Codeine is not safe for children and should not be used to ease pain or relieve coughs, a leading US pediatricians group warns.
Codeine has been prescribed for decades for both purposes, despite mounting evidence that it does not always work and sometimes causes serious or potentially fatal side effects, doctors argue in a statement from the American Academy of Pediatrics.
“We firmly believe that there is never a reason to use codeine,” said the lead author of the statement, Joseph Tobias of Ohio State University and Nationwide Children’s Hospital in Columbus, said.
Codeine has been linked to life-threatening or fatal respiratory problems in children for more than a decade, Tobias and colleagues note in the statement published in the journal Pediatrics.
A recent review by the US Food and Drug Administration (FDA) of potentially dangerous side effects in kids using codeine identified 64 cases of severe slowed breathing rates and 24 deaths related to the drug, including 21 deaths in children under 12.
Respiratory issues often developed after children had surgery to remove their adenoids and tonsils, a procedure done to address obstructed breathing during sleep or treat acute or chronic tonsillitis.
Generally, the life-threatening events and deaths associated with codeine were found in relatively young kids who received a combination of acetaminophen and codeine after surgery.
Some children with undiagnosed nighttime breathing problems may also have respiratory problems after taking codeine, and obesity may increase the risk of this occurring.
We firmly believe that there is never a reason to use codeine
As doctors weigh the risks of prescribing codeine to children, they also need to consider the instances when there’s not enough evidence that the drug works, according to the AAP statement.
There is little proof codeine is effective for kids’ coughs, and mounting evidence suggests that some children may not respond to treatment for pain.
Part of the problem is the way codeine is processed by the body. It is converted by the liver into morphine that can ease pain. But genetic differences can trigger the liver to create too little or not enough morphine. Too little means the medicine does not work; too much means there could be dangerous or even fatal slowdowns in breathing.
The FDA ordered what is known as a ‘black box’ warning – its strongest – on codeine in 2013, cautioning doctors not to give the drug to children having surgery to remove their adenoids or tonsils.
Many major children’s hospitals across the US have already advised doctors to stop prescribing codeine, noted Constance Houck, a researcher at Boston Children’s Hospital and an author of the statement.
“This statement is meant to insure that all paediatricians, paediatric subspecialists and paediatric surgical specialists (including dentists) are aware of the concerns with codeine and recognise that, for the safety of their patients, they should switch to another oral opioid,” Houck said. “Opioids should never be prescribed for coughs and there are other oral opioids such as oxycodone and hydrocodone that are available for use in children,” Houck added.
Parents should not assume codeine is ok to give to children without seeing a doctor first, said Alan Woolf, a researcher at Harvard Medical School who was not involved in the AAP statement.
“They should ask what the alternative pain relievers are,” Woolf said by e-mail.
“Parents should not give their child codeine for coughs or colds.”