User talk:Albert63093/sandbox

Genetic Risk Factors:
The process in which opioids are eliminated from the body vary. Opioids have to be metabolized by the liver before they are excreted in the urine. This biotransformation of opioids by the liver can either lead to the inactivation or activation of the drug. For example, methadone is converted primarily by CYP3A4 liver enzyme to an inactive metabolite. In contrast, Codeine is an initially inactive prodrug that is metabolized by polymorphic liver enzyme CYP2D6 to its active form morphine to exhibit its analgesic effects.

Codeine is commonly prescribed to treat pain postpartum for mothers who have undergone cesarean section. Breastfeeding while on codeine is deemed generally safe by American Academy of Pediatrics though typically low levels of codeine and morphine can cross into breast milk. However, there has been a report of an accidental infant opioid overdose that was linked to the ingestion of breastmilk from a mother taking codeine. Postmortem toxicology analysis discovered lethal levels of morphine in the infant’s blood. The mother had been prescribed Tylenol 3 (Codeine 30 mg/Acetaminophen 500mg) who took 2 tablets twice a day on day 1 and took to half the dose on day 2. Genetic analysis showed that the mother had three functional CYP2D6 alleles that would categorize her as a CYP2D6 ultrarapid metabolizer. This phenotype led to an increase in conversion of codeine to active morphine, which can increase the risk of toxicity and overdose.