Does Hydrocodone Have Codeine In It?

In our latest question and answer, the pharmacist discusses whether or not hydrocodone contains codeine.

Does Hydrocodone Have Codeine In It?
Mar 10, 2018

Patriciab asked

Does hydrocodone contain codeine? I am allergic.


CodeineWhile hydrocodone does not contain codeine, they are closely related. If you have an allergy to one, there is a good chance you may be allergic to the other.

Both hydrocodone and codeine are classified as opioid medications. In fact, they are structurally similar and both are known as phenanthrenes. Opioids, such as hydrocodone and codeine, work by binding to the mu-opiate receptor. This works in the central nervous system to decrease perception of pain and the person’s emotional response to pain.

Hydrocodone And Codeine

Codeine is a natural opiate whereas hydrocodone is a semi-synthetic opiate. Nevertheless, they are in the same class of opioids, as discussed above. Drugs of the same drug class often show cross reactivity when a true allergy is present.

This leads us to believe that there is a high chance of a cross-reactivity reaction occurring if you take hydrocodone and you have a true codeine allergy. Therefore, if you have a true allergy to either hydrocodone or codeine, taking either is not recommended.

With a true codeine allergy other medications in the same drug class that should be avoided include:

  • Morphine
  • Hydromorphone
  • Oxycodone
  • Buprenorphine

If you have a true codeine allergy, an opioid from an alternative drug class should be considered. Alternative opioid classes include:

  • Phenylheptylamines
  • Phenylpiperidines

Drugs in these alternative classes include:

  • Methadone
  • Fentanyl

Opioid Allergies

It is important to determine if your allergic reaction is a true allergy or a pseudo allergy. Sometimes an allergy to codeine will be described as an upset stomach or rash caused from a secondary histamine release, this is considered a pseudo allergy. A true codeine allergy is very rare and can be life threatening with symptoms that include:

  • Swelling of the throat, lips or mouth
  • Difficulties breathing or swallowing
  • Hypotension (low blood pressure)
  • Severe skin reaction.

If you are only experiencing pseudo allergy symptoms with pain that cannot be treated with anti-inflammatory medication and a narcotic opioid medication is needed, the lowest possible dose should be given as the symptoms are dose related and close monitoring of symptoms should be conducted by your doctor. 

Ready for a more personal experience with your meds?