Codeine is given for pain and is also in some cough medicine. It is an opiate that is a class of morphine-like medications. It can become habit-forming, thus requiring higher doses to achieve the same effect. Some side effects are dose dependent for some people. Codeine is often part of another drug or combined into syrup. It can be combined with Tylenol (e.g. Tylenol l3) or ASPIRIN® (e.g. Soma compound with codeine). Caffeine also may be a part of the compound. Codeine can be given orally, by injection, and intravenously. The side effects attributed to codeine include the following:
- nausea
- drowsiness
- constipation
- vomiting
These are not allergic reactions.
Allergy-like Side Effects to Codeine
Codeine will stimulate histamine in a different way from what happens in immune reactions when there is histamine release. This can happen with codeine, morphine, and demerol. This is called a pseudo allergy and is typified by the following.
- itching
- sweating
- hives (which can also be found in true allergy)
- flushing
These reactions are bothersome but do not mean a real allergic reaction. Sometimes a different dose can help. Taking Benadryl before the codeine helps as well.
True Codeine Allergy
When the immune system reacts to the drug then the body protests in a strong way with allergic reactions such as these:
- shortness of breath
- trouble breathing
- facial swelling
- swollen lips
- drop in blood pressure (hypotension)
Possible Alternatives to Codeine
If true allergy is suspected then a different class of pain medications should be tried observing for any reaction. The morphine group, which does include codeine would requiring caution require and vigilance is below.
- hydrocodone (Vicodin, Lorcet)
- oxycodone (Percocet, Oxycontin)
- hydromorphine (Dilaudid)
- talwin
- stadol
- tramadol (Ultram)
Safe Alternatives for Codeine Allergy
Non-opioids such as the following serve a purpose in alleviating pain. Tylenol and NSAIDS such as ibuprofen can be given in alternating doses so that coverage is complete. In other words, tylenol is taken every 4 hours and 2 hours later Ibuprofen is begun every 6 hours. Additional alternatives are listed below.
- Demerol (meperidine)
- Fentanyl (duragesic)
- Proporyphene (darvon and darvocet)
Concern about a false allergic reaction to codeine may be a reason needed pain medication may not be given. It is important to understand real allergic reaction and pseudo allergy in addition to the possibility of something such as food or beverage recently taken or insect bites or the illness itself as the cause of the reaction. Codeine in combination with other medications may be the cause of the reaction or the other meds themselves the cause. True allergic reactions are serious. A complete, thorough, and honest history of everything consumed is very important to avoid uncertain reactions or interactions. Codeine will show up in urine drug tests. Here is further reading about drugs' allergic reactions. or ingestion. Additional information about penicillin or sulfa drug allergic reactions can also be found in the following articles.
Sources:
What is a True Allergic Reaction to Penicillin?
What is a Real Sulfa Drug Allergic Reaction
Analgesic Options for Patients with Allergic Type Opoid Reactions. Pharmacists Letter 2006; 22(2)
Amy Andersen - Amy Andersen, MSN, ARNP, family & pediatrics certified, practices yoga and explores the inter-relationships of mind body fitness and ...
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