Heroin [Diacetylmorphine; Diamorphine]

Neonates and infants may display expected pharmacological actions. If heroin pharmacotherapy is required, breastfeeding should be discontinued. Collaboration with the patient’s pediatrician is indicated. Heroin elicits its analgesic and CNS and respiratory depressant actions primarily by binding to the endorphin (opiate) receptors in the CNS. Heroin is converted in the GI tract to morphine (see the morphine monograph) following oral ingestion. It is first converted to monoacetylmorphine and then rapidly (within minutes) converted to morphine following intramuscular, intravenous, or subcutaneous injection. Concurrent heroin pharmacotherapy and pharmacotherapy with other opiate analgesics, sedative-hypnotics, or other drugs that produce CNS depression (e.g., antihistamines, phenothiazines, TCAs) may result in additive CNS depression. Heroin pharmacotherapy commonly has been associated with constipation and other GI complaints, including nausea and vomiting.