The Journal of the American Dental Association
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J Am Dent Assoc, Vol 135, No 8, 1082.
© 2004 American Dental Association
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LETTERS

CODEINE USE

I would like to comment on Dr. Arthur Friedlander and colleagues’ June JADA article, "Panic Disorder: Psychopathology, Medical Management and Dental Implications."

I question Dr. Friedlander on his statement that codeine should be used in a reduced dosage in patients on SSRIs. Codeine is a prodrug that is metabolized to its active form via the cytochrome P450 isoenzyme P450IID6.

Patients on SSRIs who are prescribed codeine would therefore not attain the desired analgesic effect from this medication. It is not a matter of reducing the dose of codeine, but the use of a different opioid analgesic.



Jack J. Hirschfeld, D.D.S.
West Palm Beach, Fla.



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