"So just to clarify, he has a morphine allergy and I want to make sure you're giving him Oxycodone ER instead of Oxycontin because it has less morphine in it"
**Crickets**
Ok, now that you have probably read that three or four times, I will start by saying, What. The. Fuck.
It took me several explanations for me to explain to her that Oxycontin and Oxycodone contain no morphine in it. She kept reiterating that her computer software was telling her that the morphine allergy was triggering a 'big warning' about an allergic problem to Oxycodone. Thus, she said, Oxycontin must contain morphine.
This was from a CNP out of a major hospital working through a major pain clinic.
Ok ok ok, I'll ask the question the rest of you are already asking in your head.
HOW THE FUCK DO YOU FIGURE THAT MORPHINE = OXYCONTIN???
I mean seriously. I can understand maybe not knowing what Kadian is or something because it is relatively obscure, or at least is so in my area. But how in the hell do you not know what Oxycontin is?
I could ask any crackhead on the street what is in Oxycontin and they would answer correctly. It is one of the most used, and probably most abused, C-II narcotic on the market.
And you don't know what's in it? And you PRESCRIBE for it? And you work in a PAIN CLINIC?
Are you fucking kidding me?
To be fair, she was a rather sweet CNP, but I don't think I can excuse something like that. She wasn't new either, she eluded to the fact she hadn't been in school for quite sometime.
I'm just in shock, utter and complete shock. Anyone else see a problem with this?
16 comments:
Works for me. But that's not why I don't use Percocet.
I don't prescribe Percocet because, ya know, my patients are allergic to the Aspirin in it.
;-)
wv: lyosoppe- "Git yer lyosoppen ass in dere and tell dem the cat knocked my Vicodin down the sink, again."
Oxycodone and morphine may be two different drugs, but oxycodone is a morphine derivative. Look up the structures on Wikipedia - there's actually a pretty severe cross-reaction because they are almost the same thing.
So yeah, if someone's allergic to morphine, they're likely to be allergic to oxycodone as well. Fentanyl should be recommended instead since the structure is so different.
Oxycodone =/= morphine, and maybe the nurse should realize that, but the cross-allergy is very real and the nurse has a really good point. I hope the patient didn't get the oxycodone, is all I'm saying.
True allergic cross-sensitivity between opioid analgesics is rare especially between naturally occurring and semisynthetic opioids. Going from a naturally occurring opioid (morphine) to a semisynthetic like oxycodone is commonly done and perfectly reasonable. Both opioids are from the phenanthrene class but oxycodone lacks a morphine related structure that includes a 6-hydroxyl group.
I have no idea where the above poster got the idea that it is common to have a cross-sensitivity between the two opioids, that statement is not based on any shape/form of clinical evidence...(I welcome any quality evidence you have on the matter though).
I thought allergy to Oxycodone was rocking horse dung rare anyway. I just checked on the Brit web site where reports of ADRs are collated. 750 reactions of one sort or another to Oxycodone reported. 2 Allergic reactions, nos, and one report of an anaphylactic reaction. None of the three were fatal.
I obviously should have made myself more clear.
Reading back what I said above, I didn't specify that my line of thinking was in someone with a true morphine allergy, not someone affected by morphine's histamine release.
I know that a true allergy isn't common, and that the patient's probably just affected by the histamine in this (and nearly every) case, but if he's truly allergic to morphine, he'd likely be allergic to oxycodone as well. Erring on the side of caution, I suppose.
Are there cross-reactions here? Like between Oxycodone, Oxymorphone, and Oxygen?
Maybe she was confusing Oxycontin with MS Contin?
Well there you are; as the PI lawyers frequently point out between any two doctors you will get at least three opinions.
As for me, if a patient showed histamine release symptoms & signs with morphine, I would want to try a test dose before prescribing any other opiate with similar structure. But it simply isn't that common a problem.
I probably should add that the Oxy was not new.
He had been on Perc 5/325 for breakthru pain and they were titrating him down from Oxycontin 60mg TID dosing. He had been on this schedule for about the last two months or so.
Rotating Intern,
Any data backing up the your statement of "severe cross reaction" and "very real" in reference to cross-hypersensitivity between morphine and oxycontin? I did a quick search and could not find any data.
Theoretical assumptions are fun and all but often do not translate into what goes on in clinical practice.
I will track down the pain management clinical pharmacist next week to get an expert's take on the subject. I am still not convinced this is anymore than hand waving and medicinal chemistry connect the dots assumptions.
But then again I am proved wrong on a daily basis.
IDresident - I didn't find any substantial data, either; a case report here and there, but not much else. To be honest, that's just what I was taught by a clinical pharmacist who taught a lecture on opioids - as she had much more experience than I on the matter and was very adamant on the cross-reactivity, I took it to be a pretty big deal! Perhaps I unknowingly was taught by a handwaver?
I don't mind being proven wrong, either - it will be interesting to get the POV of your pharmacist as well and add to the discussion.
oxycontin gets metabolised to morphine u nub
Anon - No it doesn't, it even works on different receptors.
But bravo on missing the entire point of the post
Curiously enough, some research shows that oxycodone works on mu receptors (like morphine) in some cases and on k receptors in others.
Oxycodone does get metabolized to morphine.
Go and educate your dumbass.
http://paincenter.wustl.edu/c/BasicResearch/documents/KharashClinPharm06.pdf
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