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Three Kids Dead From Codeine After Surgery: FDA
Date:8/15/2012

WEDNESDAY, Aug. 15 (HealthDay News) -- Following the deaths of three children and the near death of a fourth, U.S. health officials are warning about the risks of giving the pain reliever codeine to certain children following surgery.

The Food and Drug Administration said the four youngsters, all between 2 to 5 years old, received typical doses of codeine after having their tonsils or adenoids removed as a treatment for obstructive sleep apnea, a disorder characterized by disrupted breathing during sleep. The child who didn't die suffered near-fatal respiratory depression.

The youngsters developed adverse reactions within a day or two of taking the prescription medication, and the researchers suspect they were "ultra-rapid metabolizers."

Codeine, a narcotic also used for coughs, is converted to morphine in the liver, and in some people this conversion occurs faster and more completely than in others because of their genetic makeup. Giving such children codeine after tonsillectomy and/or adenoidectomy may increase their risk of breathing problems and death, the FDA said in a statement Wednesday.

"[The] FDA wants parents and caregivers to be aware of the warning signs that could indicate their child is having trouble breathing because of this higher morphine level," the agency said.

Between one and seven of every 100 people are considered "ultra-rapid metabolizers," the researchers said. Although rare, this genetic variation is more common among certain ethnic groups. North African and Ethiopian populations account for 29 percent of "ultra-rapid metabolizers," while 1 percent to 2 percent of northern Europeans are affected.

The only way people can know if they are ultra-rapid metabolizers is to undergo a genetic test.

The FDA issued the following guidelines for parents and caregivers:

  • Give codeine only as needed for pain relief, not on a set schedule.
  • Prescribe the lowest po
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