Tuesday, March 28, 2006

You're not Allergic To Codeine

I can say that with over 99% confidence, as a real allergy to codeine is about as common as a customer that is aware they have insurance and has the proper card available to help me file a claim. Or an insurance reject message that actually has something to do with why a claim is being rejected ("missing/invalid alt bin variable code est. error" doesn't do a lot to point me in the right direction insurance industry), but I digress. You're not allergic to codeine.

I can hear the howls of protest now. I don't know why, but people seem to be proud of their allergies. It makes them feel special, like they are getting some sore of extra care or attention by making their doctor write for Toradol ( a med far more nasty than any offspring of Narcos) instead of a short course of Vicodin. Ask most people who swear on their mothers grave they are allergic to codeine and anything even distantly related what it does to them however, and the most common answer you'll get is it makes their tummy hurt. Well eating Spam (the so-called food, not the e-mail trying to cut into my Viagra sales) makes my tummy hurt, but I'm not allergic to Spam, my tummy just doesn't like it, and your tummy just doesn't like codeine. Chances are we could coax your tummy into tolerating it by having you take it with food and/or an antacid, but most of the time I know not to even bother. Given a choice between feeling special and enduring extra pain, most people will take the pain.


Otis said...

My favorite...and I've heard it, as I'm sure you have as well...

"don't use that local with epinepherine in it 'cause it makes my heart beat fast."

Anonymous said...

Im allergic to Codeine. I itch and get hives where i scratch. Very bad hives. Although, I will still take them recreationaly. The high is worth the itch. it reminds me of scratching when im on oxy only much more intense and I get HIVES. Still worth it. Unless I die from it i guess.

Anonymous said...

I laugh when people think they are allergic to codeine. My fiance truly is. I didn't believe her until she jumped out of bed in the middle of the night, ran into the closet and shut the door. About half a minute later, I call her name and knock on the door.

"Is he gone?"

"Is who gone?" I ask.

"My ex-husband"

"He was never here" I say.

I go to get a cup of water and find her not in the bedroom when I come back out. After some searching, I discover that she's in the living room on the couch. In the dark.

"What's going on?" I ask

"We should go to bed pretty soon" She replies.

I'm pretty scared by this point. I get down on my knees in front of her and ask her what she's talking about. At this point she bows her head and starts crying.

A few minutes into this, she asks me if we just had a fight.

I'm completely confustipated now... I ask her why she thinks that. She says that we must have. "Why else would I be on the couch crying and you are at kneeling at my feet?"

She "woke up" at some point when she was crying.

Apparently, she hallucinates when she's on a codeine derivatives. Needless to say, we got a different script for her the next day...

Never seen anything like that before and I hope to never see it again.

Anonymous said...

The last time I was given Codeine, injected into my IV after an operation, I ended up on the floor, dragging my IV line and catheter while I went into anaphlactic shock. Luckily I had a roommate who was able to summon the nurses quickly.

I had told my doctor that I was allergic to Codeine but he, like you, thought I was mistaken.

This wasn't the first time I was "accidentally" given Codiene.
And each time, the reaction got worse.

I've learned to announce my allergy whenever I end up in the emergency room, and the next time I have to have an operation I've sworn I will write it on my skin in indelible marker.

Anonymous said...

Drugmonkey - Does it make you feel big and proud inside to put down people's lack of medical knowledge and make spam jokes about a serious topic that people are concerned about?

If someone takes codeine, and ends up itching, hallucinating and vomiting, unable to eat/drink or smile, who are you to put them down.

Let me tell you something... the reason people like myself announce their allergies (or 'bad reactions' if it makes you feel better) to the pharmacist is that when already in enough pain to request such strong pain killers - they're rather not end up in copious amount of pain over the toilet. And because pharmacists, as you pretend to be - should have the brains to produce a similar product which will do the job without the side effects.

People aren't proud of their allergies - they're cautious, as they should be.

Lauren Ragan said...

As a future pharmacist (Class of 2013), I can definitely agree with DrugMonkey, that the majority of the public have NO clue what a true allergy is (anaphylaxis). Taking a med and having it upset your stomach is not a TRUE allergy, anyone who has had medical training can attest to this. A true allergy is one that will cause the immune system to react. Here is a link to webmd that will explain what a true allergy is, notice that nausea and vomiting are not on there.


Also, you should have more respect for pharmacists. We do the best we can to ensure that people safely and properly take their prescription medications and also 1000s of over the counter medications.
While some of DrugMonkey's remarks may have been somewhat rude, he has a good point. Most people when asked about what their allergies are and what types of reactions they have, do not have a true allergy, it is simply uncomfortable. When the pharmacist tries to explain this, the public will argue and not believe someone who has had at least 6 years of extensive college coursework plus however many years of real world experience.

This is why it is one of the most trusted professions and the job market for pharmacists is still increasing in spite of a bad economy.

Anonymous said...

Anonymous with the fiance that freaked out... this is NOT an allergy. Allergy = IgE mediated response from the immune system, histamine release, anaphylaxis. Some opiate naive people have reactions to opiates that include hallucinations. This does not equal an allergy though! Rash, hives, swelling, profound drop in BP - THESE are symptoms of an allergy.

As for the person who is upset with DrugMonkey - it's fine.. you want to declare your allergies when you get into the hospital, that's good self advocating for you. The serious harm occurs where you tell the MDs you have an allergy to penicillin or some other antibiotic (because it gave you diarrhea or nausea) and trusting that it may be a REAL allergy, they avoid giving you that drug and others in it's class leading you to receive second rate care. Or worse, an antibiotic that should be saved for only desperate cases is now being given to you and others with this documented "allergy" and leading to bugs being resistant to these drugs when they shouldn't have been used in the first place... all because you swear you have a drug allergy to avoid diarrhea.

I side with DrugMonkey 100%. I had a patient last week call in and tell me he was allergic to prednisone. Yeah, ok buddy. Well, considering we'd give you prednisone to treat that "allergy" I guess you're screwed. ;)

Anonymous said...

I would love to have codeine but the last time i had it i got hives that started on my stomach then spread to my limbs. followed by hot flashes and then once i was all sweaty i got the chills. i couldn't hardly talk because it took all my control to breath. That was from half a Tylenol 3. On the plus side my back didn't hurt anymore

Anonymous said...

I know this is a very old post, but I couldn't help commenting on this. Yes, pharmacists and doctors have a lot of education and training. Yes, they have far more understanding of these matters than the average individual. Yes, they deserve respect for the help they provide. But, no, that does NOT give them the right to act like a pompous jackass who thinks they know more than every individual who comes to them.
I learned about a few of my pharmaceutical peculiarities by personal experimentation like a reckless teenager. Having grown up with family in the medical industry, it wasn't exactly rocket science to figure out that my itching and mild hives were a histamine reaction and my feeling lightheaded was most likely a result of BP fluctuation. When I was admitted to the ER a couple of years later and specifically told my doctor that I was allergic to codeine, he had the same reaction you did- he said, "Riiiiight. Most people who think they're allergic really aren't, so we're just going to give you a script for Phenergan-codeine and see how that works for now." Against my better judgment, I had the prescription filled and tried the first dose. Only to have an even worse reaction than my first bout, with hot, itchy hives that covered my whole body this time and fainting from the drop in blood pressure. I immediately went BACK to the hospital to show him how "not allergic" I was, at which time he wrote me two new prescriptions for promethazine and ibuprofen to be taken together. Despite its inexplicable popularity with rappers, I will certainly be happy to never see another bottle of that Satan's piss for the rest of my life.
What strikes me as odd, though, is that I have no noticeable adverse reaction to hydrocodone. However, my experience with the phenanthrene class of opioids is limited to codeine and hydrocodone, so it's possible that one or the other is just a fluke. As I mentioned earlier, I have a few peculiarities when it comes to pharmaceuticals, including a fairly high tolerance for analgesics (which raises many eyebrows from doctors and pharmacists alike,) an allergy to synthetic estrogens, and zero response to the brand name Xanax (either for intended or recreational purposes) but do respond to generics.
Sadly, the incident I described and a few others like it are just a handful of the several occasions on which my trust in the allopathic medical system has been damaged. Another incident about a year later almost destroyed what little faith I have in doctors altogether. Some times, you need to get off the high horse of a degree and recognize that, once in a while, a patient just might know what they're talking about.

Alice said...

Hey, I'm special too! I have weird reactions to things it shouldn't be possible to be allergic to. I also have an immunologist who gets paid to listen to me whine and watch me scratch, so I'll spare you the fascinating details. Besides, I get the impression you wouldn't treat my personal info with the solemn reverence to which I'm entitled. ;)

Anonymous said...

Wish there was a location instead of "note" section for severe reactions which are not necessarily "allergies" but would prevent taking that medication again. The only place on a form whether it be hospital, dr , or pharmacy is Allergy. I know, I know, I've had pt's tell me they can't take penicillin, because it doesn't work, or their mother is allergic to it!! Just an idea for all those medical computer programmers out there!!