Last Tuesday the American Academy of Pediatrics (AAP) issued a statement that the dangers of codeine use in children outweigh the benefits, and formally recommended that codeine not be used in the pediatric population. Specifically, the AAP noted that children can be “ultra-rapid metabolizers” of codeine and thus suffer highly deleterious adverse effects to its active metabolites. The AAP interpretation was that the “majority” of the pediatric population runs such a risk.
In response, PharmGKB – a leading pharmacogenomics knowledge resource – argues that while it agrees that the variability in patient phenotypic response to codeine is important to consider, PharmGKB’s position is that rather than recommending such potentially highly beneficial treatment be ceased, the AAP ought to consider the enormous potential benefit of employing pharmacogenetic testing to assess whether indeed the individual patient is a rapid metabolizer of codeine.
Furthermore, PharmGKB characterized such measures as an “archaic” reaction that does not take into account that rapid metabolizers can be easily flagged through PGx, and expressed concern at the AAP’s disseminating such misinformation to the general population. Moreover, PharmGKB points out that codeine is in fact a potentially highly effective analgesic and an antitussive agent and the AAPs measure to recommend discontinuing it is misguided and a blunt, outdated and categorically misinformed response.
MD Labs agrees strongly with PharmGKB’s stance on the AAP decision. The Rxight® pharmacogenetic testing identifies patients who should be identified based on genetic profiles that would put them at risk for major contraindications from codeine and propose alternative medications for codeine based on their genetically modulated response to codeine therapy. The Rxight® test is based on SNP genotyping for hundreds of common prescription and OTC medications, including codeine and other opioids.
In contrast to the AAP’s “one-size-fits-all” recommendation to avoid codeine treatment entirely for all children, using Rxight® to screen children would help identify those who may have a negative metabolic reaction to codeine before they begin treatment. Rxight® would provide prescribing guidance for their physician to tailor the child’s treatment regimen accordingly, helping children either avoid codeine or enabling children for whom codeine is entirely safe to benefit from it.