Twycross Robert G
St. Christopher's Hospice, Lawrie Park Road, London SE2 6DZ, Great Britain.
Pain. 1977 Apr;3(2):93-104. doi: 10.1016/0304-3959(77)90072-0.
A controlled trial of diamorphine (diacetylmorphine, heroin) and morphine is reported in which the two drugs were administered regularly by mouth in individually determined effective analgesic doses. Elixirs contained cocaine hydrochloride 10 mg/dose; other drugs were prescribed when indicated clinically. 699 patients entered the trial and, of these, 146 crossed from diamorphine to morphine, or vice versa, after about two weeks using an oral potency ratio of 1.5/1 determined in a pilot trial. Additional medication and survival were closely similar in both treatment groups. In the female crossover patients, no difference was noted in relation either to pain or the other symptoms evaluated. On the other hand, male crossover patients experienced more pain, and were more depressed, while receiving diamorphine. In these, the potency ratio of diamorphine to morphine appeared to be less than 1.5/1. If this is allowed for, then the difference in mood is probably not significant. Compared with male patients, fewer females required a dose of 10 mg or more, but more were prescribed an anxiolytic. The ability to do without a 2 a.m. dose appeared to be related more to the size of the dose than to gender or treatment. It is concluded that, provided allowance is made for the difference in potency, morphine is a satisfactory substitute for orally administered diamorphine. However, when injections are necessary, the greater solubility of its hydrochloride gives diamorphine an important practical advantage over morphine, especially when large doses are required.
本文报道了一项关于二醋吗啡（海洛因）和吗啡的对照试验，试验中这两种药物以个体确定的有效镇痛剂量经口定期给药。酏剂每剂含10毫克盐酸可卡因；临床有指征时可开具其他药物。699名患者进入试验，其中146名患者在使用了预试验中确定的1.5/1的口服效价比大约两周后，从二醋吗啡转换为吗啡，或反之。两个治疗组的额外用药和生存率非常相似。在女性交叉患者中，在疼痛或其他评估症状方面未发现差异。另一方面，男性交叉患者在服用二醋吗啡时经历了更多疼痛，且更抑郁。在这些患者中，二醋吗啡与吗啡的效价比似乎小于1.5/1。如果考虑到这一点，那么情绪差异可能并不显著。与男性患者相比，需要10毫克或更高剂量的女性较少，但开具抗焦虑药的女性较多。能够不服用凌晨2点的剂量似乎更多地与剂量大小有关，而非性别或治疗。结论是，如果考虑到效价差异，吗啡是口服二醋吗啡的令人满意的替代品。然而，当需要注射时，二醋吗啡盐酸盐的更高溶解度使其在实际应用中比吗啡具有重要优势，尤其是在需要大剂量时。
