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What analgesics can be given to a patient allergic to codeine?
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For a patient with a true allergy to codeine, the risk of cross-reactiMty with another opioid can be
reduced if an analgesic from a different chemical class is used. Chemically, there are three
classes of opioid analgesics:phenanthrenes, phenylpiperidine, and phenylheptanones.
Morphine and its related opioids, including codeine, are in the phenanthrene class. The mixed
agonist-antagonist agents (buprenorphine, nalbuphine, butorphanol, pentazocine, and dezocine)
are also included in the phenanthrenes. Use of anyof these agents in a patientwith a true allergy
to codeine may result in an allergic reaction. Meperidine and its related congeners are
phenylpiperidines, while methadone and propoxlphene are phenylheptanones. Selecting agents
from a different chem ical class s hould m inim ize the risk of cross-sensitivity. However, it is
importantto note that use of an opioid from a different chemical class does not eliminate the risk
of an allergic reaction. For patients with severe or life-threatening reactions, nonnarcotic
analgesics, such as nonsteroidal anti-inllammatoryagents or acetaminophen, should be
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Phenylheptanones
(diphenylheptanes)
Phenylpiperidines
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Hydromorphone
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lpropoxyphene
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Oxycodone
Buprenorphine
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Pentazocine
Dezocine
References
Bau m ann T. Analges ic
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election when the patient is allergic to codeine. Clin pharm
1
991
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0:65g.
Hebel sK. Drug Facts and comparisons. st. Louis:Facts and comparisons.2000
Koo P. Pain. In:Young YE, Koda-Kimble MA editors. Applied Therapeutics:the clinical use of
drugs. Vancouver (WA): Applied Therapeutics.
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