Sunday, May 13, 2012
Codeine, Potentially Unpredictably Lethal
Frequently used in the pediatric population, codeine is a narcotic analgesic in prodrug form. In the body, codeine is metabolized to morphine through the CYP2D6 pathway. In the general population, it is estimated that approximate 10% of codeine undergoes conversion to morphine.
We're generally familiar with the concept that a certain percentage of the population is ineffective at metabolizing codeine, and therefore receives no additional analgesic effect. However, the flip side, as these authors report, is a CYP2D6 genotype of over-metabolizers. In this case series, the over-metabolism of codeine in three post-surgical children likely resulted in supra-therapeutic conversion to morphine, leading to respiratory arrest.
The short summary - when possible, avoid medications that are unpredictably metabolized - such as codeine.
"More Codeine Fatalities After Tonsillectomy in North American Children"