Fattinger, K., Girardin, F., Rentsch, K. M., Schwab, M. A., Maggiorini, M., Pauli-Magnus, C., Kullak-Ublick, G. A., and Meier, P. J.
Background: Medical prescription of diacetylmorphine (DAM) is currently being evaluated as a treatment option for heavily dependent narcotic addicts. Because of damaged veins, DAM is frequently administered intramuscularly (i.m.) or orally. Therefore, we characterized DAM kinetics after i.m. and oral administration in narcotic addicts.Methods: 3 i.m., 3 oral and 1 intravenous DAM doses and 1 oral deuterium-labeled morphine test dose were administered to 8 heroin-addicted patients. Plasma concentrations of DAM, monoacetylmorphine (MAM), morphine and morphine-glucuronides were measured by LC-MS.Results: i.m. administered DAM (<300mg) exhibited linear DAM, MAM and morphine kinetics and resulted in sustained DAM exposures (bioavailability: 380+/-157%, mean+/-SD) and in lower and delayed peak MA and morphine concentrations as compared to intravenous administration. Oral DAM (<900mg) yielded negligible systemic DAM and MAM exposures, but was associated with linear kinetics and high bioavailabilities for morphine (67+/-19%), morphine-3-glucuronide (205+/-52%) and morphine-6-glucuronide (180+/-61%). In addition, oral DAM was absorbed more rapidly and to a greater extent than a concomitant test dose of morphine-d3.Conclusions: Based on linear pharmacokinetics, high bioavailabilities of i.m. DAM and rapid and extended morphine absorption of oral DAM, the i.m. and oral routes can be recommended as safe and feasible alternatives for medical prescription of DAM.Clinical Pharmacology & Therapeutics (2004) 75, P22–P22; doi: 10.1016/j.clpt.2003.11.083