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Old 09-15-2009, 09:26 AM   #1
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Sulfa Allergies & Morphine


I wanted to post this because I am surprised at how many providers, both novice and experienced of all levels, have the misconception over sulfa allergy and morphine.

Sulfa allergy relates to medications know as sulfonamides which are largely a group of antibiotics (Bactrim). Furosimide (Lasix) is also in this class as well. Morphine Sulfate is NOT a sulfonamide so if a patient say's they have a sulfa allergy, they CAN have Morphine.

I was with a preceptor one time and we had a fall patient having some pain who said she had a sulfa allergy. My preceptor then went on to tell the patient that the only med we had for pain was morphine of which the patient couldn't have due to her sulfa allergy. As a student I didnt want to correct my preceptor.


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Old 09-15-2009, 09:34 AM   #2
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Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.
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7:11 PM on December 9, 2012. A date which will live in infamy. ffemt8978 agrees with medic417.
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Old 09-15-2009, 09:47 AM   #3
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Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.
medic417, is it still a "Sulfa" allergy then, or is it something different? Not second guessing you, just trying to understand more about it. If it is still considered a sulfa allergy, what is the cause for the difference in allergy? Again, curiosity.
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Old 09-15-2009, 09:54 AM   #4
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Some people are allergic to anything that contains the "sul" in its name
By chance they could be.... the same as they could be allergic to any drug with the letter "A" in it. But the point is there is no relation between sulfonamides and morphine sulfate as they are completely different chemically. They only sound similar. It's the same comparison as water and gasoline... both liquids but both totally different in their effects.

Sulfates are naturally occurring and we take them in daily in water and foods as they are largely salts.

Don't automatically withhold morphine just because your patient may have an allergy to sulfonamides. That's the point.

Last edited by ResTech; 09-15-2009 at 10:01 AM.
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Old 09-15-2009, 10:00 AM   #5
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medic417, is it still a "Sulfa" allergy then, or is it something different? Not second guessing you, just trying to understand more about it. If it is still considered a sulfa allergy, what is the cause for the difference in allergy? Again, curiosity.
W/o doing the research for you, yes at least per the patient. In other words the patient will usually just say sulfa allergy, or just have the sulfa allergy medical bracelet/necklace. To presume it only refers to the antibiotics as the OP suggests is a road you do not want to be on.

I suggest an in depth research of this subject by anyone that thinks as the OP does. Yes the majority still only react to the antibiotics, but a large number still can and do react to anything with "sul" in its name. Many cannot even chew most regular gum or eat most store bought breads as they are so sensitive. If they react to such small concentrations as that you will risk killing them with the amount in our drug solutions.
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7:11 PM on December 9, 2012. A date which will live in infamy. ffemt8978 agrees with medic417.
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Old 09-15-2009, 10:00 AM   #6
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http://www.druginformation.co.nz/Bul...hurAllergy.pdf


Yes there is confusion with these allergies and if we were overly cautious, Albuterol Sulfate would also be avoided.

Always ask what med, what happened and under what circumstances.
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Old 09-15-2009, 10:01 AM   #7
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Originally Posted by medic417 View Post
Actually you are not entirely correct. Some people are allergic to anything that contains the "sul" in its name. So you need to discuss this with the patient and not rush to give something that can cause harm to many patients.
thats impossible. Sulfur is the 8th most common element found in the human body. It is essential to human life and is found in many amino acids.

However the sulfa category is huge. But there are many other "Sul" drugs given not in that category and aren't related.

Besides the sulfonamide allergy, people do have hypersensitivity to sulfites which gets metabolized to sulfur dioxide. It is now being classified by some as an allergy.
Some asthmatics also are sensitive to sulfur dioxide, but its not because of the "sul," but because of the interaction of sulfur and two oxygens.
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Old 09-15-2009, 10:07 AM   #8
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In other words the patient will usually just say sulfa allergy, or just have the sulfa allergy medical bracelet/necklace. To presume it only refers to the antibiotics as the OP suggests is a road you do not want to be on.
Who said anything about "presuming". The point was clear that sulfonamides ARE NOT related to morphine sulfate, albuterol sulfate, atropine sulfate, etc, etc. And not to ASSUME that they are the same thing... this is the road you do not want to go down as you could withhold a beneficial medication by not knowing the difference.

This post was made with the assumption that providers can do the elementary task of ascertaining an allergy history.
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Old 09-15-2009, 10:08 AM   #9
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Originally Posted by ResTech View Post
By chance they could be.... the same as they could be allergic to any drug with the letter "A" in it. But the point is there is no relation between sulfonamides and morphine sulfate as they are completely different chemically. They only sound similar. It's the same comparison as water and gasoline... both liquids but both totally different in their effects.

Sulfates are naturally occurring and we take them in daily in water and foods as they are largely salts.

Don't automatically withhold morphine just because your patient may have an allergy to sulfonamides. That's the point.
And that is why some people have water filters that remove them and have to be very careful of the food they buy. Many cannot even eat certain fruits and vegetables.

But to avoid problems it is better to provide another pain relief med. If your service only has morphine it is time to join the 21st century.
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7:11 PM on December 9, 2012. A date which will live in infamy. ffemt8978 agrees with medic417.
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Old 09-15-2009, 10:11 AM   #10
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Medic 417... your being ridiculous... nothing posted was incorrect. Are you disagreeing that sulfonamides and sulfates are totally different?
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