Vitality

Painkiller Codeine May Be Too Dangerous To Treat Kids’ Cough And Pain Relief; Doctors Urge Restrictions

The American Academy of Pediatrics (AAP) is coming out swinging against a common opioid painkiller prescribed and marketed to children — codeine — over fears that it might be much more dangerous and less effective than widely assumed.

In a clinical report published in the October edition of the AAP’s namesake journal Pediatrics, the authors highlighted many of the growing concerns surrounding codeine. In particular, while codeine has long been assumed to be safe and effective for children of all ages, more recent research suggests that its effects on the body can vary widely due to slight differences in how individuals may metabolize the drug.

For so-called ultra-rapid metabolizers, codeine can even be life-threatening, and cause shallow breathing, coma, and death. Elsewhere, its widespread use in children’s cough medicine may be completely unwarranted since there’s little consistent evidence of its effectiveness as a cough suppressant (antitussive).

“Published reports and clinical evidence have shown the potential dangers of codeine as an analgesic or as an antitussive,” concluded the authors. They called for further actions to be taken to prevent further use among children, such as educating parents and enforcing formal restrictions.

Medication The American Academy of Pediatrics issues a new report recommending that children stay away from the commonly used opioid codeine, found in both pain and cough medication. Pixabay, Public Domain

The report’s conclusions come on the heels of similar recommendations made in recent years by organizations as far flung as the World Health Organization, the Food and Drug Administration (FDA), and the European Medicines Agency. Specifically, the FDA in 2013 required medications containing codeine to have a “black box warning” label that explicitly advised doctors to prescribe other painkillers for children who had just undergone surgery to remove their tonsils and/or adenoids.

The EMA took things one step further and recommended in 2015 that all children under the age of 12 and children between the ages 12 to 18 with breathing problems not use codeine to treat their coughs. And the FDA is expected to issue a similar decree in the near future. Currently, it’s available over-the-counter in 28 states as well as the District of Columbia.

Codeine is a prodrug, meaning it initially has no effect on the body when taken. Instead, it’s later broken into morphine, which is actually responsible for the drug’s active effects. Because there are genetic variations in how we break down codeine, though, people can range from feeling nothing to having their respiratory system shut down. Children with sleep apnea or obesity may also be more vulnerable to its severe complications. Though codeine deaths are rare, they do happen — research cited by the authors found that there had been 24 such deaths among children from 1965 to 2015.

The authors advocate that other pain treatments, whether opioid or nonopioid, start being more widely researched in children so that they can eventually replace codeine as a standard treatment of choice in the pediatrician's office. Finding a true successor, they warned, may not be easy though.

"Effective pain management for children remains challenging," said the report's lead author Dr. Joseph D. Tobias, in a statement, "because children's bodies process drugs differently than adults do."

Sour ce: Tobias J, Green T, Coté C. Codeine: Time To Say “No”. Pediatrics. 2016.

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