The FDA in 2012 started requiring that all pharmacy products containing codeine become boxed and labeled regarding its contraindications in some children in order to discourage the use of these products for post-tonsillectomy or post-adenoidectomy pain relief in youngsters.
The FDA changed the labeling requirements after reports of the deaths of children who had received the drug after having their tonsils or adenoids removed because the deaths appeared to be connected to the use of codeine in those children whose cytochrome P-450 (CYP) 2D6 genotype resulted in the very rapid alteration of codeine into morphine, the drug’s active metabolite.
Since the FDA’s labeling requirement, more and more hospital formularies have removed codeine products entirely in order to protect their young patients.
Hospitals appear to not miss it at all.
A June 15 article at ASHP.org quoted the pediatric pharmacy residency director at UF Health Shands Hospital in Gainesville, Florida as saying, that she believes hospitals “’have adjusted to having alternatives that don’t involve codeine.’”
Typical alternatives to codeine used at Shands have been acetaminophen, ibuprofen, oxycodone, and products containing a combination of acetaminophen-oxycodone.
While hospitals may be moving from non-narcotic pain-relievers for post-operative children, another person quoted in the article (Thomas Lausten, director of pharmacy services at Children’s Hospital of Wisconsin), stated that his observations as he works in community pharmacies, “indicates that more work is needed to raise awareness about the risks of codeine use in children.”
Lausten added that he believes that prescribing codeine-carrying products to children is a “habit, and the perception that codeine occupies an analgesic niche somewhere between nonprescription drugs and stronger opiods… .”
He added that there is “little benefit to using codeine, especially in children,” according to the article.
What about at your hospital or pharmacy? Are you still receiving prescriptions for young patients that include codeine, or has your pharmacy started a campaign to educate prescribing physicians?