Related Experiment Video
Updated: May 11, 2026

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Codeine-associated pediatric deaths despite using recommended dosing guidelines: three case reports
Stefan J Friedrichsdorf1, Andrea Postier Nugent, A Quinn Strobl
1Department of Pain Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
Insights
Codeine toxicity caused three child deaths despite appropriate dosing. Genetic factors and obesity increase risks, suggesting codeine should not be prescribed to children due to its dangers.
Area of Science:
- Pharmacology
- Pediatric Toxicology
- Genetics
Background:
- Codeine is a common analgesic.
- Its efficacy and safety depend on CYP2D6 metabolism.
- Genetic variations in CYP2D6 can lead to toxicity or inefficacy.
Abstract:
This report describes the deaths of three children ages 4-10 years due to codeine toxicity at home. All three children were overweight or obese; however, the codeine doses were within recommended dose ranges for adjusted lean weight. Codeine's analgesic effect depends on its metabolic conversion to morphine in the liver via the drug-metabolizing enzyme CYP2D6. Genetic variation may result in poor analgesia, opioid toxicity, or oversedation. Caregivers must be warned about risks associated with comorbidities including obesity and polypharmacy. Codeine should no longer be prescribed to children due to its poor analgesic effect and risk of opioid toxicity and oversedation.
Related Concept Videos
Drug Dosing: Infants and Children
Pharmaceutical Poisoning: Potential Scenarios
Pharmaceutical Poisoning: Treatment Strategies
Drug Toxicity: Risk factors
Pharmacokinetics in Pediatric Patients: Drug Excretion
Drug Toxicity: Dose-Dependent Reactions