Seizures with Intravenous Codeine Phosphate

Abstract

OBJECTIVE:

To describe an adverse effect with intravenous codeine in a child diagnosed with sickle cell anemia.

CASE SUMMARY:

A seven-year-old boy with sickle cell anemia was admitted to the emergency department with severe pain unresponsive to high doses of oral acetaminophen; subsequently, intravenous codeine phosphate was administered. The patient immediately developed a tonic—clonic seizure, which was treated with intravenous diazepam and naloxone.

DISCUSSION:

Seizures associated with the intravenous administration of codeine phosphate have not been extensively reported in the literature, and special precautions for using the parenteral route for this drug have been vague and limited. Because of the frequent need for acute pain control in children with sickle cell crisis, they may be exposed to this type of reaction when intravenous narcotics are administered. The need for clear guidelines regarding the drug's appropriate parenteral dosing and administration is essential.

CONCLUSIONS:

Codeine phosphate—induced seizures are not common. The need for special instructions for its intravenous administration may prevent this type of reaction, especially in patients in need of acute pain control requiring intravenous narcotics.