In 2009 we reported the fatal case of a toddler who had received codeine after adenotonsillectomy for obstructive sleep apnea syndrome. The child was an ultra-rapid metabolizer of cytochrome P4502D6 (CYP2D6). We now report 3 additional fatal or life-threatening cases from North America. In the 2 fatal cases, functional gene duplications encoding for CYP2D6 caused a significantly greater production of potent morphine from its parent drug, codeine. A severe case of respiratory depression in an extensive metabolizer is also noted. These cases demonstrate that analgesia with codeine or other opioids that use the CYP2D6 pathway after adenotonsillectomy may not be safe in young children with obstructive sleep apnea syndrome.
More Codeine Fatalities After Tonsillectomy in North American Children
FINANCIAL DISCLOSURE: Ms Kelly and Dr Madadi are funded by the Canadian Pharmacogenomics Network for Drug Safety (CPNDS) and the Canadian Institutes for Health Research (CIHR); Dr Carleton and the University of British Columbia have received funds from Pfizer Canada; and Dr Neely served as an expert consultant for Pietragallo Gordon Alfano Bosick & Raspanti, LLP; the other authors have indicated they have no financial relationships relevant to this article to disclose.
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Lauren E. Kelly, Michael Rieder, John van den Anker, Becky Malkin, Colin Ross, Michael N. Neely, Bruce Carleton, Michael R. Hayden, Parvaz Madadi, Gideon Koren; More Codeine Fatalities After Tonsillectomy in North American Children. Pediatrics May 2012; 129 (5): e1343–e1347. 10.1542/peds.2011-2538
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