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  • Title: Codeine intoxication associated with ultrarapid CYP2D6 metabolism.
    Author: Gasche Y, Daali Y, Fathi M, Chiappe A, Cottini S, Dayer P, Desmeules J.
    Journal: N Engl J Med; 2004 Dec 30; 351(27):2827-31. PubMed ID: 15625333.
    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.
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