Trusted Resources: Evidence & Education
Scientific literature and patient education texts
Pharmacogenetics for Safe Codeine Use in Sickle Cell Disease
source: Pediatrics
year: 2016
authors: Gammal RS, Crews KR, Haidar CE, Hoffman JM, Baker DK, Barker PJ, Estepp JH, Pei D, Broeckel U, Wang W, Weiss MJ, Relling MV, Hankins J
summary/abstract:After postoperative deaths in children who were prescribed codeine, several pediatric hospitals have removed it from their formularies. These deaths were attributed to atypical cytochrome P450 2D6 (CYP2D6) pharmacogenetics, which is also implicated in poor analgesic response. Because codeine is often prescribed to patients with sickle cell disease and is now the only Schedule III opioid analgesic in the United States, we implemented a precision medicine approach to safely maintain codeine as an option for pain control. Here we describe the implementation of pharmacogenetics-based codeine prescribing that accounts for CYP2D6 metabolizer status. Clinical decision support was implemented within the electronic health record to guide prescribing of codeine with the goal of preventing its use after tonsillectomy or adenoidectomy and in CYP2D6 ultra-rapid and poor metabolizer (high-risk) genotypes. As of June 2015, CYP2D6 genotype results had been reported for 2468 unique patients. Of the 830 patients with sickle cell disease, 621 (75%) had a CYP2D6 genotype result; 7.1% were ultra-rapid or possible ultra-rapid metabolizers, and 1.4% were poor metabolizers. Interruptive alerts recommended against codeine for patients with high-risk CYP2D6 status. None of the patients with an ultra-rapid or poor metabolizer genotype were prescribed codeine. Using genetics to tailor analgesic prescribing retained an important therapeutic option by limiting codeine use to patients who could safely receive and benefit from it. Our efforts represent an evidence-based, innovative medication safety strategy to prevent adverse drug events, which is a model for the use of pharmacogenetics to optimize drug therapy in specialized pediatric populations.
organization: St. Jude Children's Research Hospital, Memphis; Medical College of WisconsinDOI: 10.1542/peds.2015-3479
read more full text
Related Content
-
Priapism in Sickle Cell AnemiaPriapism in Sickle Cell Anemia: II. Epi...
-
Alzheimer’s Treatment Memantine Shows Promise in Treating Sickle Cell DiseaseMemantine, a standard treatment for Alzh...
-
The role of nutrition in the pathophysiology and management of sickle cell disease among children: A review of liter...Sickle cell disease (SCD) is one of the ...
-
Kenneth Ataga, MDDr. Ataga's clinical interest is in clas...
-
CTX001 Earns FDA’s Fast Track Status for Treating Sickle Cell DiseaseThe U.S. Food and Drug Administration (F...
-
Wake Forest University Sickle Cell Center of ExcellenceWake Forest School of Medicine has serve...
-
The Role of Sleep Impairments on Pain Severity in Adults With Sickle Cell DiseaseSleep is a complex process and impairmen...
To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.