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  • BDD Moderators: Keif’ Richards | negrogesic

Urticaria caused by Actavis-branded Diamorphine For Injection 10mg BP when injected

honeywhite

Bluelighter
Joined
Apr 5, 2012
Messages
90
Some background: my usual pain medication for about 10 years has been morphine - in the form of Zomorph morphine sulphate 60's for routine analgesia and various preparations of morphine (10's) for breakthrough analgesia. When I'm at uni, the breakthrough meds are blue Sevredol; when I'm in London, they're the first opiate I ever had - Actavis-branded glass ampoules with the oh-so-creative name of "Diamorphine For Injection 10mg BP". The story behind the ampoules is that my London doc is a qualified paediatrician who works as a GP (in other words treats adult patients as well), so when I presented with pain as a 13-year-old, she treated it the way children's units in British hospitals do it. In other words, as follows:

  1. Crack open an ampoule of diamorphine powder.
  2. Crack open an ampoule of Distilled Water BP
  3. Draw up water into 2cc syringe and squirt into opened ampoule of diamorphine.
  4. Agitate ampoule until well mixed.
  5. Draw up the diamorphine mixture.
  6. Insert syringe (note: no needle, obviously) into left nostril and administer half the mixture. Have patient inhale so as to coat walls of nose.
  7. Insert syringe into right nostril and administer remainder of the mixture. Have patient continue inhaling.

Anyway, that was the first prescription opiate I ever tried (before my accident, it was in fact my ONLY prescription opiate to treat pain stemming from a foot deformity/operation to fix deformity). Plus, the doc gave me freedom as to how I could use it: up the nose as she demonstrated, or simply mix it with coffee/OJ and drink it. (I always administered it intranasally when convenient.) My university doctor refuses to supply it, strangely not because of addictive potential but because of cost to the NHS (British single-payer healthcare plan).

And here comes my question. Since I was first prescribed Actavis Diamorphine For Injection BP, I've IVed a number of opiate preparations, most of which weren't meant for injection. The effects were consistent and predictable. Same with Knoll-branded Dilaudid, which (thanks to a historical quirk) is made for injection. A few nights ago, though, I tried IVing the Actavis Diamorphine. It says it's OK for injection right on the box, right? Wrong. Utter bliss for 10 seconds, painkilling effect kicks in after that, but I also got a non-itching, painless rash of the urticaria or "hives" type on the arm I injected into. This is a painkiller explicitly made for injection, yet it causes hives. What, besides the morphine, do they put in it? Is it harmful?
 
Lookup the ingredient list, you could be allergic to one of the (probably) few inert substances in it.

This just seems like a strange and insane scenario, your doc gave you intranasal heroin when you were 13. The same formula that caused you no issues up the nose seemed to cause you "hives" when injected.

You may want to consider the possibility that you either A. you messed up the injection B. contaminated your heroin or C. bacteria/something that wasn't meant to be in there got in there somehow and caused your reaction.

We can't really say what caused this from over the internet.
 
Lookup the ingredient list, you could be allergic to one of the (probably) few inert substances in it.

That's the first thing I did. Literally the only ingredient listed was "diamorphine (as hydrochloride salt)". Which is why I'm surprised.

This just seems like a strange and insane scenario, your doc gave you intranasal heroin when you were 13. The same formula that caused you no issues up the nose seemed to cause you "hives" when injected.

Not that strange. Intranasal morphine is the first thing administered when a child presents with pain in accident+emergency; Talwin, Diconal, Pipadone, Physeptone, and even Tramadol are contraindicated in children---I just kept the same meds and same ROA into adulthood, that's all. As for self-administration, well, I suppose the doc knew I was mature enough to mix and take it myself.

You may want to consider the possibility that you either A. you messed up the injection B. contaminated your heroin or C. bacteria/something that wasn't meant to be in there got in there somehow and caused your reaction.

A is possible; I did do it rather fast, and morphine's meant to be given by slow push. I doubt B or C happened.

We can't really say what caused this from over the internet.

Fair enough. For what it's worth, I've IV'ed the same Actavis Diamorphine HCl BP a few more times since then. I found that the hives develop reliably every time, last for about fifteen minutes, and that taking an antihistamine an hour before the fact prevents this. I also faintly remember having diamorphine hives when I was on a drip of it at the hospital. Which rather leads me to believe that the same "inert" ingredient occurs in every batch, whether made by Bayer, Actavis, SmaxoGlithKline, etc. In fact, I wonder if it's some poppy alkaloid or other (noscapine, perhaps?) causing my "trouble".

I put "trouble" in quotation marks because I'm not sure if the hives are harmful or not; they're not itchy or painful, just unsightly for a quarter hour or so. Still, it could be a sign of something serious, which is why I asked.
 
If it says 'diamorphine' on the amps, then it IS diamorphine, aka heroin. Assuming, as it sounds like it must be, they are medically prescribed and dispensed, then it is heroin, not morphine.

And in any case, opioids cause histamine release, I get zomorph too, and when prepped for IV, or IM, then immediately after there will be painless, but very itchy hives, especially if a little bit is missed and goes subcut. Some opioids cause much less itching than others, codeine is particularly bad, for instance, dihydrocodeine a bit less so, morphine when injected causes a great deal of itching, whilst for me at least, methadone, orally, plugged or injected, causes very very little, and fentanyl (for me at least) none.

The itching can be effectively dealt with by pre-dosing with an antihistamine, the sedating type will also help potentiate euphoria and of course, sedation/relaxation.
 
If it says 'diamorphine' on the amps, then it IS diamorphine, aka heroin. Assuming, as it sounds like it must be, they are medically prescribed and dispensed, then it is heroin, not morphine.

And in any case, opioids cause histamine release, I get zomorph too, and when prepped for IV, or IM, then immediately after there will be painless, but very itchy hives, especially if a little bit is missed and goes subcut. Some opioids cause much less itching than others, codeine is particularly bad, for instance, dihydrocodeine a bit less so, morphine when injected causes a great deal of itching, whilst for me at least, methadone, orally, plugged or injected, causes very very little, and fentanyl (for me at least) none.

The itching can be effectively dealt with by pre-dosing with an antihistamine, the sedating type will also help potentiate euphoria and of course, sedation/relaxation.

Yes indeed. Medically prescribed and obtained for ?8.50 per prescription at Boots.

What you're saying then is that it's no cause for concern? All right, that's re-assuring. Yeah, the only substance that causes the histamine release for me is the diamorphine HCl, and possibly Zomorph if I cared to inject it. Oxycodone causes itching but no hives, hydromorphone causes neither, tramadol causes a very unpleasant "electric shock to the brain" sensation, and I zone out on buprenorphine.

AFAIK diamorphine is just the diacetate salt of morphine - so I don't make much of a distinction between the two. Yeah, it's sold as Bayer? Heroin sometimes (in Germany and Britain); the Swiss have Diagesic?, the Canucks have Diacephin? and the French have Diaphorm?. Not much of a difference between those and, say, Zomorph?, except that one is Morphine (C2H3O2?HCl)2 and the other is Morphine HCl. The relative weights of one compared to the other differ, but not enough to make dosing an issue (the diacetate "feels" slightly stronger though).
 
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