• Jason Kendall, Ian Maconochie, Ian C K Wong, Richard Howard, and DIASAFE study.
• Emergency Department, Frenchay Hospital, Bristol, UK.
• Emerg Med J. 2015 Apr 1; 32 (4): 269-73.

ObjectivesTo establish the safety of an intranasal diamorphine (IND) spray in children.DesignAn open-label, single-dose pharmacovigilance trial.SettingEmergency departments in eight UK hospitals.ParticipantsChildren aged 2-16 years with a fracture or other trauma.Outcome MeasuresAdverse events (AE) specifically related to nasal irritation, respiratory and central nervous system depression.Results226 patients received 0.1 mg/kg IND. No serious or severe AEs occurred. The incidence of treatment-emergent AEs (TEAEs) was 26.5% (95% CI 20.9% to 32.8%), 93% being mild. 89% were related to treatment, all being known effects of the drug or route of administration except for three events in two patients. 20.4% (95% CI 15.3% to 26.2%) patients reported nasal irritation, all mild except one moderate and one 'unknown' severity. No respiratory depression was reported. Three AEs related to reduced Glasgow Coma Score (GCS) occurred, all mild.ConclusionsThere were no safety concerns raised during the conduct of the study. In addition to expected side effects, IND can cause mild nasal irritation in a proportion of patients.European Union Drug Regulating Authorities Clinical Trial No2009-014982-16.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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