• The Laryngoscope · May 2014

    Codeine-related adverse drug reactions in children following tonsillectomy: a prospective study.

    • Cynthia A Prows, Xue Zhang, Myra M Huth, Kejian Zhang, Shannon N Saldaña, Nancy M Daraiseh, Hope R Esslinger, Edita Freeman, John H Greinwald, Martin Lisa J LJ, and Senthilkumar Sadhasivam.
    • Division of Human Genetics, University of Cincinnati, Cincinnati, Ohio; Division of Pharmacy, University of Cincinnati, Cincinnati, Ohio.
    • Laryngoscope. 2014 May 1; 124 (5): 1242-50.

    Objectives/HypothesisTo prospectively determine factors associated with codeine's adverse drug reactions (ADRs) at home in a large homogenous population of children undergoing outpatient tonsillectomy.Study DesignProspective, genotype blinded, observational study with a single group and repeated ADR measures documented by parents at home.MethodsA total of 249 children 6 to 15 years of age scheduled for tonsillectomy were enrolled. The primary outcome was number of daily codeine-related ADRs. We examined the number and type of ADR by race and by days and further modeled factors potentially associated with ADR risk in a subcohort of white children. Sedation following a dose of codeine was a secondary outcome measure. Parents recorded their children's daily ADRs and sedation scores during postoperative days (POD) 0 to 3 at home.ResultsDiaries were returned for 134 children, who were given codeine. A total of 106 (79%) reported at least one ADR. The most common ADRs were nausea, lightheadedness/dizziness for white children and nausea, and vomiting for African American children. In a subcohort of white children ≤ 45 kg, increased ADR risk was associated with the presence of one or more full function CYP2D6 alleles (P < 0.001), POD (P < 0.001), and sex (P = 0.027). Increased pain intensity (P = 0.009) and PODs 0 and 1 (P = 0.001) contributed to a higher sedation risk. Neither obstructive apnea nor predicted CYP2D6 phenotype were associated with sedation risk.ConclusionsOur results provide evidence that multiple factors are associated with codeine-related ADRs and support the FDA recommendation to avoid codeine's routine use following tonsillectomy in children.© 2013 The American Laryngological, Rhinological and Otological Society, Inc.

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