en
Scientific article
English

Codeine intoxication associated with ultrarapid CYP2D6 metabolism

Published inThe New England journal of medicine, vol. 351, no. 27, p. 2827-2831
Publication date2004
Abstract

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.

Keywords
  • Analgesics, Opioid/administration & dosage/metabolism/poisoning
  • Antitussive Agents/administration & dosage/metabolism/poisoning
  • Codeine/administration & dosage/metabolism/poisoning
  • Cough/drug therapy/etiology
  • Cytochrome P-450 CYP2D6/genetics/metabolism
  • Cytochrome P-450 CYP3A
  • Cytochrome P-450 Enzyme System/genetics/metabolism
  • Dextromethorphan/metabolism/therapeutic use
  • Genotype
  • Humans
  • Lung Diseases, Fungal/drug therapy
  • Male
  • Methylation
  • Middle Aged
  • Phenotype
  • Pneumonia/complications/drug therapy
Citation (ISO format)
GASCHE, Yvan et al. Codeine intoxication associated with ultrarapid CYP2D6 metabolism. In: The New England journal of medicine, 2004, vol. 351, n° 27, p. 2827–2831. doi: 10.1056/NEJMoa041888
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal0028-4793
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