Apnea in a child after oral codeine: a genetic variant - an ultra-rapid metabolizer

Paediatr Anaesth. 2007 Jul;17(7):684-7. doi: 10.1111/j.1460-9592.2006.02182.x.


We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism.

Publication types

  • Case Reports

MeSH terms

  • Acetaminophen
  • Adenoidectomy
  • Analgesics, Non-Narcotic
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / pharmacokinetics*
  • Child, Preschool
  • Codeine / adverse effects*
  • Codeine / pharmacokinetics*
  • Cytochrome P-450 CYP2D6 / genetics
  • Genetic Variation
  • Humans
  • Male
  • Polymorphism, Genetic
  • Sleep Apnea Syndromes / chemically induced*
  • Sleep Apnea Syndromes / enzymology
  • Tonsillectomy


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Acetaminophen
  • Cytochrome P-450 CYP2D6
  • Codeine