Three children died in August 2012 after receiving usual doses of codeine for postoperative pain following a tonsillectomy and/or adenoidectomy (U.S. Food and Drug Administration [FDA], 2013a). Those incidents, combined with a case report of a breast-feeding infant who died in 2005 of an apparent overdose after the mother received a standard dose of codeine for episiotomy pain (Health Sciences Authority, 2009; Koren, Cairns, Chitayat, Gaedigk, & Leeder, 2006), heighten the need to understand the pharmacogenomics of codeine metabolism.
References
Crews, K. R., Gaedigk, A., Dunnenberger, H. M., Klein, T. E., Shen, D.D, Callaghan, J. T., … Skaar, T. C. (2012). Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for codeine therapy in the context of cytochrome P450 2D6 (CYP2D6) genotype. Clinical Pharmacology and Therapeutics, 91, 321-326. doi:10.1038/cipt.2011.287
Health Sciences Authority. (2009). Codeine toxicity in breastfed infants. Retrieved from
http://bit.ly/15vmJp5
Koren, G., Cairns, J., Chitayat, D., Gaedigk, A., & Leeder, S. J. (2006). Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother. Lancet, 368, 704. doi:10.1016/S0140-6736(06)69255-6
Sheffield, L. J., & Phillimore, H. E. (2009). Clinical use of pharmacogenomic tests in 2009. Clinical Biochemist. Reviews, 30(2), 55-65.
U. S. Food and Drug Administration. (2013b). FDA drug safety communication: Safety review update of codeine use in children; new boxed warning and contraindication on use after tonsillectomy and/or adenoidectomy. Retrieved from
http://www.fda.gov/Drugs/DrugSafety/ucm339112.htm