Allergic to Morphine Sulfate but on Hospice Care

ckh23, BSN, RN · Oct 26, 2012

Yes, clarify. Also check to see what the allergy is and the severity. There is a chance it might not be a true allergy.

tewdles, RN · Oct 26, 2012

may not be a true allergy...but even if it is you can use a liquid concentrated oxycodone 20mg/ml.

rngolfer53 · Oct 30, 2012

I would just ask for an order for oxyfast, as tewdles suggests.

Even if it isn't a true allergy, the patient/family may still not be comfortable with giving Roxanol in this case.

Why add any more stress if it can be avoided easily?

SuesquatchRN, BSN, RN · Oct 31, 2012

You can aso use Dilaudid. Why would you give something to which the pt is allergic?

akulahawkRN, ADN, RN, EMT-P · Oct 31, 2012

I would expect that the patient may be allergic to some component in all the fluid (including the morphine itself), or could be having a reaction (histamine release anyone?) to morphine administration. Benadryl might be used to combat a histamine release or you could try another medication for the pain relief. It could be that Roxanol may not generate the same histamine release as IV morphine, so... Check with the MD about whether or not it's appropriate for your patient. If you find out the answer, please let us know as I, for one, would like to know!

payang0722 · Oct 31, 2012

i came in for the morning shift, pt Respiration 44, pulse 144, clammy, the MD ordered it anyway...pt expired 4 hours after. i went home and can't stop thinking about it.

melsch · Nov 3, 2012

i came in for the morning shift, pt Respiration 44, pulse 144, clammy, the MD ordered it anyway...pt expired 4 hours after. i went home and can't stop thinking about it.

The pt was probably dying anyway, and didn't die from an allergic reaction, but we always use a lower dose of dilaudid rather than morphine if they say they have an allergy to morphine. If the patient is still able to take meds orally we sometimes get them on oxycodone, but usually it is just a direct switch to dilaudid. We find lots of people say they are allergic but when asked what their reaction is they say it makes them nauseous or sleepy, which are expected side effects and not allergies, but if the pt can't say we would err on the side if caution and use something else.