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Related Experiment Videos

Codeine: Time to Say "No".

Joseph D Tobias, Thomas P Green, Charles J Coté

    Pediatrics
    |September 21, 2016
    PubMed
    Summary
    This summary is machine-generated.

    Codeine is a prodrug metabolized to morphine, but genetic variations in CYP2D6 enzyme activity cause unpredictable responses in children. Ultrarapid metabolizers, especially those with sleep apnea, face risks of respiratory depression and death, prompting safety warnings.

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    Area of Science:

    • Pharmacology
    • Genetics
    • Pediatrics

    Background:

    • Codeine is a widely used analgesic and antitussive in children.
    • Codeine requires hepatic metabolism by CYP2D6 to its active form, morphine.
    • Genetic variability in CYP2D6 activity leads to diverse patient responses to codeine.

    Purpose of the Study:

    • To review the safety concerns associated with codeine use in pediatric patients.
    • To highlight the risks of codeine in specific populations, such as ultrarapid metabolizers and those with obstructive sleep apnea.
    • To discuss the evolving regulatory landscape and recommendations regarding pediatric codeine use.

    Main Methods:

    • Review of drug surveillance data and published literature.
    • Analysis of genetic factors influencing codeine metabolism (CYP2D6).

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  • Examination of adverse event reports, including respiratory depression and fatalities.

    • Main Results:

    • Significant genetic variability in CYP2D6 activity impacts codeine efficacy and safety.
    • Ultrarapid CYP2D6 metabolizers are at increased risk of severe adverse events, including death.
    • Pediatric patients with obstructive sleep apnea are particularly vulnerable to codeine's opioid effects.

    Conclusions:

    • Codeine poses significant safety risks in children due to variable metabolism.
    • Regulatory bodies have issued warnings, and contraindications are being considered.
    • Further research into opioid and nonopioid alternatives for pediatric pain management is essential.