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Physicians Advise Against Using Codeine in Children

Sep 22, 2016

The American Academy of Pediatrics has issued a new clinical report warning against the use of codeine in children due the risk of a potentially deadly reaction. Codeine is an opioid; it is used as a painkiller and cough suppressant. The report notes that codeine is widely prescribed in clinical settings. In 28 states, it can be purchased over-the-counter in some form. Regulators and physician groups, including the AAP, the U.S. Food and Drug Administration (FDA), Health Canada, the World Health Organization and the European Medicines Agency have issued strong warnings for codeine.

Codeine is frequently combined with acetaminophen. Brand names include: Capital Codeine; Phrenilin with Caffeine, Codeine; and Tylenol with Codeine; and Fioricet with Codeine. Codeine is often prescribed to children after surgeries such as tonsillectomies.

Codeine acts as a painkiller when it gets metabolized by the liver and gets converted into morphine. However, codeine is not processed the same way by all patients. In some children, the drug is metabolized quickly, leading to high levels of morphine. The authors of the report state that in some cases, codeine can reduce breathing and cause death.

The report comments that codeine is often the painkiller of choice because pediatricians have few safe and effective options for children. Similarly, there are not many alternatives for coughs. Lead author Dr. Joseph Tobias said in a press release, "Effective pain management for children remains challenging because children's bodies process drugs differently than adults do,"

The authors contend that the risks of codeine are not worth its benefits. "Maybe a little pain is better than the alternative," said author Dr. Charles Coté to Associated Press. The report suspects that codeine poses greater risks for children who already suffer from breathing problems such as sleep apnea.

"The evolving information about the genetic variability in drug metabolism will yield important insights to guide physicians in the safe and effective treatment of their patients," the authors stated in the report. "Additional clinical research must extend the understanding of the risks and benefits of both opioid and nonopioid alternatives for orally administered, effective agents for acute pain."

The FDA voted to advise against using codeine to treat coughs in children last December. Previously, it has recommended that codeine can be used for pain if the perceived benefits outweigh the risks. The agency said that caretakers should look out for signs of morphine overdose, however. One FDA study found that in 2011, codeine was prescribed to over 800,000 children under age 11. The agency identified 21 deaths related to codeine use between 1965 and 2015.

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