Analgesic with codeine Allergy

UIC College of Pharmacy

September 6, 2013 – 11:03

Are There Any Alternative Painkillers for Those Who Cannot Use


What analgesics can be given to a patient allergic to codeine?

For a patient with a true allergy to codeine, the risk of cross-reactivity 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 any of these agents in a patient with a true allergy to codeine may result in an allergic reaction. Meperidine and its related congeners are phenylpiperidines, while methadone and propoxyphene are phenylheptanones. Selecting agents from a different chemical class should minimize the risk of cross-sensitivity. However, it is important to 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-inflammatory agents or acetaminophen, should be considered.

Phenanthrenes Phenylpiperidines Phenylheptanones (diphenylheptanes)
Morphine Meperidine Methadone
Hydromorphone Fentanyl Propoxyphene
Oxymorphone Sufentanil Levomethadyl
Levorphanol Alfentanil


Baumann T. Analgesic selection when the patient is allergic to codeine. Clin Pharm 1991;10:658.

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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