Pediatric Codeine Use

[BJJVP]

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More bad press:

http://www.cbsnews.com/news/codeine-given-to-kids-despite-warning-study-finds/

Basically, the article blames ER doctors for the use of codeine in kids. To be fair, it does suggest that sometimes parental pressure has something to do with it.

 

[Daiphon]

More bad press:

http://www.cbsnews.com/news/codeine-given-to-kids-despite-warning-study-finds/

Basically, the article blames ER doctors for the use of codeine in kids. To be fair, it does suggest that sometimes parental pressure has something to do with it.

Yeah... and their assertion that hydrocodone is safer makes no sense.

30 of codeine as in a single T#3 = 3 of hydrocodone = 4-5 of morphine.
Can't get hydrocodone in less than 5 (Norco)... so, sure, it's a prodrug and metabolism can vary, but still giving an appropriate dose provided one uses the right weight-based calculation.

Wholly agree, though, on the point about codeine for cough suppression. Don't do it. Parents often dose more frequently than prescribed... leading to the problems CBS wants to lay at our feet.

Cheers!
-d

 

[Arcan57]

Bonus points for the peds EM doc throwing us "adult" EPs under the bus. I wonder what the safety profile on hydrocodone would look like if every codeine script was changed over. The figures I saw were 10 deaths since 1999 which given the conservative estimate of 500k/yr Rxs means that roughly 1 in every 750,000 kids that gets codeine dies. It's a crappy pain medicine and you probably should be figuring something else out for your post-op OSA kids, but I can't believe that handing out Norco elixir is the solution.

 

[xaelia]

Yeah... and their assertion that hydrocodone is safer makes no sense.

Agree – doesn't make sense to trumpet hydrocodone as safer, although, its metabolism is more predictable. Presumably, they're referring to the codeine hypermetabolizers, which contributed to death by overdose in otherwise safe codeine administration:
http://www.fda.gov/drugs/drugsafety/ucm313631.htm

 

[Birdstrike]

Agree – doesn't make sense to trumpet hydrocodone as safer, although, its metabolism is more predictable. Presumably, they're referring to the codeine hypermetabolizers, which contributed to death by overdose in otherwise safe codeine administration:
http://www.fda.gov/drugs/drugsafety/ucm313631.htm

I agree, in that you can have rapid metabolizers to any opiate, and hydrocodone is metabolized to hydromorphone (dilaudid). Is that any better than a drug (codeine) that's metabolized to morphine? If enough kids get hydrocodone, there will be overdoses to it, also. Be sure of it.

Why do kids need any opiate containing cough syrup? I have two kids, they've been sick many times and I've never once given them an opiate containing cough medicine. It's a classic setup for adverse events.

 

[Daiphon]

I agree, in that you can have rapid metabolizers to any opiate, and hydrocodone is metabolized to hydromorphone (dilaudid). Is that any better than a drug (codeine) that's metabolized to morphine? If enough kids get hydrocodone, there will be overdoses to it, also. Be sure of it.

Why do kids need any opiate containing cough syrup? I have two kids, they've been sick many times and I've never once given them an opiate containing cough medicine. It's a classic setup for adverse events.

Took the words right outta my mouth...

 

[Tiger26]

One solution is to just not prescribe the ghetto prodrug of sizzzurrp .....

Strangely, people seem less interested when I offer albuterol for their cough .....

 

[Rendar5]

I prescribe honey for cough suppression anyway, as long as they're over 1. 1 Tbsp q3h prn cough. May dose as often as you want, side effects include kids running around and driving you crazy.

 

[WilcoWorld]

Why do kids need any opiate containing cough syrup? I have two kids, they've been sick many times and I've never once given them an opiate containing cough medicine. It's a classic setup for adverse events.

Press Ganey.

 

[Birdstrike]

Press Ganey.

Yes, exactly. This is Medicine as "business" and simply a "job" as opposed to Medicine as a "higher calling" or a "profession." You didn't make it this way, I didn't make it this way, but this unfortunately, is where we find ourselves.