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CPIC Dosing Guideline for codeine and CYP2D6 - PharmGKB

6/18/2014
03:41 | Author: Tyler James

Codeine dosing
CPIC Dosing Guideline for codeine and CYP2D6 - PharmGKB

A label recommended age- or weight-specific codeine dose is warranted for CYP2D6 extensive and intermediate metabolizers.

Adapted from Tables 1 and 2 of the 2014 guideline update manuscript.

Advance online publication Dec 2011.

Alternate analgesics are recommended for CYP2D6 ultrarapid and poor metabolizers. A label recommended age- or weight-specific codeine dose is warranted for CYP2D6 extensive and intermediate metabolizers.

a Frequency estimates are based on data from Caucasians and may differ substantially for other ethnicities. See 2014 supplement above for estimates of phenotype frequencies among different ethnic/geographic groups. b Rating scheme is described in supplemental material - see 2014 update above. c Note that some investigators define patients with an activity score of 0.5 and 1.0 as intermediate metabolizers and define patients with an activity score of 1.5 and 2.0 as extensive metabolizers. Classifying patients with an activity score of 1.0 as extensive metabolizers in this guideline is based on data specific for formation of morphine from codeine in these patients. d There is substantial evidence for decreased efficacy of tramadol in poor metabolizers and a single case report of toxicity in an ultrarapid metabolizer with renal impairment following tramadol post-surgery. Use of other analgesics in CYP2D6 poor and ultrarapid metabolizers may therefore be preferable (see 2014 update above). e Some other opioid analgesics are metabolized by CYP2D6, such as hydrocodone and oxycodone. To avoid treatment complications, opioids that are not metabolized by CYP2D6, including morphine, oxymorphone, buprenorphine, fentanyl, methadone and hydromorphone, along with non-opioid analgesics, may be considered as alternatives for use in CYP2D6 poor and ultrarapid metabolizers.

Advance online publication January 2014.

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Dose - What is maximal, but safe dose of codeine for person with

4/17/2014
01:42 | Author: Hannah Ramirez

Liquid codeine syrup
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I have developed a tolerance of codeine due to taking prescription pain relief but i don't take more than 60mg at a time and never more than 4.

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Codeine-associated pediatric deaths despite using recommended

12/26/2014
09:37 | Author: Sarah Gray

Codeine dosing
Codeine-associated pediatric deaths despite using recommended

Codeine-associated pediatric deaths despite using recommended dosing guidelines: three case reports. Friedrichsdorf SJ, Nugent AP, Strobl AQ. This report.

This report describes the deaths of three children ages 4-10 years due to codeine toxicity at home. All three children were overweight or obese; however, the codeine doses were within recommended dose ranges for adjusted lean weight. Codeine's analgesic effect depends on its metabolic conversion to morphine in the liver via the drug-metabolizing enzyme CYP2D6. Genetic variation may result in poor analgesia, opioid toxicity, or oversedation. Caregivers must be warned about risks associated with comorbidities including obesity and polypharmacy. Codeine should no longer be prescribed to children due to its poor analgesic effect and risk of opioid toxicity and oversedation.

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