www.gov.uk/drug-driving-law
3. How Diamorphine injection should be given
The doctor or nurse will prepare the injection by mixing the powder with water. He/she will know how much to give you. You can have the injection either under the skin, or into a muscle, or directly into a vein. Diamorphine injection must be used immediately after preparation.
The recommended doses for adults are:
To relieve pain caused by cancer or other terminal illnesses: 5mg – 10mg every 4 hours. A higher dose may be used if necessary. The doctor will adjust the dose as necessary to control your pain.
Following a heart attack 5mg directly into a vein, followed, if needed, by a further 2.5mg – 5mg.
For fluid in the lungs 2.5mg – 5mg directly into a vein.
If you are elderly, a child, are severely run down including feeling weak and feeble, or have liver and kidney problems the dose will be lower. You may also be given a reduced dose if you suffer from any of the conditions listed in section 2 entitled “Speak to your doctor before Diamorphine Injection is given if you:”
Your doctor will decide the dose that is best for you. If you do not understand what you are being given, or are in any doubt, ask your doctor or nurse.
Your prescriber should have discussed with you, how long the course of treatment will last. They will arrange a plan for stopping treatment. This will outline how to gradually reduce the dose and stop taking the medicine.
If you use more Diamorphine than you should
People who have taken an overdose may get pneumonia from inhaling vomit or foreign matter, symptoms may include breathlessness, cough and fever.
People who have taken an overdose may also have breathing difficulties leading to unconsciousness or even death.
If you miss a dose of Diamorphine Injection
If you think that an injection has been missed, speak to your doctor or nurse.
If you stop using Diamorphine
Do not stop treatment with Diamorphine unless agreed with your doctor. If you want to stop the treatment with Diamorphine, ask your doctor how to slowly decrease the dose so you avoid withdrawal symptoms. Withdrawal symptoms may include restlessness, difficulty sleeping, agitation, body aches, tremors, diarrhoea, shaking, shivering or sweating, stomach pain, nausea, flu-like symptoms, fast heartbeat and large pupils.
Psychological symptoms include an intense feeling of unsatisfaction, anxiety and irritability.
4. Possible side effects
Like all medicines, Diamorphine Injection can cause side effects, although not everybody gets them. Tell your doctor or nurse immediately if you experience the following serious side effect:
- A severe allergic reaction, such as breathing difficulties, shock or low blood pressure. If you suffer such a reaction, you should not be given any more diamorphine. Your doctor will decide on the appropriate treatment for allergic reactions.
Difficulty in breathing and physical and psychological dependence are possible serious side effects. It is possible that you could become dependent on diamorphine.
Other side effects include:
- drowsiness
- feeling sick or being sick
- constipation
- sweating.
Apart from constipation, these side effects tend to disappear with time.
- dizziness
- feeling faint on standing up
- small pupils (in the eye)
- blurred vision
- double vision or other changes in vision
- mental clouding or confusion
- mood changes
- feeling extremely happy for no particular reason
- imagining things (hallucinations)
- headache
- vertigo
- facial flushing
- dry mouth
- difficulty or pain in passing urine
- passing less urine than usual
- biliary spasm (causing pain in the right side of your abdomen, particularly after eating a meal, which may spread towards your right shoulder)
- palpitations
- slower or faster pulse
- skin rash
- wheals or itching
- reduced sexual drive or impotence after long term use
- dependence and addiction (see section “How do I know if I am addicted?”).
Drug Withdrawal
When you stop taking Diamorphine Injection, you may experience drug withdrawal symptoms, which include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, shaking, shivering or sweating.
How do I know if I am addicted?
If you notice any of the following signs whilst taking Diamorphine Injection, it could be a sign that you have become addicted.
- You need to take the medicine for longer than advised by your prescriber
- You feel you need to use more than the recommended dose
- You are using the medicine for reasons other than prescribed
- When you stop taking the medicine you feel unwell, and you feel better once taking the medicine again
If you notice any of these signs, it is important you talk to your prescriber
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product, Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in Google Play or Apple App Store.
5. How to store Diamorphine injection
Do not store above 25°C. Keep the injection in the outer carton to protect it from light.
This medicine should not be used after the expiry date on the carton or if the powder in the ampoule or the solution is discoloured.
Diamorphine Injection must be used immediately after the solution has been prepared.
Diamorphine Injection must be kept in a secure place out of the sight and reach of children.
Diamorphine hydrochloride is a Controlled Drug and must be stored and disposed of according to regulations.
6. Contents of the pack and other information
The following information is intended for healthcare professionals only:
Physicochemical incompatibility (formation of precipitates) has been demonstrated between solutions of morphine sulphate and 5- fluorouracil.
Each ampoule contains either 5mg, 10mg, 30mg, 100mg or 500mg of the active ingredient, Diamorphine hydrochloride, which is a white or off- white powder.
The medicine is prepared for use by dissolving the powder in water.
Packs of Diamorphine Hydrochloride for Injection 5mg, 10mg and 30mg contain five 2 ml ampoules.
Packs of Diamorphine Hydrochloride for Injection 100mg and 500mg contain five 5 ml ampoules.
Marketing Authorisation Holder
Ennogen IP Ltd. Unit G4 Riverside Industrial Estate Riverside Way Dartford DA1 5BS UK.
Manufacturer
Novartis Vaccines and Diagnostics Ltd, Gaskill Road, Speke, Liverpool L24 9GR, UK.
This leaflet was last revised in 10/2025.
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