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Related Experiment Videos

Probable codeine phosphate-induced seizures.

Shih-Chen Kuo1, Ya-Chu Lin, Shu-Min Kao

  • 1Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

The Annals of Pharmacotherapy
|October 7, 2004
PubMed
Summary
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Elderly patients with end-stage renal disease (ESRD) may experience seizures from standard codeine phosphate doses due to impaired drug clearance. Dosage adjustment based on renal function is crucial to prevent codeine toxicity.

Area of Science:

  • Pharmacology
  • Nephrology
  • Neurology

Background:

  • Codeine phosphate is a widely used opioid analgesic for moderate to severe pain.
  • Its use is common when other analgesics like acetaminophen or NSAIDs are insufficient.
  • Limited data exist on codeine-associated seizures, with unknown mechanisms.

Observation:

  • A 73-year-old woman with end-stage renal disease (ESRD) received oral codeine phosphate 30 mg four times daily for pain.
  • Without dosage adjustment for her renal impairment, she developed stupor and tonic-clonic seizures after seven days of therapy.
  • Seizures ceased upon phenytoin initiation, codeine discontinuation, and naloxone administration.

Findings:

  • An objective causality assessment identified the seizures as a probable drug-related event.

Related Experiment Videos

  • This case suggests elderly patients with ESRD are susceptible to codeine-induced seizures, potentially due to accumulation from impaired excretion.
  • The exact mechanism of codeine-related seizures remains unclear.

    • Implications:

    • This case highlights the critical need to adjust codeine phosphate dosage regimens according to renal function in elderly patients with ESRD.
    • Failure to adjust dosage can lead to opioid toxicity, including seizures.
    • Clinicians should exercise caution when prescribing codeine to this vulnerable population.