Who is pushing patients to death trap by improper use of codeine? Time now to reorient physicians or ban the use of codeine!

  • KC Singhal Former Vice-Chancellor, NIMS University, Jaipur & Consultant, WHO Centre for International Drug Monitoring, Uppsala, Sweden
  • KC Garg Formerly Professor, Department of Medicine, Maulana Azad Medical College, New Delhi
  • Syed Ziaur Rahman Professor, Department of Pharmacology, Jawaharlal Nehru Medical College, AMU, Aligarh
Keywords: Codeine therapy, geriatric patient, physician’s ignorance, physician’s negligence, iatrogenic death, analgesic nephropathy

Abstract

A single case report of an elderly female patient was discussed in this present paper. The patient was admitted to a metropolitan tertiary care hospital as a case of analgesic nephropathy and ankylosing spondylitis. She was advised codeine and other groups of medicines, but her condition got worsened day by day and eventually expired. The case was found irrationally treated and led to alleged iatrogenic death and hence discussed here in terms of the patient’s age, comorbidities, concomitant medicines, and dose calculation.

 

Author Biographies

KC Singhal, Former Vice-Chancellor, NIMS University, Jaipur & Consultant, WHO Centre for International Drug Monitoring, Uppsala, Sweden

 

 

KC Garg, Formerly Professor, Department of Medicine, Maulana Azad Medical College, New Delhi

 

 

Syed Ziaur Rahman, Professor, Department of Pharmacology, Jawaharlal Nehru Medical College, AMU, Aligarh

 

 

References

1. Owen, J.A., Sitar, D.S., Berger, L., Brownell, L., Duke, P.C. and Mitenko, P.A. Age‐related morphine kinetics. Clinical Pharmacology & Therapeutics 1983; 34: 364-368
2. Jochimsen PR, Yes R.N., JR. Appraisal of Codeine as an Analgesic in Older Patients. Journal of the American Geriatrics Society 1978; 26: 521-523
3. Kevin C. Wilson, Jussi J. Saukkonen. Acute respiratory failure from abused substances. J Intensive Care Med. 2004; 19(4): 183–193
4. Reynolds JEF, ed. (1993) Martindale, the extra pharmacopoeia, 30th ed. London, The Pharmaceutical Press. pp 1069-1071
5. Sindrup SH, Brosan K. The Pharmacogenetics of codeine hypoalgesia. Pharmacogenetics 1995; 5: 335-46
6. Schiller EY, Goyal A, Cao F, et al. Opioid Overdose. [Updated 2020 Mar 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470415
7. SZ Rahman, RA Khan & A Kumar, Experimental study of the morphine de-addiction properties of Delphinium denudatum Wall, BMC Complementary and Alternative Medicine 2002: 2/6 http://www.biomedcentral.com/1472-6882/2/6
8. L.E.J. Evans, C.P. Swainson, P. Roscoe, L.F. Prescott. Treatment of Drug Overdosage with Naloxone, a specific narcotic antagonist. The Lancet 1973; 301 (7801): 452-455
9. Turnheim, K. Drug Dosage in the Elderly. Drugs Aging 1998; 13, 357–379
10. Klaus Turnheim. Drug therapy in the elderly. Experimental Gerontology 2004; 39 (11–12): 1731-1738
11. Beyth RJ, Shorr RI. Principles of Drug therapy in older patients; rational drug prescribing Clin. Geriatr. Med. 2002; 18 (3): 577-692
12. Pratibha Nand, Roop K Khar. Pharmaceutical dispensing. CBS Publishers and Distributors, 2006
13. ELDesoky, Ehab S. Pharmacokinetic-Pharmacodynamic Crisis in the Elderly. American Journal of Therapeutics 2007; 14 (5): 488-498
14. Wallace S M, Verbeeck R K. Plasma Protein Binding of Drugs in the Elderly. Clin Pharmacokinetic. 1987;12(1):41-72
15. Guiding H, Lundqvist G, Boreus LO, Bondesson U, Ohrvik J. Analgesic effect and plasma concentrations of codeine and morphine after two dose levels of codeine following oral surgery Eu. J. Clin Pharmacol 1993; 44: 319-23
16. Nolan L, O Malley K. Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug Reactions. Journal of the American Geriatrics Society 1988: 36: 142-9
17. Dolhery C. Therapeutic Drugs in 2nd Ed Edinburgh: Churchill Livingstone 1999; C 317-20
18. El Desoky E S. Pharmacokinetic-pharmacodynamics Crisis in the Elderly. American Journal of Therapeutics 2007;14 (5):488-98
19. Klotz U. Pharmacokinetics and Drug Metabolism in the Elderly. Drug metab Rev;2009;41(2):67-76
20. Dean L. Codeine Therapy and CYP2D6 Genotype. 2012 Sep 20 [Updated 2017 Mar 16]. In: Pratt VM, McLeod HL, Rubinstein WS, et al., editors. Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK100662/
21. MacDonald N, MacLeod S M. Has the time come to phase out codeine? Can Med Ass J 2010: 182 (17); 1825
22. Charak Samhita with English translation by P V Sharma. Chaukhamba Orientalia Prakashan, Varanasi.
Published
2020-06-30