How do you treat an allergic reaction to Dilaudid? - page 2

by art71372

12,653 Visits | 36 Comments

If a patient is allergic (not overdosed) to Dilaudid can you treat it with Narcan or do you have to give epinephrine? Also how can you tell if they are overdosed vs having an allergic response?... Read More


  1. 5
    Quote from Meriwhen
    Yes: patient had tons of pruritis and rashes all over the body, but breathing was not impaired. All other possible causes ruled out. Treated with diphenhydramine.
    I think this was a joke because you often see a certain type of patient who is allergic to tylenol, ibuprofen, all NSAIDS, toradol, morphine, etc etc but can tolerate dilaudid just fine.
  2. 7
    As a previous poster noted, you treat allergic reactions the same regardless of the allergen. I think I can clear up a little though about a non-allergic reaction to some narcotics.

    I've had several occasions where IV morphine has caused a localized histamine release which results in itching and hives running up the arm from the IV site. We treat this in the PACU with IV diphenhydramine and it resolves quickly. I've seen this happen only one time with hydromorphone although an anesthesiologist once told me it could happen with any narcotic. It's not considered a true allergic reaction because it's not mediated by the immune system.

    I've also had patients who are on morphine PCAs develop a generalized pruritis which is treated with a small dose of naloxone or nalbuphine. The trick to remember is you want to use small doses and titrate to effect. Giving an entire dose of narcan will pretty much reverse all narcotics and leave your patient itch free but in great pain.
  3. 2
    Following surgery on his foot and ankle in 2010, my husband was given a dose of Dilaudid post-op,
    and he immediately broke out in hives and a rash. He had absolutely no respiratory issues. They
    treated his hives and rash and noted the word "ALLERGY" on his chart.

    Since then, he has been told that while it was "a quick and severe" reaction, it was most likely a
    side effect and not an actual allergy. If there ever is a next time, he'll be given another drug.
    marda and art71372 like this.
  4. 3
    Personally, I'd consider "itching" a side effect. It happens with a lot of narcotics. I'd call "hives" or "rash" an allergy. (Unless the "rash" was just redness from scratching, in which case, I don't consider that an actual "rash."
    psu_213, GrnTea, and sharpeimom like this.
  5. 0
    I remember a patient who was allergic to dilaudid, with rash and itching ( I hate the word pruritis). And was given Benadryl wil the dilaudid.
  6. 0
    Also, I take tramadol for back pain and sometime I get very itchy with no rash. I would call it a side effect. I don't consider myself allergic.
  7. 0
    Quote from hiddencatRN
    I think this was a joke because you often see a certain type of patient who is allergic to tylenol, ibuprofen, all NSAIDS, toradol, morphine, etc etc but can tolerate dilaudid just fine.
    It was a joke and a serious question, all at the same time, if that makes any sense =).

    I have actually seen dilaudid listed as an allergy, but like most, I suspect it was that the patient did not care for the side effects.
  8. 1
    Quote from art71372
    Thank you that makes sense. I was really confused because this patient who received Dilaudid was having respiratory depression and was treated with Narcan and they labeled her as allergic to Dilaudid.
    Sounds like over-sedated to me. Narcan treats over-sedation not allergic reaction.. All safety information re: this med states to watch for resp depression

    Many people do list meds as "allergies" because of the side effects. Pain meds are notorious for causing itching, antibiotics are notorious for causing upset tummy..It's not a true allergy.
    nrsang97 likes this.
  9. 3
    Quote from Meriwhen
    Yes: patient had tons of pruritis and rashes all over the body, but breathing was not impaired. All other possible causes ruled out. Treated with diphenhydramine.
    Me thinks that was supposed to be tongue in cheek, since dilaudid seems to be the narcotic of choice for many. Correct me if I'm wrong.
    GrnTea, hiddencatRN, and Altra like this.
  10. 0
    Quote from tokmom
    Me thinks that was supposed to be tongue in cheek, since dilaudid seems to be the narcotic of choice for many. Correct me if I'm wrong.
    In this instance, you are wrong

    I've seen more than my share of questionable "allergies" (they're very common in addictions and psychiatric nursing), but this Dilaudid patient was an elderly patient during one of my med-surg clinicals. Bona-fide reaction to the medication.

    Whether you want to consider it a "side effect" or "allergy" is your decision. I'll admit that my expertise is psych...but given the hives that appeared on this patient, I would consider this to be "allergy" and treat it as such.


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