The FDA (Food and Drug Administration) released a drug alert that codeine use after tonsillectomy and/or adenoidectomy, may increase the risk of death in children. Three children recently died after receiving codeine to treat pain associated with this relatively common outpatient surgery.
The children who died were between the ages of two and five. They were found to be ultra-rapid metabolizers of codeine. When they ingested appropriate doses of codeine, their bodies rapidly metabolized it to dangerously high levels of morphine.
Codeine is converted to morphine in the liver by an enzyme called cytochrome P450 2D6 (CYP2D6). Certain children have inherited DNA that makes this enzyme convert codeine to morphine unusually fast. These children are called “ultra-rapid metabolizers.” Because they are fast metabolizers, they will quickly have much higher levels of morphine in their systems. These high levels of morphine can be toxic and life-threatening.
The ability to rapidly metabolize codeine is thought to affect between 1-7% of the general population. Certain ethnic groups are at a higher risk of being ultra-rapid metabolizers. Close to 29% of Ethiopians, 6% of Greek and between 3-6% of African-Americans may be ultra-rapid metabolizers of codeine.
The surgeries were performed to treat obstructive sleep apnea. Obstructive sleep apnea is when breathing is periodically interrupted during sleep. Enlarged tonsils and/or adenoids often cause a blockage that makes it difficult for a child with obstructive sleep apnea to breath during the night. The child will periodically waken to take a breath.
The FDA is recommending that physicians prescribe the lowest effective dose of codeine for pain control, and parents should be educated about signs of codeine overdose. The FDA urges parents to only use codeine “as needed” for pain. It should NOT be given on a schedule. Serious side effects of codeine in children include unusual sleepiness, confusion, and difficult breathing. If your child shows these signs, stop giving your child codeine and take your child to the closest emergency room or call 911.
The advice provided in this blog is for informational purposes only and is not a substitute for medical diagnosis, advice or treatment for specific medical conditions