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Updated: Mar 6, 2026

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Codeine and opioid metabolism: implications and alternatives for pediatric pain management

Vidya Chidambaran1, Senthilkumar Sadhasivam, Mohamed Mahmoud

  • 1Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.

Current Opinion in Anaesthesiology
|March 22, 2017
PubMed

Insights

Pediatric perioperative pain management faces challenges with opioid use, especially codeine, due to genetic factors like CYP2D6. Understanding pharmacogenetics can improve opioid selection and safety in children.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacogenetics
  • Pain Management

Background:

  • Perioperative opioid use in children poses risks, including respiratory depression, particularly in those with obstructive sleep apnea.
  • Adverse events like respiratory depression and death have been reported with codeine in pediatric patients post-tonsillectomy.

Purpose of the Study:

  • To review factors and genetic polymorphisms influencing opioid metabolism and postoperative outcomes in children.
  • To explore the impact of pharmacogenetics on pediatric perioperative pain management.

Main Methods:

  • Literature review of current knowledge on opioid metabolism and adverse effects in children.
  • Analysis of case reports and advisories concerning codeine use in pediatrics.
  • Discussion of alternative pain management strategies.

Main Results:

  • Cytochrome P450 family 2 subfamily D type 6 (CYP2D6) pharmacogenetics is a key factor in codeine metabolism and associated risks.
  • Increased reports of severe adverse events linked to codeine use in children, prompting organizational advisories.
  • Evaluation of alternative analgesics to codeine for pediatric pain relief.

Conclusions:

  • Pharmacogenetics, specifically CYP2D6, holds potential for guiding perioperative opioid selection and dosing in children.
  • Personalized opioid use based on genetic profiling is a future goal for enhancing pediatric pain management safety and efficacy.
Abstract

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