What is the black box warning associated with codeine?

The black box warning associated with codeine highlights the serious risks of respiratory depression and death, especially in certain populations. Codeine is an opioid analgesic that can cause significant sedation and respiratory suppression, which can be dangerously heightened in children, particularly those who are ultrarapid metabolizers of the drug. In these patients, the metabolism of codeine to morphine occurs at an increased rate, leading to higher levels of morphine in the bloodstream. This heightened potency can impair respiratory function and potentially be fatal.

The warning is especially critical for healthcare providers to recognize when prescribing codeine for pain management or cough suppression, as it emphasizes the need for caution due to the potential for life-threatening side effects. Managing dosages and closely monitoring patients, particularly those most vulnerable, is essential to mitigate these risks.