The Use of Codeine and Tramadol in the Pediatric Population—What is the Verdict Now?

Codeine and tramadol are opioid analgesics approved for the management of pain in the United States. Both agents are metabolized in the liver to active compounds via the cytochrome P450 2D6 enzyme. Case reports of pediatric patients with overactive CYP2D6 enzymes have been reported. These ultra-rapi...

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Bibliographic Details
Published in:Journal of pediatric health care 2019-01, Vol.33 (1), p.117-123
Main Authors: Fortenberry, Megan, Crowder, Justin, So, Tsz-Yin
Format: Article
Language:English
Subjects:
Codeine
cytochrome P-450 CYP2D6
Nursing
pediatrics
pharmacogenetics
tramadol
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Summary:Codeine and tramadol are opioid analgesics approved for the management of pain in the United States. Both agents are metabolized in the liver to active compounds via the cytochrome P450 2D6 enzyme. Case reports of pediatric patients with overactive CYP2D6 enzymes have been reported. These ultra-rapid metabolizers experience an increase in the production of active metabolites of codeine and tramadol, which can lead to oversedation, respiratory depression, and death. In 2017, the U.S. Food and Drug Administration updated their warnings regarding codeine and tramadol use in the pediatric population, making their use contraindicated in patients under the age of 12 years.
ISSN:0891-5245
1532-656X
DOI:10.1016/j.pedhc.2018.04.016