Due to concerns outlined previously (Why “therapeutic dose” of codeine can kill | gutsandgrowth), the FDA has now placed a boxed warning on all codeine-containing products and is now contraindicated after adenotonsillectomy.  This is reviewed in a recent perspective article: NEJM 2013; 368: 2155-57.

“In the case of codeine, a combination of case reporting and our evolving understanding of genetic influences on drug response has clarified the need to avoid this drug after adenotonsillectomy.”

Bottomline: Due to the variability in codeine metabolism, alternative narcotic agents are usually a better choice even in those who have not undergone adenotonsillectomy.