Medline ® Abstract for Reference 13
of 'Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis'
13
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Codeine intoxication associated with ultrarapid CYP2D6 metabolism.
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Gasche Y, Daali Y, Fathi M, Chiappe A, Cottini S, Dayer P, Desmeules J
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N Engl J Med. 2004;351(27):2827.
Life-threatening opioid intoxication developed in a patient after he was given small doses of codeine for the treatment of a cough associated with bilateral pneumonia. Codeine is bioactivated by CYP2D6 into morphine, which then undergoes further glucuronidation. CYP2D6 genotyping showed that the patient had three or more functional alleles, a finding consistent with ultrarapid metabolism of codeine. We attribute the toxicity to this genotype, in combination with inhibition of CYP3A4 activity by other medications and a transient reduction in renal function.
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Divisions of Surgical and Medical Intensive Care, Geneva University Hospital, Switzerland. yvan.gasche@medecine.unige.ch
PMID