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Codeine After Surgery Could Endanger Certain Kids: Study
Date:4/11/2012

By Alan Mozes
HealthDay Reporter

WEDNESDAY, April 11 (HealthDay News) -- Concerns about codeine safety have gained traction in the wake of the postoperative experience of four children who all carried a rare genetic mutation. A new study describes what happened to three of the patients, while a similar case came to light in 2009.

In certain very rare genetic cases, the common painkiller codeine can be lethal. The gene mutation causes the body to metabolize codeine into morphine at levels 50 percent to 70 percent higher than normal. Among such patients, an otherwise standard amount of codeine can unpredictably turn into a toxic overdose.

After undergoing tonsillectomies for sleep apnea, three children with the gene mutation ultimately died, while the fourth patient barely survived.

"Codeine has been around for the better part of a century as a medication, including as a syrup for children," said study lead author Dr. Gideon Koren, a professor of pediatrics, pharmacology, pharmacy and medical genetics at the University of Toronto. "That's the drug that is used by most surgeons in the U.S. to control pain. But codeine is not actually the analgesic. To deal with pain it has to be transformed in the liver into morphine. And that happens with everyone who takes it to some degree," he explained.

"Most people take 10 molecules of codeine and make one molecule of morphine," added Koren, who is also a professor at the University of Western Ontario. "The problem is that our knowledge of genetics has revealed that there are people who are ultra-rapid metabolizers. They take 10 molecules of codeine and make two, three or even five molecules of morphine. In other words, they take the right doses but end up poisoning themselves."

Koren and his colleagues described the cases of the three recent pediatric codeine overmetabolizers in the April 9 online and May print issue of Pediatrics. The earlier case was re
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