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CYP2D6 Screening for Adverse Drug Reactions to Codeine in Breast Milk

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified January 2010 by Lawson Health Research Institute.
Recruitment status was:  Recruiting
Information provided by:
Lawson Health Research Institute Identifier:
First received: January 11, 2010
Last updated: January 13, 2010
Last verified: January 2010
The purpose of this study is to determine if non-invasive salivary genetic screening of breastfeeding mothers taking codeine will allow for the successful identification of mother-infant pairs susceptible to adverse events and to prevent these adverse events by personalizing their medication to their genetics.

Condition Intervention
Cytochrome P450 2D6 Ultra-rapid Metabolism
Genetic: Cytochrome P450 2D6 (CYP2D6) genetic screening.

Study Type: Observational
Study Design: Time Perspective: Prospective
Official Title: CYP2D6 Screening for Adverse Drug Reactions to Codeine in Breast Milk

Resource links provided by NLM:

Further study details as provided by Lawson Health Research Institute:

Primary Outcome Measures:
  • Incidence of maternal and neonatal CNS depression in the prospective pharmacogenetic screening group to that of a retrospectively screened population [ Time Frame: 5-8 days post c-section surgery ]

Secondary Outcome Measures:
  • Incidence of the phase II uridine diphosphate glucuronyltransferase 2B7 (UGT2B7)*2/*2 variant which has been associated with higher morphine 6-glucuronide to morphine ratios. [ Time Frame: Minimum 1 week prior to c-section ]
  • Incidence of the C3435T polymorphism in the multi-drug resistance gene (MDR1) which has been associated with significantly greater pain relief from morphine treatment. [ Time Frame: Minimum 1 week prior to c-section ]
  • Incidence of the A118G polymorphism in the opioid receptor 1 (OPRM1) which has been associated with reduced response to morphine treatment. [ Time Frame: Minimum 1 week prior to c-section ]

Biospecimen Retention:   Samples With DNA
Saliva and breast milk samples.

Estimated Enrollment: 660
Study Start Date: October 2009
Estimated Study Completion Date: December 2012
Estimated Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Individuals within this group will receive pharmacotherapy according to the established institutional guidelines.
Genetic: Cytochrome P450 2D6 (CYP2D6) genetic screening.
Genetic screening for cytochrome P450 2D6 (CYP2D6) polymorphism will be conducted on genetic information obtained from non-invasive salivary samples.
Prospective CYP2D6 genetic screening
Individuals within the prospective group will receive their CYP2D6 genotype results prior to pharmacotherapy and their analgesic regimen will be tailored to their genetic results.
Genetic: Cytochrome P450 2D6 (CYP2D6) genetic screening.
Genetic screening for cytochrome P450 2D6 (CYP2D6) polymorphism will be conducted on genetic information obtained from non-invasive salivary samples.

Detailed Description:
Currently, the opioid analgesic codeine is commonly administered to breastfeeding mothers after Caesarean section for pain relief. Codeine was originally considered safe to use while breastfeeding however, increased risk of adverse drug reactions has been demonstrated in mothers taking codeine, as well as their breastfed infants, when the mother possesses a genetic variation resulting in cytochrome P450 2D6 (CYP2D6) ultra-rapid metabolizer (UM) phenotype. On average, most people convert about 10-15% of their codeine dose to morphine resulting in pain relief however, UM individuals can convert up to 50% of their codeine doses into active morphine. As many as 4% of North Americans may be UMs and these mothers and their breastfed infants are at high risk of serious adverse events despite "safe" codeine dosing due to morphine overproduction and accumulation in the mother and her breast milk. Observed side effects include severe sedation, decreased rate and depth of breathing and even infant death. In response to this problem, our hospital-based clinical trial strives to identify at-risk UM mother-infant pairs by performing a genetic test on non-invasive, voluntary saliva samples from mothers giving birth by Caesarean section and who will need codeine for pain relief while breastfeeding. We believe that this test will allow us to reliably identify at-risk UM mother-infant pairs and prevent adverse drug reactions in both by tailoring analgesic therapy to their genetic results: mothers identified as being UMs will be given other suitable analgesics, such as ibuprofen, in place of codeine-containing preparations. We propose that this prospective study will generate high-level data supporting the cost-effective genetic screening of mothers who will be taking codeine while breastfeeding before they begin taking their medications. Such testing is currently possible on a nation-wide scale through collaboration with the Canadian Pharmacogenomics Network for Drug Safety (CPNDS).

Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Sampling Method:   Probability Sample
Study Population
Women undergoing elective caesarian section surgery and planning to breastfeed while concurrently taking codeine for post-partum pain relief within St. Joseph's Hospital in London and St. Michael's Hospital in Toronto.

Inclusion Criteria:

Women who:

  • Have a pre-scheduled Caesarean section
  • Provide DNA for CYP2D6 genetic analysis
  • Breastfeed their infants
  • Take codeine-containing medication during breastfeeding (retrospective screening group and non-CYP2D6 ultrarapid metabolizers in prospective screening group)

Exclusion Criteria:

  • Mothers who do not provide consent prior to Caesarian section surgery
  • Mothers who take other sedative medications besides codeine during breastfeeding (these include benzodiazepines, skeletal muscle relaxants, psychotropic agents).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01050400

Contact: Catherine Ciszkowski, BMSc 519-661-2111 ext 83221

Canada, Ontario
St. Joseph's Hospital Recruiting
London, Ontario, Canada, N6A 4V2
Principal Investigator: Gideon Koren, MD         
Sponsors and Collaborators
Lawson Health Research Institute
Principal Investigator: Gideon Koren, MD University of Western Ontario, Canada
  More Information

Responsible Party: Dr. Gideon Koren, University of Western Ontario Identifier: NCT01050400     History of Changes
Other Study ID Numbers: R-09-442
Study First Received: January 11, 2010
Last Updated: January 13, 2010

Keywords provided by Lawson Health Research Institute:
Genetic Polymorphism

Additional relevant MeSH terms:
Drug-Related Side Effects and Adverse Reactions
Chemically-Induced Disorders
Analgesics, Opioid
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Antitussive Agents
Respiratory System Agents processed this record on May 22, 2017