Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother.

By G. Koren, J. Cairns, D. Chitayat, A. Gaedigk, S. Leeder. The Lancet, 2006

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Pharmacogenomics of Drug Metabolizing Enzymes and Transporters: Relevance to Precision Medicine (2016, background): “In 2006, a case of a 13-day newborn death was reported when the infant’s mother was placed on the codeine therapy after delivery for pain management of episiotomy [57].”
Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. (2013, result): “Conversely, increased effectiveness of codeine with sometimes life-threatening opioid intoxication was observed in patients with multiple CYP2D6 gene copies but also in neonates whose breastfeeding mothers were genetic CYP2D6 UMs, consistent with higher rates of conversion to morphine in patients wi”
Polymorphism of human cytochrome P450 enzymes and its clinical impact (2009, background): “Recently, a fatal case of a neonate was reported by Koren et al. (2006), which was caused by high levels of morphine resulting from high doses of codeine taken by a breastfeeding mother who was an UM.”
Influence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects. (2007, background): “For example, a recent case of infant death was described to be caused by a breast feeding mother of the UM phenotype and taking high doses of codeine with the resulting formation of morphine at levels being lethal to the infant (Koren et al., 2006).”