Pediatric Codeine Use

[wucool33]

Under what circumstance(s) do you feel is appropriate for a child under 12 to be prescribed a codeine product? Just want to get some opinions... thanks!

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[Dred Pirate]

with the latest data - never

unless you know they are not a fast metabolizer and they have a history of legit allergies to other pain control options

edit: - essentially never

 

[radio frequency]

It's off formulary where I work for those under 16. We won't dispense it if you are under 16. Codeine is a crummy drug anyway; can't figure out why it's still so widely used.

 

[Lnsean]

probably if they can't find oxy or hydrocodone solution and it's the weekend

 

[Dred Pirate]

probably if they can't find oxy or hydrocodone solution and it's the weekend

and you hope they don't die? (small risk, but ya, not worth it - good luck explaining that one when defending a lawsuit)

 

[zelman]

Under what circumstance(s) do you feel is appropriate for a child under 12 to be prescribed a codeine product? Just want to get some opinions... thanks!

When every other opioid is unavailable. Though, I might choose codeine over Demerol and fentanyl/derivatives.

 

[trailerpark]

Purple Drank


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[zelman]

I would pick fentanyl over Demerol or codjne

In an opiate naïve outpatient?

 

[Dred Pirate]

In an opiate naïve outpatient?

depends on the situation - for acute pain in an ED setting - yes - we use fentanyl often in peds - we NEVER use codeine

outpatient - probably not going to use fentanyl

 

[zelman]

depends on the situation - for acute pain in an ED setting - yes - we use fentanyl often in peds - we NEVER use codeine

outpatient - probably not going to use fentanyl

Yeah. This is what I was hinting at, and the reason I initially said "might".

 

[farmadiazepine]

My hospital completely removed all codeine entries for pediatric patients.

 

[RxPreceptor]

If it's a hard copy it would be highly suspicious whether it's fake/stolen Rx. Contact MD

 

[WVUPharm2007]

Codeine: Time To Say “No” | From the American Academy of Pediatrics | Pediatrics

Nein.

 

[wucool33]

I agree completely with you guys. A follow up question, do you guys still dispense it to children at community setting? I had to deny it for a 7 yo and the doc refused to change it. He even convinced the mom that it was completely safe. What would you guys do?

 

[WVUPharm2007]

I agree completely with you guys. A follow up question, do you guys still dispense it to children at community setting? I had to deny it for a 7 yo and the doc refused to change it. He even convinced the mom that it was completely safe. What would you guys do?

Educate the caregiver and tell her that she should make the decision based on her own judgement. And if that decision is to fill it, she's going to have to go elsewhere because I don't want any part of it. I've done it before.

 

[CetiAlphaFive]

Ask the parent:

"If there were a stadium that would be full of kids, and they were going to pick 2 to kill, would you put your child in the stadium, even though the odds they're going to be picked are super low?"

 

[MindOverMatter]

Educate the caregiver and tell her that she should make the decision based on her own judgement. And if that decision is to fill it, she's going to have to go elsewhere because I don't want any part of it. I've done it before.

I really like this response. It emphasizes the fact that this is a terrible choice for this patient. If they are going to go against a medical professional who has been trained in these matters, then they will be going at it alone. I'll have to remember this for next time.

 

[cozypark]

What about apap/codeine to kids (between 9-12 yo) for pain control after surgery? We have been filling it as long as it is not for tonsilectomy surgery pain.

 

[CetiAlphaFive]

What about apap/codeine to kids (between 9-12 yo) for pain control after surgery? We have been filling it as long as it is not for tonsilectomy surgery pain.

 

[Dred Pirate]

What about apap/codeine to kids (between 9-12 yo) for pain control after surgery? We have been filling it as long as it is not for tonsilectomy surgery pain.

no - never

I am sure @msweph can come in and correct me, but the issues is due to fast metabolism of the codeine to morphine - yes the deaths were seen post tonsilectomies, but that is where it was first seen due to those patients are more at risk for breathing issues - it can happen in any pain control situation, the surgery doesn't change how the child process the drug.

 

[cozypark]

no - never

I am sure @msweph can come in and correct me, but the issues is due to fast metabolism of the codeine to morphine - yes the deaths were seen post tonsilectomies, but that is where it was first seen due to those patients are more at risk for breathing issues - it can happen in any pain control situation, the surgery doesn't change how the child process the drug.

Thanks.

 

[Wickett]

Funny that I read this post the other day. I had no experience with this being written for a child at my pharmacy, so I hadn't put much thought into it before/had scant knowledge of its specific dangers.

I received an Rx today for Tylenol #3 suspension for a 5 year old to take 3mL every 4 hours. I called and left a message for the physician to consider a different therapy.

MD (orthopedic surgeon) calls me back and starts yelling at me on the phone. Tells me he has been prescribing this for years/I'm an idiot/and says I am keeping a child in pain and wasting his precious time on this idiotic phone call. He didn't write it for a "boo boo or cough" and to "****ing fill it." He laughed at my suggestion of traditional non opioid pain therapy.

I told him my system requires to call and verify for codeine use in children under 12, and I'm basing my opinion on the posted fall article from the AAP. He tells me he's not a pediatrician and hangs up.

OK, dude.

 

[CetiAlphaFive]

Funny that I read this post the other day. I had no experience with this being written for a child at my pharmacy, so I hadn't put much thought into it before/had scant knowledge of its specific dangers.
I received an Rx today for Tylenol #3 suspension for a 5 year old to take 3mL every 4 hours. I called and left a message for the physician to consider a different therapy.
MD (orthopedic surgeon) calls me back and starts yelling at me on the phone. Tells me he has been prescribing this for years/I'm an idiot/and says I am keeping a child in pain and wasting his precious time on this idiotic phone call. He didn't write it for a "boo boo or cough" and to "****ing fill it." He laughed at my suggestion of traditional non opioid pain therapy.
I told him my system requires to call and verify for codeine use in children under 12, and I'm basing my opinion on the posted fall article from the AAP. He tells me he's not a pediatrician and hangs up.
OK, dude.

How did you handle it?

I had a doctor try to yell at me once and I told them that I wasn't about to deal with an emotionally unstable clown, and asked them to have a real doctor call me back.

 

[deleted820760]

How did you handle it?

I had a doctor try to yell at me once and I told them that I wasn't about to deal with an emotionally unstable clown, and asked them to have a real doctor call me back.

 

[confettiflyer]

Funny that I read this post the other day. I had no experience with this being written for a child at my pharmacy, so I hadn't put much thought into it before/had scant knowledge of its specific dangers.

I received an Rx today for Tylenol #3 suspension for a 5 year old to take 3mL every 4 hours. I called and left a message for the physician to consider a different therapy.

MD (orthopedic surgeon) calls me back and starts yelling at me on the phone. Tells me he has been prescribing this for years/I'm an idiot/and says I am keeping a child in pain and wasting his precious time on this idiotic phone call. He didn't write it for a "boo boo or cough" and to "****ing fill it." He laughed at my suggestion of traditional non opioid pain therapy.

I told him my system requires to call and verify for codeine use in children under 12, and I'm basing my opinion on the posted fall article from the AAP. He tells me he's not a pediatrician and hangs up.

OK, dude.

What an arse, I wouldn't fill it. I'd have asked if he confirmed the patient was not a fast metabolizer.

Sorry kid, better in pain than dead.


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[radio frequency]

Funny that I read this post the other day. I had no experience with this being written for a child at my pharmacy, so I hadn't put much thought into it before/had scant knowledge of its specific dangers.

I received an Rx today for Tylenol #3 suspension for a 5 year old to take 3mL every 4 hours. I called and left a message for the physician to consider a different therapy.

MD (orthopedic surgeon) calls me back and starts yelling at me on the phone. Tells me he has been prescribing this for years/I'm an idiot/and says I am keeping a child in pain and wasting his precious time on this idiotic phone call. He didn't write it for a "boo boo or cough" and to "****ing fill it." He laughed at my suggestion of traditional non opioid pain therapy.

I told him my system requires to call and verify for codeine use in children under 12, and I'm basing my opinion on the posted fall article from the AAP. He tells me he's not a pediatrician and hangs up.

OK, dude.

You can still consider low doses of oxycodone liquid for short term use in these situations; I see that a lot for peds and haven't yet seen anything to suggest it is as unsafe as codeine...though they both undergo CYP2D6 metabolism to produce active metabolites. Good on you for calling.

 

[Wickett]

You can still consider low doses of oxycodone liquid for short term use in these situations; I see that a lot for peds and haven't yet seen anything to suggest it is as unsafe as codeine...though they both undergo CYP2D6 metabolism to produce active metabolites. Good on you for calling.

Yea we had no liquid oxy so OTC was only thing I could suggest for a stat alternative. I just kept telling the MD that I'm not going to apologize for doing my job. When he made his "I'm no pediatrician" retort, I responded with "well I gathered that." The convo ended quite quickly.

I made notes on the Rx and profiled it. I spoke to the patients mom and convinced her not to fill the med. She said her kid had been fine past 24hrs on only Tylenol. By far the biggest jerk MD I've encountered.

 

[CetiAlphaFive]

Medicaid in Texas just announced they won't pay for codeine or tramadol for kids under 12.

 

[skegee12]

Dont all pharmacy systems make you call MD on codeine in pediatric use? At least all chains, I did read somewhere else that a flag didn't pop up but this was an independent pharmacy

 

[WVUPharm2007]

Dont all pharmacy systems make you call MD on codeine in pediatric use? At least all chains, I did read somewhere else that a flag didn't pop up but this was an independent pharmacy

CVS does...and they have the worst IT dept in the history of humanity, so I imagine everyone probably has to.

 

[owlegrad]

Dont all pharmacy systems make you call MD on codeine in pediatric use? At least all chains, I did read somewhere else that a flag didn't pop up but this was an independent pharmacy

CVS does...and they have the worst IT dept in the history of humanity, so I imagine everyone probably has to.

And you make every call the system prompts you to?

 

[wucool33]

CVS does...and they have the worst IT dept in the history of humanity, so I imagine everyone probably has to.

When I started this thread, I could have bypassed the DUR. Is that not an option anymore?

 

[WVUPharm2007]

When I started this thread, I could have bypassed the DUR. Is that not an option anymore?

I'm fairly certain that it's a level 1 severe interaction for children under 12...which makes you hit either "A" or "C" in the DUR resolution screen, which forces a phone call. I've only had to deal with it once and it was in the middle of the night, obviously...so I couldnt call the urgent care that wrote it.