• N. Engl. J. Med. · Dec 2004

    Case Reports

    Codeine intoxication associated with ultrarapid CYP2D6 metabolism.

    • Yvan Gasche, Youssef Daali, Marc Fathi, Alberto Chiappe, Silvia Cottini, Pierre Dayer, and Jules Desmeules.
    • Divisions of Surgical and Medical Intensive Care, Geneva University Hospital, Switzerland. yvan.gasche@medecine.unige.ch
    • N. Engl. J. Med. 2004 Dec 30; 351 (27): 282728312827-31.

    AbstractLife-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.Copyright 2004 Massachusetts Medical Society.

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