Codeine is contraindicated for pain management in children undergoing tonsillectomy or adenoidectomy. The primary reason is:

• A Codeine causes severe hemorrhagic complications in the oropharyngeal region
• B Codeine is ineffective in oropharyngeal pain due to poor tissue penetration
• C Codeine causes laryngospasm in children under 12 years
• D Codeine is a prodrug converted to morphine by CYP2D6, and ultra-rapid metabolizers can produce fatal morphine levels ✓

Explanation

Codeine is a prodrug requiring CYP2B6 conversion to morphine for analgesia. Ultra-rapid metabolizers convert codeine to morphine rapidly and excessively, causing fatal respiratory depression. Post-tonsillectomy children are particularly vulnerable due to airway edema compounding respiratory depression. The FDA and WHO have issued black box warnings for codeine in this population.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.