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Probable Codeine Phosphate–Induced Seizures

Research Associate, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Ya-Chu Lin, BSPharm

Graduate Student, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University

Shu-Min Kao, BSPharm MSCP

Section Chief, Department of Pharmacy, National Cheng Kung University Hospital; Adjunct Lecturer, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University

Yea-Huei Kao Yang, BSPharm

Associate Professor, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University

Reprints: Yea-Huei Kao Yang BSPharm, Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University, 1 University Rd., Tainan 70101, Taiwan, fax 886-6-2373149, yhkao{at}mail.ncku.edu.tw

OBJECTIVE: To report a case of seizure activity associated with oral codeine phosphate administered for analgesia in an elderly woman with end-stage renal disease.

CASE SUMMARY: A 73-year-old Taiwanese woman with end-stage renal disease received oral codeine phosphate 30 mg 4 times daily for her back and rib pain without adjustment of her dosage regimen. Seven days after starting codeine therapy, the woman became stuporous and developed tonic–clonic seizures. After phenytoin initiation, codeine discontinuation, and naloxone administration, the seizures did not recur.

DISCUSSION: Codeine is a frequently used opioid analgesic, especially when pain control with acetaminophen or nonsteroidal antiinflammatory drugs fails. Although seizures associated with codeine have been reported, pertinent data are very limited and the exact mechanism is unknown. An objective causality assessment indicated the seizure to be a probable drug-related event in this patient.

CONCLUSIONS: Elderly patients with end-stage renal disease may be predisposed to seizures with higher doses of codeine phosphate. It is imperative to adjust the codeine dosage regimen based on patients' renal function to avoid the potential toxicity with overdose.

Key Words: end-stage renal disease, oral codeine phosphate, seizures

Published Online, October 5, 2004. www.theannals.com, DOI 10.1345/aph.1E189