Abstract
The pro-drug codeine is commonly prescribed for postpartum pain relief in North America. The safety of codeine during breastfeeding is related in part to the extent of the active morphine metabolite catalyzed from codeine via the cytochrome P450 2D6 (CYP2D6) enzyme. In mothers who have greater than two functional copies of the CYP2D6 gene (CYP2D6 ultrarapid metabolism phenotype; UM) a substantially higher proportion of morphine is produced. Label changes on codeine-containing medications will highlight the risks associated with this genotype for breastfeeding mothers, but are not supported by translation strategies on how to incorporate this pharmacogenetic knowledge into clinical practice. To address the immediate issue of CYP2D6 UM inheritance in family members of a breastfed infant who succumbed to fatal opioid intoxication and whose codeine-prescribed mother was a CYP2D6 UM, we constructed a pedigree. While the pedigree approach is helpful to aid diagnosis, identify other at risk family members, and simplify pharmacogenetic analysis, its clinical usefulness is dependant on an institutional framework which is not available in most centers at this time.
Keywords: CYP2D6, duplication, codeine, breastmilk, ultrarapid metabolism, pedigree, Genotype, UM, phenotype, Genomic DNA, morphine, toxicity, opioid, NSAIDs, codeine-acetaminophen, pharmacogenetic
Current Drug Safety
Title: Genetic Transmission of Cytochrome P450 2D6 (CYP2D6) Ultrarapid Metabolism: Implications for Breastfeeding Women taking Codeine
Volume: 6 Issue: 1
Author(s): Parvaz Madadi, Catherine Ciszkowski, Andrea Gaedigk, J. Steven Leeder, Ronni Teitelbaum, David Chitayat and Gideon Koren
Affiliation:
Keywords: CYP2D6, duplication, codeine, breastmilk, ultrarapid metabolism, pedigree, Genotype, UM, phenotype, Genomic DNA, morphine, toxicity, opioid, NSAIDs, codeine-acetaminophen, pharmacogenetic
Abstract: The pro-drug codeine is commonly prescribed for postpartum pain relief in North America. The safety of codeine during breastfeeding is related in part to the extent of the active morphine metabolite catalyzed from codeine via the cytochrome P450 2D6 (CYP2D6) enzyme. In mothers who have greater than two functional copies of the CYP2D6 gene (CYP2D6 ultrarapid metabolism phenotype; UM) a substantially higher proportion of morphine is produced. Label changes on codeine-containing medications will highlight the risks associated with this genotype for breastfeeding mothers, but are not supported by translation strategies on how to incorporate this pharmacogenetic knowledge into clinical practice. To address the immediate issue of CYP2D6 UM inheritance in family members of a breastfed infant who succumbed to fatal opioid intoxication and whose codeine-prescribed mother was a CYP2D6 UM, we constructed a pedigree. While the pedigree approach is helpful to aid diagnosis, identify other at risk family members, and simplify pharmacogenetic analysis, its clinical usefulness is dependant on an institutional framework which is not available in most centers at this time.
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Cite this article as:
Madadi Parvaz, Ciszkowski Catherine, Gaedigk Andrea, Steven Leeder J., Teitelbaum Ronni, Chitayat David and Koren Gideon, Genetic Transmission of Cytochrome P450 2D6 (CYP2D6) Ultrarapid Metabolism: Implications for Breastfeeding Women taking Codeine, Current Drug Safety 2011; 6 (1) . https://dx.doi.org/10.2174/157488611794479991
DOI https://dx.doi.org/10.2174/157488611794479991 |
Print ISSN 1574-8863 |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-3911 |
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