August 16, 2012
Breathing Trouble, Death Found In Children Who Were Given Codeine
Connie K. Ho for redOrbit.com — Your Universe Online
The Food and Drug Administration (FDA) recently stated that a few children who were given codeine, a pain reliever, after surgery may have developed serious breathing problems that lead to death.The FDA first learned about the issue from perusing articles in the New England Journal of Medicine in 2009 as well as the journal Pediatrics in 2012.
According to My Health News Daily, the FDA stated that it would begin reviewing cases regarding three children who passed away and one child who have suffered from serious breathing problems following the use of codeine. Their ages ranged between two and five. The children had been given typical dosages of codeine to help relieve pain after surgery of tonsils or adenoids; the surgeries were related to sleep apnea, a condition that makes it difficult for people to breathe during sleep as the upper airways are blocked.
“This will be news to the majority of [doctors] who are not well versed in opioid pharmacology, and it is very important,” Dr. Elliot Krane, a professor of anesthesia and pediatrics at Lucile Packard Children´s Hospital, told ABC News.
In particular, the FDA believes that the three children who died due to codeine could have been affected by being “ultra-rapid metabolizers.” According to the agency, between one to seven percent of people are ultra-rapid metabolizers. There can also be a higher number of ultra-rapid metabolizers in specific ethnic groups. In particular, there can be as many as 28 per 100 people who are ultra-rapid metabolizers for people who are of North African, Ethiopian, or Saudi Arabian descent.
“If you are an ultra-rapid metabolizer, then the concentration of the active form of the drug can rise in the patient´s bloodstream quickly,” commented Dr. Joseph R. Tobin, professor and chairman of anesthesiology at Wake Forest University School of Medicine, in the ABC News article. “When this is also associated with residual anesthetics, a child may be at risk to stop breathing or become completely obstructed.”
As well, the agency believes that parents and guardians need to be aware of the symptoms associated with codeine overdose, which include confusion, sleepiness, as well as difficulty breathing or waking up. If any of these signs appear in a child, parents should stop giving the child codeine and consult a medical expert as soon as possible.
For doctors, the FDA recommends using the lowest effective dose when prescribing drugs that contain codeine. The dosages should be given on an as-needed basis and not used regularly. When used, a liver enzyme to become morphine can convert codeine. Particular individuals can have a higher risk of suffering from side effects as the liver can change codeine into morphine much quicker than the livers of other people. If this occurs, people are likely to have the effects of high amounts of morphine in their blood due to taking codeine. These high levels of morphine can be life threatening and result in difficulty of breathing.
Overall, the agency is planning to conduct a review to look at whether there have been more cases related to unintentional death or overdose of children taking codeine. According to Reuters, codeine is an ingredient that has also been used in over-the-counter cough syrups and other prescription pain relievers.
In 2007, the FDA published warnings on a similar issue to warn breast-feeding mothers on the dangers of using codeine to decrease pain after giving birth. The difficulty of the medication was that some mothers could possibly be ultra-metabolizers and could endanger their child with the risk of a morphine overdose. Other than that, the narcotic was thought to be safe for women and children.