Adverse Drug Reaction - Could This Be Malpractice?

[CaliforniaMom]

Hi Everyone,

I have a question for you. Not that I intend on filing a suit, I just would like to know.

I had some dental work done last week where my dentist sent me to an Endodontist. I filled out all of the prerequisite medical forms, etc, etc. and indicated that I am extremely allergic to morphine. After the procedure was completed, the endodontist gave me a prescription for Tylenol #3 (w/ codeine). After about 8 hours, I began to have a horrible reaction to something and ended up in the hospital emergency room in the middle of the night. After doing some research after my release, it seems that codeine converts to morphine in your body when breaking down, I would think signaling that I should not have been given anything with codeine to begin with. This caused me to be out of work for more than a week, several rounds of steriod treatments, etc. I can't be sure whether the medical insert that I received contraindicated people with morphine allergies, but doing a google search, I found the above information. I've not taken codeine in the past, but when doing dental work previously, my previous dentist gave me vicodin or motrin 800. Because I was drugged, my sister took me home and filled the prescriptions for me. I had no idea even what I was taking (besides an antibiotic) until I was coherent several hours later.

What's your take on this?

P.S. I'm in California

[seniorjudge]

Hi Everyone,

I have a question for you. Not that I intend on filing a suit, I just would like to know.

I had some dental work done last week where my dentist sent me to an Endodontist. I filled out all of the prerequisite medical forms, etc, etc. and indicated that I am extremely allergic to morphine. After the procedure was completed, the endodontist gave me a prescription for Tylenol #3 (w/ codeine). After about 8 hours, I began to have a horrible reaction to something and ended up in the hospital emergency room in the middle of the night. After doing some research after my release, it seems that codeine converts to morphine in your body when breaking down, I would think signaling that I should not have been given anything with codeine to begin with. This caused me to be out of work for more than a week, several rounds of steriod treatments, etc. I can't be sure whether the medical insert that I received contraindicated people with morphine allergies, but doing a google search, I found the above information. I've not taken codeine in the past, but when doing dental work previously, my previous dentist gave me vicodin or motrin 800. Because I was drugged, my sister took me home and filled the prescriptions for me. I had no idea even what I was taking (besides an antibiotic) until I was coherent several hours later.

What's your take on this?

P.S. I'm in California

Who told you that codeine converts to morphine in your body?

[rmet4nzkx]

If you have a known documented drug allergy then your pharmacy records should also be flagged, then the pharmacist can call the prescribing doctor for a different Rx. Sometimes it is not an allergy per se but rather a hypersensitivity or collateral reaction to the combination. If you have taken Vicodin in the past without problems then Tylenol with Codeine should not be a problem, in combination with another Rx may affect the metabolism of either Rx and cause an adverse drug event. Your sister should have consulted with the Pharmacist when filling your script.

[lealea1005]

If you have a known documented drug allergy then your pharmacy records should also be flagged, then the pharmacist can call the prescribing doctor for a different Rx. Sometimes it is not an allergy per se but rather a hypersensitivity or collateral reaction to the combination. If you have taken Vicodin in the past without problems then Tylenol with Codeine should not be a problem, in combination with another Rx may affect the metabolism of either Rx and cause an adverse drug event. Your sister should have consulted with the Pharmacist when filling your script.

You beat me to it, Rmet! OP, what other medications, if any, were you taking?

[CaliforniaMom]

You beat me to it, Rmet! OP, what other medications, if any, were you taking?

At the time of the procedure, I had only been taking penicillin for a possible infection in the tooth/gum. The pharmacy does have in its records that I am allergic to morphine, however, I had never had an adverse reaction to codeine or vicodin. I just happened to be looking through my purse at work today and found the instructional insert with the prescription. It doesn't indicate anything about not taking codeine if you are allergic to morphine, simply that those having an adverse reaction to hydrocodone, codeine or vicodin (and the likes) should not take this medication.

[CaliforniaMom]

Who told you that codeine converts to morphine in your body?

Seniorjudge,

The first person I heard it from was the pharmacy assistant after needing to go back to fill prescriptions for the allergic reaction. That prompted me to the net, where I found "The conversion of codeine to morphine occurs in the liver and is catalysed by the cytochrome P450 enzyme CYP2D6. CYP3A4 produces norcodeine and UGT2B7 conjugates codeine, norcodeine and morphine to the corresponding 3- and 6- glucuronides. " That I found on a medical site (I know we aren't supposed to provide links) and that's what's prompting my question.

I didn't die (obviously) so I'm not looking to make a buck off of anyone, I'd more like to make sure this doesn't happen to me again and figure out whether anyone (dentist, endodontist or pharmacist) should have been aware.

[deadlock]

Seniorjudge,

The first person I heard it from was the pharmacy assistant after needing to go back to fill prescriptions for the allergic reaction. That prompted me to the net, where I found "The conversion of codeine to morphine occurs in the liver and is catalysed by the cytochrome P450 enzyme CYP2D6. CYP3A4 produces norcodeine and UGT2B7 conjugates codeine, norcodeine and morphine to the corresponding 3- and 6- glucuronides. " That I found on a medical site (I know we aren't supposed to provide links) and that's what's prompting my question.

I didn't die (obviously) so I'm not looking to make a buck off of anyone, I'd more like to make sure this doesn't happen to me again and figure out whether anyone (dentist, endodontist or pharmacist) should have been aware.

The liver is a complex organ that breaks down ingested by-products in order to excrete them. It is not where anything is prepared, broken down or metabolized for "REABSORBTION". In other words your attempt to understand a drug reaction by studying the how your liver breaks down codeine is waste of time.

[CaliforniaMom]

The liver is a complex organ that breaks down ingested by-products in order to excrete them. It is not where anything is prepared, broken down or metabolized for "REABSORBTION". In other words your attempt to understand a drug reaction by studying the how your liver breaks down codeine is waste of time.

Deadlock,

I was not studying, nor attempting to study how codeine breaks down in the liver, I ran across that information trying to figure out why I had a reaction after taking it (codeine). My question (I believe) was simple. Knowing that this occurs in the body, should a medical professional know NOT to prescribe codeine to a person who has a documented allergy to morphine.

[deadlock]

Deadlock,

I was not studying, nor attempting to study how codeine breaks down in the liver, I ran across that information trying to figure out why I had a reaction after taking it (codeine). My question (I believe) was simple. Knowing that this occurs in the body, should a medical professional know NOT to prescribe codeine to a person who has a documented allergy to morphine.

California, what did the pharmacy assistant say? or ER staff say when they treated you ? Why didn't the pharmacist note your allergy?

[CaliforniaMom]

California, what did the pharmacy assistant say? or ER staff say when they treated you ? Why didn't the pharmacist note your allergy?

The morphine allergy is in (to my knowledge) the pharmacy's records (I remember them asking me about it the very first time I filled a scrip with them), the dentists records and my physician's records. My sister said that the pharmacy assistant took the prescription from her and said "they gave her this?" She said yes, waited about 10 minutes and was handed a bag. I don't know how much conversation they had, but my sister is a relatively intellingent human being so my guess is that if they told her "tell her not to take this" she probably would have (1) gone ballistic on the dentist and (2) not given it to me. Again, I was drugged up on valium (dental phobic) so I really wasn't "here" to tell you exactly what went on.

When I got to the ER, the doc stated that I was definately having an allergic reaction to the pain medication I was on as at the time it was the only medication I was taking. The last dose of penicillin was 24 hours before (had been taking it for the prior 7 days), the valium I had taken at 10am that morning (it was almost 3am before I got to the ER). They gave me some steriods, benadryl and something to prevent my stomach from being upset from all the drugs, wrote me more prescriptions for benadryl, strong doses of prednisone and sent me on my way back home and was told I probably wanted to stay home for a few days until the welts went down (I ended up home for a week). Follow up with my primary physician was just "I obviously had a reaction to the codeine. It's safe to say you won't be taking that again."