Codeine is an opiate used mainly to relieve pain and suppress cough, and it can be found in many prescription and non-prescription drugs. It has been known as a standard cough-suppressant, and the pain-relieving effect is due to the fact that some of it is metabolized into morphine upon administration.
One of the problems of codeine (and its metabolites) is that it is secreted in the milk of nursing mothers, and this can lead to morphine overdose for the baby if the mother was an “ultra-rapid metabolizer” of codeine.
This week, the Food and Drug Administration in the US have issued a warning following a report of the death of a 13-day-old breast-fed infant who died from morphine overdose. His mom had been taking codeine to treat pain from an episiotomy and was later found to be an “ultra-rapid metabolizer” of codeine.
Ultra-rapid metabolism occur with a big variation among different ethnic groups, and people who have it usually don’t know about it. However, Saudis in particular must pay extra attention to this case. According to studies, 16-28% of Saudis have the genetic potential, compared to 1-10% among whites, 3% for blacks and 1% for Hispanics and Asians.
This is a very high prevalence and doctors in the Kingdom should be very careful when prescribing codeine for nursing mothers. The Ministry of Health should take a quick action and issue a warning to all health professionals in the country in order to prevent any possible harm.
Codeine products remain safe for most people, FDA says, but drug manufacturers should add information to the label about the phenomenon of codeine ultra-rapid metabolism, especially as it relates to breast-feeding.
Saudi Jeans 
Is Codeine legal in Saudi? I believe it’s illegal in the UAE.
I don’t know about the UAE, but codeine is legal here.
thanks a lot for the warning … regarding the legality of the drug in some countries …. it is usually a restricted medication … which means that you need a prescription to get the drug and you are only allowed a limited amount for a known period of time … the reason for that is to reduce the availability of the drug down the streets because it can be used to make IV drugs.
there is no such thing as “saudi” ethnicity. it should read Peninsula Arabs.
Now I know you are a pharmacist. Very professional. Hope they give you job soon
with all do respect there is no such thing as envivo codeine ALL OPIATES are converted to morphine without exception in the body!!! from the strongest
fentanyl(10 X more potent than heroin) to one of the weakest propoxephene etc
with all do respect there is no such thing as envivo codeine ALL OPIATES are converted to morphine without exception in the body!!! from the strongest
No, that isn’t correct. Fentanyl, the very example you cited, does not even have a chemical structure remotely resembling morphine. Codeine (a methoxy-derivative of morphine) and heroin (a diacetyl-derivative of morphine) both are converted into morphine at some point in the body, but there are many other semi-synthetic and purely synthetic opiates that resemble morphine but are not converted into morphine or belong to entirely different classes of opiates than morphine (like fentanyl, methadone and meperidine, for example). The brain’s natural opiates, the endorphins and enkephalins, do not resemble morphine either. They are polypeptides (small protein-like chemicals composed of amino acids).
The strongest opiate I know of is carfentanil, a cousin of fentanyl, with a phenomenal 10,000 x the potency of morphine. Radio-labeled carfentanil is used in mapping opiate receptors in the brain during neurological studies.
Great article.
Thanks for posting!