More Codeine Fatalities After Tonsillectomy in North American Children

Author:

Kelly Lauren E.123,Rieder Michael12,van den Anker John4,Malkin Becky2,Ross Colin5,Neely Michael N.6,Carleton Bruce57,Hayden Michael R.5,Madadi Parvaz89,Koren Gideon389

Affiliation:

1. Schulich School of Medicine, and

2. Department of Clinical Pharmacology, London Health Sciences Centre, London, Canada;

3. Ivey Chair in Molecular Toxicology, University of Western Ontario, London, Canada;

4. Children’s National Medical Center, Center for Clinical and Community Research, Washington, District of Columbia;

5. Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada;

6. Communication Sciences Institute, University of South California, Los Angeles, California;

7. Child and Family Research Institute, Vancouver, Canada;

8. Department of Clinical Pharmacology, University of Toronto, Toronto, Canada; and

9. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Canada

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference17 articles.

1. Paediatric obstructive sleep apnoea.;Powell;BMJ,2010

2. Pediatric obstructive sleep apnea.;Chhangani;Indian J Pediatr,2010

3. Statistics Canada. 2006 Census release topics: age and sex. Available at: www12.statcan.gc.ca/census-recensement/2006/rt-td/as-eng.cfm. Accessed September 10, 2011

4. United States Census. Age and sex composition 2010. Available at: www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed September 10, 2011

5. Ibuprofen for tonsillectomy pain in children: efficacy and complications.;Harley;Otolaryngol Head Neck Surg,1998

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