By Curtis Alexander, Pharm.D.
Summary: A true codeine allergy is actually rare. Most patients have what could be called a intolerance to codeine – meaning they get an upset stomach. If you have a true allergy to codeine than your chance for having allergy to other pain killers rises. The actual rate at which your risk will increase isn’t easy to determine.
Dear Curtis: In the past my doctor prescribed Tylenol #3. It made me sick including hives, nausea and it closed up my nose and throat. Now, my doctor has prescribed Lortab and I’m wondering if I’m going to run into the same problems?
My Answer: I get patient’s all the time who claim a codeine allergy but who really don’t have a true allergy. Right off the bat, it sounds like you have a true allergy to codeine. In other words, the hives and ‘closing up’ of the nose and throat are hallmark signs. That’s opposed to a codeine intolerance which basically means that you don’t tolerate codeine well and it upsets your stomach. If codeine truly causes an allergy like this it’s classified as an anaphylactoid reaction and can be very serious.
I’m assuming that your doctor knows well what happened last time when you took codeine. That’s very important because if he or she doesn’t know it may very well change the fact that he prescribed Lortab.
As you may already know Lortab is the brand name for a combination of hydrocodone and acetaminophen. Tyelonol #3 is the brand name for codeine with acetaminophen. If you are truly allergic to codeine it’s important for you and your doctor to know that codeine is closely related to hydrocodone. In fact, codeine is the starting point, chemically, for a number of different pain killers on the market – hydrocodone being one of them. So, consider hydrocodone and codeine ‘cousins’ if you will. In practical terms, this raises the chance of what is called cross-reactivity. Meaning you can be allergic to a drug that closely resembles another drug. In this case hydrocodone and codeine.
I can’t give you numbers or what your absolute risk is – but a risk exists and I would caution you and your doctor to tread lightly. At the very least it might be wise to try your first dose in the doctor’s office and wait for at least 1/2 hour just to see how you react.
