More Codeine Fatalities After Tonsillectomy in North American Children

In 2009 the fatal case of a toddler who had received codeine after adenotonsillectomy for OSA syndrome was first reported. The child was an ultra-rapid metabolizer of cytochrome P4502D6 (CYP2D6). Three additional fatal or life-threatening cases are now reported. 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 OSA syndrome.