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Codeine is a weak narcotic pain reliever and cough suppressant similar to morphine and hydrocodone. Small amounts of codeine is converted into morphine in the body. It can impair thinking and physical abilities required to driving and operating machinery. It also has other side effects such as nausea, vomiting, skin rash, constipation, shortness of breath and abdominal pain. Codeine could develop addiction. Mental and physical dependence of the drug may develop which is unlikely when it is used for short-term pain relief. If codeine is suddenly withdrawn after a prolonged use, symptoms of withdrawal may develop. The dose of codeine should be reduced gradually in order to avoid withdrawal symptoms.
Codeine is converted into morphine in the liver by the enzyme Cytochrome P450 2D (CYP2D6) routinely, thus it works as an effective pain killer. Most people have normal CYP2D6 activity and their system respond to codeine in an expected manner. However, a substantial minority of people differing by national origin and race, manifest CYP2D6 activity higher or lower than normal. These variant enzyme level potentially result in either excessive (higher activity) or inadequate (lower activity) response to codeine.
For the people with an over reactive enzyme codeine gets converted into morphine in faster rate than others causing breathing problems which could turn fatal sometime. People belong to this group are known to be the ultra rapid metabolizers (UMs). In most humans, only 7-10% of the administered codeine dose is bio-transformed into morphine. In ultra rapid metabolizers up to 20% of their codeine dose could be transformed into morphine, yielding an excessive level morphine that could be potentially toxic. People deficient in CYP2D6 known as "poor metabolizers" (PMs), have inherited a nonfunctional gene from each parent, and have no CYP2D6 activity. People who has inherited one nonfunctional gene but have some CYP2D6 activity, but it is lower than normal called "intermediate metabolizers" (IMs). Most people have at least one functional gene with normal CYP2D6 activity. are known as "extensive metabolizers" (EMs).1-7 in every 100 people have this rapid conversion metabolizers, 27% of north African and Ethiopian and 6% of African, American, Greek population suffer from this. Most of this is occurred in people with 2-5 years old.
Codeine is prescribed in mild doses with a combination of acetaminophen and aspirin to children who have undergone surgery for tonsils and adenoids. It is recommended by FDA that the children should not be given more than six doses in a day. The agency is warning the public of the danger of using codeine which could be converted to morphine which in turn would cause breathing problems and could be even fatal sometimes. According to FDA there have been 3 deaths caused due to this reason in the year 2009, in New England, USA when this drug has been given to children after surgery. Parents and any caretakers who would be with the children after the surgery are warned to watch the child after surgery for any breathing problem the child might face after taking this drug. They are required to look out for symptoms such as (1)Unusual sleepiness, difficulty waking up, (2)Disorientation or confusion, (3)Noisy breathing, shallow breathing or abnormal pause in breathing,(4)Blueness on the lips.
The only way to avoid this type of incidences is to get a genetic test .The other preventive step could be take or give less doses of codeine. If more doses are required to be taken due lack of enduring the pain, the patient needs to be under constant watch by parents if it is a child or a caregiver if the patient is an adult. The other alternative option could be discussing the to the health care professional for either the dose changes or other pain relievers. People taking codeine or related drugs for the first time should be alert for an excessive response like marked sedation, respiratory depression, gastrointestinal effects e.g. severe constipation, which might be indicative that they are the ultra rapid metabolizers of these drugs.
Is Post-Surgery Codeine a Risk for Kids?
Codeine is often given to childrens for pain relief after surgery to remove tonsils or adenoids, a condition in which they cant sleep due to breathing problem. This may be a risk in some children having some adverse side effects like coma and even causing death. Due to this there were 3 deaths and one life threatening case in children as per FDA. The agency is warning the public that this danger exists for some children whose liver converts codeine to morphine in higher than normal amounts.
Codeine is an opioid pain reliever, a narcotic medication, used to treat mild to moderate pain. It is also used to reduce coughing, either alone or in combination with acetaminophen or aspirin, and in some cough and cold medications. Due to some genetic variations some people have faster ability to convert codeine to morphine in the liver by an enzyme. This may lead to breathing difficulty, which may be fatal. This method is called ultra rapid metabolizers. This occur in one to seven people in 100. 27% of north African and Ethiopian and 6% of African, American, greek population suffer from this. The only way to know if someone is ultra rapid metabolizer is to take genetic test. Most of this is occurred in people with 2-5 years old.
FDA warns that children should not be received more than six doses in a day. Parents and caretakers should watch children carefully even after returned to home.
There are a number of symptoms to watch for, says Rappaport. If your child shows these signs, stop giving the codeine and seek medical attention
• Unusual sleepiness, such as being difficult to wake up
• Disorientation or confusion
• Labored or noisy breathing, such as breathing shallowly with a "sighing" pattern of breathing or deep breaths separated by abnormally long pauses
• Blueness on the lips or around the mouth
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