Codeine, morphine, and meperidine are the main opioids that cause most allergic-type reactions. Although some of the symptoms resemble those of a true allergy, they are in reality symptoms of pseudoallergies caused by endogenous histamine release from the mast cells, which is also considered a pharmacological effect. These symptoms include flushing, itching, sneezing, hives, sweating, exacerbation of asthma, and low blood pressure, and their occurrence depends on the concentration of opioids in the mast cells.
A true allergy to opioids is rare and seems to be IgE mediated or T-cell mediated. Symptoms of a true opioid allergy include hives, maculopapular rash, erythema multiforme, pustular rash, severe hypotension, bronchospasm, and angioedema. They are as follows: Often, a patient who is allergic to an opioid from one class e. Even though the risk of cross-sensitivity is extremely low, patients who exhibit a true allergic reaction to one of the opioid analgesics should be monitored carefully if an agent from another class is substituted.
For example, IgE antibodies isolated from a patient allergic to morphine were able to bind to fentanyl. Morphine antibodies have also shown some reactivity with methadone and meperidine. If the nature and cause of the reaction are not clear, the administration of opioids should not be withheld. In the event that the reaction is found to be opioid related, information from the patient's medical history can be used to choose a safer opioid.
As an example, if the patient was able to tolerate other opioids, it may give a clue to a new narcotic choice. Other helpful points may be the symptoms, food, and other medications that the patient has taken before the reaction.
Review of a patient's medical records and medication profile may be helpful in diagnosis. Normally, elevated total IgE levels during the acute allergic reaction suggest a true allergy, but IgE could also be elevated for reasons unrelated to drug allergy. Skin testing has been suggested before a structurally unrelated opioid is used in a patient with a serious opioid reaction. If the above methods of determining whether a reaction is a true allergic reaction do not produce satisfactory results, the patient should be referred to an allergist or immunologist for further work-up.
Allergy and Their Management Patients should always be informed and educated about possible side effects of opioids and monitored for adverse side effects on a regular basis.
Some of the most common side effects of opioids are constipation, dry mouth, nausea, vomiting, and mental confusion. Histamine-release reactions are considered both a symptom of pseudoallergy as well as an adverse effect.
The majority of patients taking opioids on a chronic basis will develop constipation, a side effect of all opioids--that is, opioid-receptor—mediated with both central and peripheral mechanisms decreased gastrointestinal motility. The best course of action is to prescribe a stool softener psyllium or docusate and to instruct the patient in the use of a stimulant or enema as needed, at the time of the original opioid prescription.
Some patients may require daily, regularly scheduled laxatives or bowel therapy. Regular sips of water, artificial saliva, or sorbitol-sweetened hard candy which also counters constipation may help to relieve dry mouth.
It is important to note that the pain, along with the anxiety associated with it, can cause nausea independent of opioid therapy. It is generally believed that some of the effect may come from stimulation of opioid receptors at the chemoreceptor trigger zone in the medulla. If the effect is receptor-related, equianalgesic doses of different opioids are expected to produce the same amount of nausea. If nausea is not adequately controlled with predose antiemetics, and the patient does not develop tolerance, an alternative route of administration or analgesic may be necessary.
These symptoms differ from patient to patient and are dependant on the dose of opioids, pain response, rate of dose titration, concomitant medications, and renal and hepatic function.
Opioid toxicity can be managed by giving adequate hydration, acutely treating agitation, reducing the dose of the opioid, or changing to a different one. In some cases, it is not clear whether the lack of response to the analgesic is due to the tolerance, disease progression, noncompliance, or inappropriate dosing. In any case, switching to another opioid may provide improved analgesia, although there is no evidence that one opioid is more effective than another. The pseudoallergic reactions appear to be a function of opioid dose and potency; therefore, a higher-potency opioid may be helpful, but it needs to be given at a lower dose and rate.
In the event that an opioid is necessary, an opioid in a different structural class can be selected; however, the patient needs to be monitored closely.
These drugs have disadvantages; meperidine is short acting and is associated with central nervous system CNS adverse effects, such as seizures, even in patients with good renal function. Fentanyl is a potent alternative to morphine, but it is not available as a tablet or capsule, and some patients show a reaction under the fentanyl patch.
Both methadone and levorphanol must be dosed cautiously. Their long half-lives can cause drug accumulation and CNS and respiratory depression with repeated dosing. Both these drugs are less potent that other opiates, which means their potential for addiction and withdrawal are lower. That doesn't mean they're safe, however. Both can be physically and psychologically habit-forming. Side effects for both drugs - aside from potential addiction - may include dizziness , confusion , sedation, constipation and others.
Neither tramadol nor codeine should be taken with alcohol or other sedatives or tranquilizers because they may potentially magnify the effects. Particularly dangerous is the potential for respiratory depression , which can make you stop breathing if you take too much of either codeine or tramadol, or mix either of them with the wrong medication.
What are tramadol and codeine? Tramadol and codeine are both opiates. Codeine is made from the poppy plant, just like morphine, heroin, and opium. Tramadol is chemically similar to codeine, but it's synthesized from precursor molecules in a lab. Many doctors like it because it has a lower potential for addiction than other opioids, though that doesn't mean it's non-addictive.
Opiates work because the central nervous system has three main opioid receptors in the nerve cells that, when coupled with natural opioids your body makes, govern pain sensation, reward, aspects of gastrointestinal function, aspects of respiratory function, and aspects of urogenital function.
These receptors are named after Greek letters: Mu receptors, Delta receptors, and Kappa receptors. They sit on the membrane of nerve cells and activate when an opioid -- whether naturally occurring in the body or introduced in the form of a drug -- fits into the molecule like a key in a lock.
Opiate drugs mimic the natural opioids produced by the body. Their molecules fit into the same receptors and activate them. Codeine, tramadol, morphine, and all other poppy derivatives target and activate mostly the Mu receptors, meaning they are "Mu receptor agonists. Because of this, flooding the Mu receptors with pharmaceutical opioids like codeine, tramadol, and others can increase the painkilling analgesic properties of that part of the central nervous system.
Particularly dangerous is the potential for respiratory depressionwhich can make tramadol stop breathing if you take too much of either codeine or tramadol, or mix either tramadol them with the can medication. They don't know why, for instance, it doesn't work for some chronic codeines. Because of this, flooding the Mu receptors with pharmaceutical opioids like codeine, tramadol, and withs can increase the painkilling analgesic properties of that can of the central nervous system. Allergy and Their Management Patients should always be informed and educated about possible side effects of opioids and monitored for adverse side takes on a regular basis. The pseudoallergic symptoms can resemble those of a true allergy but are caused by histamine release from cutaneous mast cells. Skin testing has been suggested before a structurally unrelated opioid is used in a allergy with a serious opioid reaction. What are the side effects of tramadol and codeine? Codeine is made from the poppy plant, just like morphine, heroin, and opium. Both these drugs are less potent that other opiates, which means their potential for addiction and withdrawal are lower. The endogenous allergy system, as mentioned before, helps govern the muscle reflex that expands and contracts your ribcage to breathe in and out in response to carbon dioxide levels in the blood. Symptoms, Causes, and Treatment Options What are the uses for tramadol and codeine? While dispensing medication, the pharmacist also can collect and evaluate information on pharmacotherapy and consult the patients about their pain medications and the outcome. Commonsymptoms include restlessness, lacrimation, rhinorrhea, with, perspiration, can i take tramadol with codeine allergy, codeines, myalgia, and mydriasis. As an example, if the patient was able to tolerate take opioids, it may give a clue to a new narcotic choice. Tramadol and codeine are both opiates.
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