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The Perioperative Use of Codeine and Tramadol in Pediatric Population

Wiriya Maisat1, Koichi Yuki2,3

  • 1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Translational Perioperative and Pain Medicine
|April 21, 2025
PubMed

Insights

Codeine and tramadol, used for pediatric pain, show varied responses due to genetic factors (CYP2D6). This led to FDA warnings, impacting pediatric pain management strategies.

Area of Science:

  • Pharmacogenomics
  • Pediatric Pain Management
  • Opioid Analgesics

Background:

  • Codeine and tramadol are frequently prescribed for managing pain in children.
  • Significant variability exists in pediatric patients' responses to these opioids.
  • Adverse events, including fatalities and respiratory distress, have been linked to codeine use.

Purpose of the Study:

  • To review the current landscape of pediatric pain management.
  • To discuss the implications of pharmacogenetic variability, specifically CYP2D6 phenotypes, on codeine and tramadol efficacy and safety.
  • To highlight the impact of regulatory warnings on clinical practice.

Main Methods:

  • Literature review of studies on codeine and tramadol in pediatric populations.
  • Analysis of pharmacogenetic data related to CYP2D6 enzyme activity.
  • Examination of FDA warnings and their consequences.

Main Results:

  • CYP2D6 genotype significantly influences the metabolic activation of codeine and tramadol.
  • Poor metabolizers exhibit reduced efficacy, while ultra-rapid metabolizers face increased risk of toxicity.
  • These findings underscore the heterogeneous patient response to these common analgesics.

Conclusions:

  • The use of codeine in pediatric populations is increasingly restricted due to safety concerns related to CYP2D6 metabolism.
  • Tramadol also presents risks, particularly for ultra-rapid metabolizers.
  • Alternative pain management strategies are crucial for safe and effective pediatric pain control.

Keywords:
CYP2D6CodeineTramadol

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