From the Guidelines
For patients with an allergy to oxycodone, hydromorphone (Dilaudid) is a suitable alternative, typically starting at 0.015 mg/kg intravenously, as it has a quicker onset of action and is comparable in cost to morphine 1. When considering alternative narcotics, the following options are available:
- Hydromorphone: often a good first choice, with a quicker onset of action compared to morphine 1
- Morphine: can be used, but has a longer onset of action and greater risk for dose stacking, placing patients at a higher risk for toxicity 1
- Fentanyl: a viable option, especially for acute moderate to severe pain, with a shorter onset of action and higher potency than morphine 1
- Tramadol: may be appropriate for moderate pain, but its use should be considered with caution due to potential side effects and interactions
It's essential to note that true allergies to opioids are rare, and many reported "allergies" are actually side effects like nausea or itching 1. If the reaction to oxycodone was severe (anaphylaxis, respiratory distress, or severe hives), consider consulting with an allergist before trying another opioid, as cross-reactivity between opioids is possible 1. Start with lower doses when switching to a new opioid and monitor closely for adverse reactions. Non-opioid alternatives like NSAIDs, acetaminophen, or adjuvant medications should also be considered as part of a multimodal pain management approach 1.
Some key points to consider when using opioids for pain management include:
- Regularly assessing sedation levels, respiratory status, and the possible development of adverse events in patients on systemic treatment with opioids 1
- Avoiding initial infusion of opioids using intravenous patient-controlled analgesia in opioid naïve patients 1
- Preferring infusion of opiates using intravenous patient-controlled analgesia to spinal patient-controlled analgesia in postoperative pain management whenever the intravenous route is viable 1
From the FDA Drug Label
Other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency. The answer is: Other opioids may be given for allergy to oxycodone.
- Key points:
- No particular opioids are identified as being more likely to be associated with adrenal insufficiency.
- Other opioids may be tried as an alternative to oxycodone in cases of allergy 2
From the Research
Alternatives to Oxycodone for Allergy Sufferers
- For patients allergic to oxycodone, alternative opioids or non-opioid analgesics may be considered, as the risk of cross-reactivity among opioid classes is low 3, 4.
- A study found that among patients with historical opioid allergies, 92.5% successfully tolerated readministration of opioids despite a chart-documented allergy 3.
- Another study reported 100% re-exposure tolerance rates among patients with previously documented allergy or adverse drug reaction to at least one opioid, across three opioid drug classes (natural, semisynthetic, and synthetic opioids) 4.
Non-Opioid Alternatives
- Ibuprofen is a non-opioid alternative that can be used for pain relief, and its combination with oxycodone has been shown to be effective for short-term management of acute, moderate-to-severe pain 5.
- Acetaminophen is another non-opioid option that can be used alone or in combination with oxycodone for pain relief, and has been found to be effective for patients with acute musculoskeletal pain refractory to ibuprofen 6.