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To prescribe codeine or not to prescribe codeine?
Insights
Annually, over 700,000 children aged 3-17 received codeine prescriptions during emergency department (ED) visits. This commentary reviews codeine
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Public Health
Background:
- Codeine-containing products are frequently prescribed for children (3-17 years) during emergency department (ED) visits, averaging 700,000 prescriptions annually over the past decade.
- Despite American Academy of Pediatrics warnings in 1997 and 2006 regarding safety and effectiveness, codeine remains common for upper respiratory infections.
- Potential shifts in prescribing patterns, including increased codeine use due to hydrocodone rescheduling, warrant a review of its risks.
Purpose of the Study:
- To critically evaluate the safety and effectiveness of codeine-containing products in pediatric patients.
- To highlight concerns regarding codeine use, particularly within the emergency department setting.
- To inform prescribers about the risks associated with codeine, especially in light of evolving drug scheduling.
Main Methods:
- Review of existing literature and guidelines concerning codeine use in pediatric populations.
- Analysis of prescribing trends for codeine-containing products in association with emergency department visits.
- Discussion of pharmacologic and safety considerations relevant to codeine in children.
Main Results:
- An average of approximately 700,000 annual prescriptions for codeine products were issued to children aged 3-17 in conjunction with ED visits over the last decade.
- Existing guidelines have previously raised concerns about the safety and efficacy of codeine.
- Anticipated changes in the scheduling of other medications may inadvertently increase reliance on codeine.
Conclusions:
- Codeine's continued widespread use in pediatric emergency care necessitates a thorough examination of its safety and effectiveness profile.
- Prescribers should be aware of the potential risks and limited benefits of codeine in children.
- Further consideration of alternative pain and cough management strategies is warranted for pediatric patients, especially in the ED setting.
Abstract:
A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.