Opioids Which Opiate Causes Least Histamine Release?

Hi everybody. I am new here but am loving your work.

I have various health issues and have been taking 300mg dihydrocodeine for about 12 years every day. Earlier this year I was taken to A and E with severe facial swelling (angioedema). I was put on steroids and antihistamines. The problem is still there, my face swells up each day but is controlled by prednisone and anthistamines.

My doc took me off the DHC for ten days or so to see if it was that causing the angioedema. It wasn't as I still had symptoms. So I am back on it.

However I have been doing some reseach and found out that the angioedema may be exacerbated by the histamine releasing qualities of the DHC. It can't help, let's face it. My doctor just mutters something about - well, all opiates are the same, they all release histamine. He suggested trying paracetomol. Thanks.

To cut a long dull story short, I think you lot know a lot more about opiates than my GP. What would you try next if you wanted to lessen the histamine qualities of an opiate? Someone suggested oxycodone?

As you can imagine paracetomol is not an option....

Many thanks for reading.

I itch the least on oxycodone, and the most morphine/heroin

long term opiate use is known to cause water retention. for example, some heavy users have died from fluid buildup in the lungs. I'm imagining that since you are a long-term opiate user, you have some fluid retention.

I'm not really sure how to treat that....but it seems like it would be an easy fix once you know whats going on...

actually, just looked it up. apparently if you are not drinking enough water, your body will retain it and cause fluid buildup. webmd says to drink more water (8-10 glasses a day) and try to cut sodium intake for a bit.

In my experience, fentanyl produced the least histamine release relative to other effects. I don't know if this would be an appropriate option for you, or if my experience would transfer to you

Cane2theLeft said:

In my experience, fentanyl produced the least histamine release relative to other effects. I don't know if this would be an appropriate option for you, or if my experience would transfer to you

Click to expand...

I experienced the same thing when I used Fentanyl via the Actiq pops (800mcg)

Morphine gave me the most serious histamine reaction out of all the opiates I've done. Not even heroin gave me such a pins and needles, redness effect compared to what IV morphine did to me.

IME, oxycodone/morphone and hydromorphone gave me little to no histamine reaction either

Thank you for the idea about water retention, never knew opiates did that, I'll start getting more water down my gullet.

So my GP IS wrong? There are other alternatives to DHC.

What would happen if I were actually allergic to DHC? That wouldn't in my opinion mean I can never take an opiate again would it - I would just keep trying lots of the lower histamine ones til one fitted?

You can tell I am TERRIFIED of losing my opiates can't you?!

If I am on 300mg DHC a day I guess I would be looking at 30mg oxycodone?

Does anyone know what the Fentanyl equivalent is?

Just before all this hell started I had an operation and was put on one of those morphine booster things you operate yourself. It did NOTHING nada. I was in agony. Morphine always worked for me in the past but it was like taking paracetomol this time.

Dilauladid definently, oxycodone makes me itch like a mother- although it's not crazy like morphine.

Trouble is I don't think the GP will have even HEARD of Dilauladid?

Has anyone a view on Tramadol, say?

There's plenty that have less histamine release than codeine/DHC or morphine... Take your pick, really, since those are the worst offenders ITOOM.


(ITOOM = in the opinion of most... It needs an abbreviation)

I itch on Trams which I counter with antihistamines. My only opiod/opiate experience though.

I would definitly try modifing your diet... ie water intake, sodium
easy enough to try
research Dilauladid and suggest to the Doctor

I would actually have to say that for some people dilauded may cause just as bad if not worse of a histamine reaction than morphine.

When i got one of my surgerys i had the IV dilaudid button but they had to take me off it and put me on morphine ( which worked way better ) because i was reacting so bad to it ( could not stop itching myself etc. )

Just know that everyone reacts differently and what may work for some people may not be the same for you.

I dont really get the whole itchy/histamine release thing from most opiates, but morphine is definitely one of the ones that does it. I'd say dilaudid is the least, also fent but I've only done it once and don't really remember.

for me, oxycodone has little to no histamine reaction. sometimes it itches just a tiny little bit on the left side of my back... but only very very little.

tramadol also has no histamine effects on me, but i don't take tramal anymore. i'd have to take gram-doses.

i think that, the more you go away from the natural structura a.k.a. morphine/codeine to fully-synthetic opioids like fentanyl, piritramide, and so on, the more histamine effects decrease. oxycodone, oxymorphone, hydromorphone also have very little histamine effects. but they have them. you get the itches from time to time, but only very little ones, barely noticeable. fentanyl has no histamine reaction. methadone???

the more natural an opioid is, the higher the histamine reaction.

Opana AKA Oxymorphone had the least histamine reaction so far, next would be Oxycodone or fent.

Ok guys, let's sit back and think about this for a minute. They won't want the OP's tolerance skyrocketing. If she's on DHC right now, do you really think they would switch her to some of the most potent opioids available? No offence what so ever, but that would be like me going in with a sprained ankle and saying "Tylenol and Advil hurt my stomach, can I have some morphine, please?" I seriously doubt it'd fly, but I'm not a doctor, so I don't know for sure. That's just my two pennies.

It's interesting that you took this for so long without an issue and now it's causing one. Is there anything else that may be causing your symptoms? Just a thought. Also, have you tried using different antihistamines to see if a different one may provide greater relief?

If you do have to switch to another opiate then, as others have indicated, it's kind of hit or miss. Each individual will react in their own way.

I would suggest that your first option be Hydrocodone. Since you did well on dihydrocodeine for so long. Hydrocodone would be the closest in strength and your MD would most likely be wiling to give it a try. If you go in asking for Dilautid I would think he may question your motives. Dilautid is notorious for drug seekers. Hydrocodone is a nice opiate. Also, Co-Tramadol is a great antihistamine and seems to work exceptionally well with Hydrocodone. You can get them together in a suspended release cough medication called Tussionex. It's very expensive though-if you don't have health insurance.

It would be excellent in your case though because it's similar to what you have been taking for pain-strength wise. It comes with a great antihistamine in it already AND it's suspended release (which doctors prefer to give for chronic pain vs. and immediate release)

I've had to take it several times for a cough and I've never had any itching from it-which I DO have if I take Hydrocodone alone. I have also had issues with edema myself-but never from Tussionex. OxyContin gave me severe generalized edema once. Scared me to death.

So, that's my .02. I would try asking for Tussionex and explain to your MD that it is extended release and has a antihistamine in it already. You may need a higher dose than a reg. pt uses for a cough, hopefully your MD can work that out with you. If you do need a unique dosage then you may have to get it from a compounding pharmacy. But, trust me, it's worth it.

Tussionex is my, and many others, favorite form of opiates. It's really like nothing else. The euphoria is out of this world, the mental and body effects are amazing. I would give anything for this to be the medication I used for my pain. I like it better than any other opiate I've ever taken. That's just me but, numerous other people seem to feel the same way.

Good Luck

Keeping pretty much on track with what several others have said, all Opioids will indeed provoke some level of histamine release, with morphine being absolutely the worst; I'll be scratching all over like it's going out of style. Hydro and Oxycodone are better, but can still cause substantial histamine reaction, especially with moderate/larger doses.

Out of everything, I too would say Hydromorphone. The conversion from DHC would allow you a pretty low dose, and most likely very little (if any) histamine-related discomfort. In my experience, a decent dose of any Opioid will cause itch/water retention/etc, but I have gotten absolutely blasted off of Hydromorphone, with barely any itchiness or what have you.

Methadone too tends to be tolerated well by people in your situation, but I'm not sure you want to go down that road.