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Stop using codeine in kids

November 8, 2016

Short Attention Span Summary

Just say no
Codeine is a bad drug, especially for kids.  It has to be metabolized to its active form, morphine, by the liver, and everyone metabolizes it a little differently.  That means for some it doesn’t work at all, and others find themselves (or their children) either in an opiate-induced coma or dead.  The FDA has been warning about the dangers for a long time.  With so many other good choices, just don’t use codeine in kids.  And it’s probably best to avoid it in adults as well.

Spoon Feed
Stop using codeine in kids.  It’s a terrible choice.


Pediatrics. 2016 Sep 19. pii: e20151648. [Epub ahead of print]

Codeine: Time To Say “No”.



Codeine has been prescribed to pediatric patients for many decades as both an analgesic and an antitussive agent. Codeine is a prodrug with little inherent pharmacologic activity and must be metabolized in the liver into morphine, which is responsible for codeine’s analgesic effects. However, there is substantial genetic variability in the activity of the responsible hepatic enzyme, CYP2D6, and, as a consequence, individual patient response to codeine varies from no effect to high sensitivity. Drug surveillance has documented the occurrence of unanticipated respiratory depression and death after receiving codeine in children, many of whom have been shown to be ultrarapid metabolizers. Patients with documented or suspected obstructive sleep apnea appear to be at particular risk because of opioid sensitivity, compounding the danger among rapid metabolizers in this group. Recently, various organizations and regulatory bodies, including the World Health Organization, the US Food and Drug Administration, and the European Medicines Agency, have promulgated stern warnings regarding the occurrence of adverse effects of codeine in children. These and other groups have or are considering a declaration of a contraindication for the use of codeine for children as either an analgesic or an antitussive. 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 and chronic pain.

Copyright © 2016 by the American Academy of Pediatrics.

PMID: 27647717 [PubMed – as supplied by publisher]

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