No, I'm not joking.

[NecessaryCatharsis]

Interesting.
From personal experience I am not allergic to codeine the same way, but still won't take it. 1/3 of a regular person dose and I am basically in a coma for 6-7 hours or so. Like actually couldn't wake up or respond, would have to be dragged out of building in case of fire kind of state.

[Minflick]

I have a hypersensitivity to codeine. I've been given it twice, once when I had my wisdom teeth out, and again when I sliced my hand open. Stuff depresses my breathing to the point where I start to pass out, and then gasp and breath. I demand other stuff these days...

[OneMoreTime]

I somtimes wonder if MDs actually read what they prescribe. I work as a pharmacy tech and we received an RX that stated "place one tablet in each nostril".

[wolfie]

Bonus points if the medication in question is in liquid form, so there ARE NO TABLETS to be placed in the nostrils.

[Shalom]

Not quite. Morphine and Codeine are two similar molecules, but are different enough that a person can be allergic to one and not the other.

*Stop reading if you don't care about chemistry*

They are both derivatives of the heroine molecule.

It's kind of the other way around, actually. Morphine (and codeine) is the natural product, derived from opium; heroin is the diacetylated derivative of it. Good quality opium is 10% morphine and about 2% codeine by weight.

(Codeine is monomethylmorphine (CH₃-O-R, where R=C₁₇H₁₇NO₂). What you've described is monoacetylmorphine (CH₃-C(=O)-O-R), which is a different beast altogether: much more potent, for one thing.)

I'd think that if you were truly allergic to morphine, you probably shouldn't take codeine either, as morphine is one of the metabolites of it.

However, it should be pointed out also that one of the side effects of the opiates is to directly trigger release of histamine, so it's possible that a patient may be experiencing what looks like an allergic reaction, but in fact it's a different pathway that doesn't involve IgE, thus not actually an allergy. Which means that other drugs in the class might not be contraindicated, which they would be if it was an actual allergy.

Way back when I volunteered in a hospital, standing orders were than any time a patient was on morphine, two vials of Benadryl and two ampules of naloxone were at the bedside; the first to counter the histamine release (itching, etc.) and the second in case of an overdose. We ordinarily didn't like to have drugs go out of date, being kind of a waste, but the naloxone was an exception: every two ampules that got outdated meant one more patient that didn't OD...

[Seshat]

That's scary. I have anaphylactic reaction to morphine, now I'm wondering what else it is in with a different name. I just assume hospitals would know (my drugstore also has that on my file I think).

If you want to, go to your drugstore some time when the pharmacist is likely to not be busy (make an appointment if you like). Sit down with the pharmacist and discuss the anaphylactic reaction, potential other drugs that might cause it*, generic and brand names of those.
Also, precautions that can be taken to protect you, in case you do have an anaphylactic reaction to a drug. Such as the precautions Shalom just mentioned.


* Morphine is part of a large family of painkillers (with other effects), called opiates. There are also synthetic opiates, called opiods, which are similar in molecular structure and thus might (or might not) also cause the anaphylaxis.
(Um. opiates/opiods might be the other way around. Either way, two large families of useful painkillers.)

Sadly, the only way to know for certain is probably to give you a controlled dose of each substance and see if you react. Which I DON'T recommend!

[EricKei]

phlebotomist (sp?)

I do believe it's spelled "vampire"

[Luna Baby]

(Codeine is monomethylmorphine (CH₃-O-R, where R=C₁₇H₁₇NO₂). What you've described is monoacetylmorphine (CH₃-C(=O)-O-R), which is a different beast altogether: much more potent, for one thing.)

I'd think that if you were truly allergic to morphine, you probably shouldn't take codeine either, as morphine is one of the metabolites of it.

However, it should be pointed out also that one of the side effects of the opiates is to directly trigger release of histamine, so it's possible that a patient may be experiencing what looks like an allergic reaction, but in fact it's a different pathway that doesn't involve IgE, thus not actually an allergy. Which means that other drugs in the class might not be contraindicated, which they would be if it was an actual allergy.

Question for the knowledgeable one....I am allergic to codeine (hives, trouble breathing, etc.) You mention above that morphine has a metabolite of codeine within it. If my medical records specifically state that I am allergic to codeine, should I not steer clear from the morphine as well? I ask because I was given morphine after the delivery of my first child. I did have a reaction that I was told was common (hives/itching). I also refused a second dose. Four years later when I delivered my 2nd baby, I specified no narcotics afterwards for fear they'd try and give me morphine again. I didn't notice any respiratory issues when given the morphine, just the hives and extreme itching.

[Shalom]

Codeine is converted into morphine in the body; if you've experienced allergic reactions to codeine, it's very possible that what you're actually allergic to is the morphine which the codeine turns into after you take it. Thus it would probably be a good idea to avoid morphine in the future.

(Again, it could be a direct trigger of histamine release, which isn't IgE modulated and thus not officially defined as an allergy. It's treated the same way, though, so the difference is moot.)

OK, there is one more difference. As seshat pointed out above, you might not be allergic to other opioids whose metabolic pathway does not involve actual morphine. If you were truly allergic to morphine, there might be other opioids that you couldn't take, because they all have similar chemical structure, just different side chains; if you were only experiencing histamine release, other opioids might still be safe. See this publication for more details.

[Seshat]

If you're allergic to any medications, PLEASE see a pharmacist (or doctor, or nurse, etc) who can take your personal medical information, become familiar with your individual case, and then give you personal, individual advice.

[Sapphire Silk]

If you're allergic to any medications, PLEASE see a pharmacist (or doctor, or nurse, etc) who can take your personal medical information, become familiar with your individual case, and then give you personal, individual advice.

Absolutely.

Whenever I change pharmacies, the pharmacist questions how I can take codeine when I'm allergic to morphine, for the exact reason Shalom described above. Except that my morphine allergy isn't a true allergy. It's an adverse reaction: actual morphine makes me very anxious; I think I'm going to stop breathing and I have a panic attack. There used to be a time when health care providers didn't want to hear the difference between allergy and adverse reaction so they always put it down as an allergy. Now they are required to ask about what actually happens when I take certain drugs, and that's made my life easier explaining what I can't take and why.

I can't take morphine because of panic attacks. Ditto for compazine (a nausea drug).

I avoid Phenergan because it gave me a terrible phlebitis once.

I'm actually allergic to hydrocodone (Vicodin, Norco, Anexia) and oxycodone (Percocet): my throat will swell shut.

Demerol gave me a rash last time I got it; given my reaction to the above two, it's likely a true allergy and not a histamine reaction.

Tetanus made my arm swell, get red and itchy. So I don't take chances when I need a booster: my doc puts me on prednisone and Benadryl just in case.

I keep a record of all that whenever I see a new doctor so they understand what happens with my body when I take certain drugs, and I also talk it over with the pharmacist when I change pharmacies.

Write it all down: the name of the drug and what happens when you take it. That will help your providers decide if something is safe for you or not.

[Luna Baby]

I make sure to note with each of my doctors (primary, ortho, dentist,and gyn) as well as my pharmacy what my allergies are. However, that doesn't always prevent the prescribing nor the filling of medications that I'm allergic to. I make it a point now that unless a narcotic is absolutely necessary, I refuse unless/until I can know exactly what I'm taking. I had a dentist pull a couple of wisdom teeth and prescribe Tylox. Being young and relatively inexperienced, I knew no different until I started having a reaction very similar to the codeine reaction. When I called the office to see what it was they had given me, their response was, "Oh, it's synthetic codeine. You should be fine." I'm not finding anything online that states that it is a synthetic version, but none the less that particular drug gets noted as well now. I also noted my file with my allergy (including the big red sticker) when I worked for the doctor. After I left that job, I came back for a sick visit and the doc wanted to prescribe a codeine based cough syrup. I mentioned my allergy and we looked and my file had been altered after I left. I ALWAYS discuss my allergy anytime there is a discussion of an RX with any of my doctors.

Was mainly curious about the how's/why's of the codeine vs morphine reaction. I think it has been explained fairly well.

[mathnerd]

It's kind of the other way around, actually. Morphine (and codeine) is the natural product, derived from opium; heroin is the diacetylated derivative of it. Good quality opium is 10% morphine and about 2% codeine by weight.

(Codeine is monomethylmorphine (CH₃-O-R, where R=C₁₇H₁₇NO₂). What you've described is monoacetylmorphine (CH₃-C(=O)-O-R), which is a different beast altogether: much more potent, for one thing.)

I'd think that if you were truly allergic to morphine, you probably shouldn't take codeine either, as morphine is one of the metabolites of it.

However, it should be pointed out also that one of the side effects of the opiates is to directly trigger release of histamine, so it's possible that a patient may be experiencing what looks like an allergic reaction, but in fact it's a different pathway that doesn't involve IgE, thus not actually an allergy. Which means that other drugs in the class might not be contraindicated, which they would be if it was an actual allergy.

Way back when I volunteered in a hospital, standing orders were than any time a patient was on morphine, two vials of Benadryl and two ampules of naloxone were at the bedside; the first to counter the histamine release (itching, etc.) and the second in case of an overdose. We ordinarily didn't like to have drugs go out of date, being kind of a waste, but the naloxone was an exception: every two ampules that got outdated meant one more patient that didn't OD...

Oooops. Sorry. My organic chemistry classes were 20 years ago. Somewhere along the way I must have mixed those up. Remind me next time to consult my better half, the biophysicist/biochemist/pharmaceutical researcher to confirm details before I make an idiot out of myself.

ETA: I do have an adverse reaction, not a true allergy to codeine, but I can take morphine and synthetic codeines just fine. It's weird.

[Sliceanddice]

Well, morphine is the generic name. There are some formulations that have other names, but a pharmacist would pick up on that quick. I often have to explain why I can take codeine when I'm allergic to so many other opioids, but that actually does not bother me: the pharmacist is doing his job by asking me about that.

funnily the only painkiller i have adverse reactions to is codeine. it wont kill me, i think, just make me wish i was dead what with wreaking marry havoc on my digestive track and making me vomit to the point of dehydration. vicodin though i can handle.