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Medical Forum / General / Pharmacy / December 2004

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Cross-intolerance between codeine and hydrocodone

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Matt Beckwith - 29 Dec 2004 20:06 GMT
Anybody have any data on the percentage of patients intolerant of
codeine who are also intolerant of hydrocodone?

I have been prescribine hydrocodone cough syrup to patients who have
codeine "allergy" for years, and have only had 2 patients have a
problem with the hydrocodone.  That's such a small percentage, that I
suspect their intolerance of hydrocodone is just a coincidence (that
is, that it has nothing to do with their intolerance of codeine).
Heaven knows, there are lots of patients who can't take hydrocodone.

Recently I prescribed hydrocodone to a patient who has an intolerance
to codeine.  I told him that it's possible but unlikely to have an
intolerance to hydrocodone.  The pharmacist told him that hydrocodone
is "a derivative of codeine", and that there's a possible problem.

Of course, this put the idea into his head, and he had a side effect of
the hydrocodone.

On the other hand, if my personal experience is not indicative of the
actual percentage of cross-allergies, then I'll start prescribing
differently.

Thanks.
Matt
Timbertea - 30 Dec 2004 00:28 GMT
Matt,

I think you are going to have to do a better job interviewing...

Most people who say they are allergic to codeine simply get bad side
effects like: nausea, itching, hot/cold flashes & sweating...IE: Typical
opioid drug side effects.  They may indeed not be able to tolerate
codeine, at least not without taking something for nausea, but they
aren't truly allergic to it, they also may not have liked the dysphoric
head effects, or felt it didn't give them very good relief, it also has
a reputation as a rather weak drug.  You need to ask them what
specifically happened when they took it. Did they break out in hives?
Trouble breathing? Rashes? ...etc things that would indicate a true
allergy.  I don't know the percentage of true cross reactions, one of
the Rph's here probably will.

There are people out there who simply don't want it again and just list
it as an allergy for that reason. While not completely honest with their
doctor, if they had a miserable time with it before that is probably
good enough reason to use something else.

Then you come across the folks who are allergic to everything but
dilaudid injections, and that is a different problem. >G<

> Anybody have any data on the percentage of patients intolerant of
> codeine who are also intolerant of hydrocodone?
[quoted text clipped - 20 lines]
> Thanks.
> Matt
Matt Beckwith - 30 Dec 2004 03:08 GMT
> Matt,
>
> I think you are going to have to do a better job interviewing...
>
> Most people who say they are allergic to codeine simply get bad side
> effects...

Yeah, I think you're right.  If the patient had anaphylaxis to codeine
then prescribing hydrocodone is risky.  But a little nausea, what the
heck, it's worth the risk to relieve their cough.
Thanks for the feedback.
Tom Malcolm - 31 Dec 2004 02:30 GMT
> then prescribing hydrocodone is risky.  But a little nausea, what the
> heck, it's worth the risk to relieve their cough.

What I've found about Codiene is it's a anti-fun drug -
if you take it for fun, it causes itching and other not
fun side effects. If you take it when in bad pain, all it
does is kill the pain - but it lasts not too long.
 
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