The US Food and Drug Administration (FDA) has warned physicians of 3 deaths and 1 severe case of respiratory depression in children who received codeine for pain relief following tonsillectomy or adenoidectomy.
The surgeries were performed to treat obstructive sleep apnea. FDA officials said it appeared that the 3 children who died, who were aged 2 to 5 years, were “ultrarapid metabolizers” who metabolize codeine much more quickly and completely than others. This trait results from a gene variant that makes the drug-metabolizing enzyme cytochrome P450 2D6 in the liver more active (http://www.fda.gov/Drugs/DrugSafety/ucm313631.htm). Overall prevalence of the inherited trait is 1% to 7% but reaches 29% in Ethiopian populations, the FDA reported. The agency has approved genetic tests that can detect the trait.
Voelker R. Children’s Deaths Linked With Postsurgical Codeine. JAMA. 2012;308(10):963. doi:10.1001/2012.jama.11525