48.下列何者引起histamine release的作用最強，而較易引發相關藥品不良反應？
(A)morphine
(B)codeine
(C)oxycodone
(D)fentanyl

所有的鴉片類藥物會直接作用在血液與組織細胞，使其釋放出histamine。
→造成：潮紅、心搏過速、低血壓、蕁麻疹與支氣管痙攣

★釋放Histamine的能力與止痛效力(potency)成反比
→釋放Histamine最強：大劑量meperidine或morphine
→釋放Histamine最低：fentanyl與remifentanil

翻譯整理自UpToDate: Pain control in the critically ill adult patient

對morphine過敏的病人可改用hydromorphone

fentanyl是唯一完全不會引起histamine release 的opioids

Morphine and meperidine cause the greatest histamine releasein both in vitro and in vivo studies.

Codeine, hydromorphone, oxycodone, and butorphanol stimulate histamine release lesscommonly;

and levorphanol, fentanyl, sufentanil, methadone, and oxymorphone have little to no effect on histamine levels.

管制藥分級

1 morphine

2 >5% codeine, levophanol, oxycodone, hydromorphone, fentanyl,sulfentanil, methadone,oxymorphone, meperidine

3 1-5% codeine

4 <1% codeine, butorphanol