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本文引用的文献

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Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother.一位服用可待因母亲的母乳喂养新生儿吗啡中毒的药物遗传学
Lancet. 2006 Aug 19;368(9536):704. doi: 10.1016/S0140-6736(06)69255-6.
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Codeine intoxication associated with ultrarapid CYP2D6 metabolism.与CYP2D6超快速代谢相关的可待因中毒
N Engl J Med. 2004 Dec 30;351(27):2827-31. doi: 10.1056/NEJMoa041888.
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Isoform selectivity and kinetics of morphine 3- and 6-glucuronidation by human udp-glucuronosyltransferases: evidence for atypical glucuronidation kinetics by UGT2B7.人尿苷二磷酸葡萄糖醛酸基转移酶对吗啡3-和6-葡萄糖醛酸化的同工型选择性及动力学：UGT2B7非典型葡萄糖醛酸化动力学的证据。
Drug Metab Dispos. 2003 Sep;31(9):1086-9. doi: 10.1124/dmd.31.9.1086.
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Postoperative pain in the neonate: age-related differences in morphine requirements and metabolism.新生儿术后疼痛：吗啡需求量及代谢的年龄相关性差异
Intensive Care Med. 2003 Nov;29(11):2009-15. doi: 10.1007/s00134-003-1899-4. Epub 2003 Jul 25.
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A pharmacogenetic study of uridine diphosphate-glucuronosyltransferase 2B7 in patients receiving morphine.接受吗啡治疗患者的尿苷二磷酸葡萄糖醛酸转移酶2B7的药物遗传学研究。
Clin Pharmacol Ther. 2003 Jun;73(6):566-74. doi: 10.1016/S0009-9236(03)00053-5.
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Unique CYP2D6 activity distribution and genotype-phenotype discordance in black Americans.美国黑人中独特的细胞色素P450 2D6（CYP2D6）活性分布及基因型-表型不一致性
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Pediatrics. 2001 Sep;108(3):776-89. doi: 10.1542/peds.108.3.776.
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哺乳期使用可待因的安全性：一位服用可待因的母亲所哺乳的新生儿发生致命性吗啡中毒

Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine.

作者信息

Madadi Parvaz, Koren Gideon, Cairns James, Chitayat David, Gaedigk Andrea, Leeder J Steven, Teitelbaum Ronni, Karaskov Tatyana, Aleksa Katarina

出版信息

Can Fam Physician. 2007 Jan;53(1):33-5.

PMID:17872605
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1952551/
Abstract

QUESTION

Recently a newborn died from morphine poisoning when his mother used codeine while breastfeeding. Many patients receive codeine for postlabour pain. Is it safe to prescribe codeine for nursing mothers?

ANSWER

When a mother is an ultrarapid metabolizer of cytochrome P450 2D6, she produces much more morphine when taking codeine than most people do. In this situation, newborns might be exposed to toxic levels of morphine when breastfeeding. Options to reduce this risk include discontinuing codeine after 2 to 3 days of use and being aware of symptoms of potential opioid toxicity in both mothers and newborns.

摘要

问题

最近有一名新生儿因母亲在母乳喂养期间使用可待因而死于吗啡中毒。许多患者在产后疼痛时会使用可待因。给哺乳期母亲开可待因是否安全？

答案

当母亲是细胞色素P450 2D6的超快代谢者时，她服用可待因时产生的吗啡比大多数人多得多。在这种情况下，新生儿在母乳喂养时可能会接触到有毒剂量的吗啡。降低这种风险的选择包括在使用2至3天后停用可待因，并留意母亲和新生儿潜在阿片类药物毒性的症状。