More codeine fatalities after tonsillectomy in North American children

Lauren E. Kelly, Michael Rieder, John Van Den Anker, Becky Malkin, Colin Ross, Michael N. Neely, Bruce Carleton, Michael R. Hayden, Parvaz Madadi, Gideon Koren

Research output: Contribution to journalArticlepeer-review

332 Scopus citations


In 2009 we reported the fatal case of a toddler who had received codeine after adenotonsillectomy for obstructive sleep apnea syndrome. The child was an ultra-rapid metabolizer of cytochrome P4502D6 (CYP2D6). We now report 3 additional fatal or life-threatening cases from North America. In the 2 fatal cases, functional gene duplications encoding for CYP2D6 caused a significantly greater production of potent morphine from its parent drug, codeine. A severe case of respiratory depression in an extensive metabolizer is also noted. These cases demonstrate that analgesia with codeine or other opioids that use the CYP2D6 pathway after adenotonsillectomy may not be safe in young children with obstructive sleep apnea syndrome.

Original languageEnglish
Pages (from-to)e1343-e1346
Issue number5
StatePublished - May 2012
Externally publishedYes


  • Codeine
  • Sleep apnea
  • Tonsillectomy


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