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

doi:10.1542/peds.2011-2538

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 journal › Article › peer-review

333 Scopus citations

Abstract

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 language	English
Pages (from-to)	e1343-e1346
Journal	Pediatrics
Volume	129
Issue number	5
DOIs	https://doi.org/10.1542/peds.2011-2538
State	Published - May 2012
Externally published	Yes

Keywords

Codeine
Sleep apnea
Tonsillectomy

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10.1542/peds.2011-2538

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abstract = "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.",

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AU - Rieder, Michael

AU - Van Den Anker, John

AU - Malkin, Becky

AU - Ross, Colin

AU - Neely, Michael N.

AU - Carleton, Bruce

AU - Hayden, Michael R.

AU - Madadi, Parvaz

AU - Koren, Gideon

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More codeine fatalities after tonsillectomy in North American children

Abstract

Keywords

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