Archive May 2018 XIX, No. 5

Ideas That Work: Pediatric Pain Management

Reminder: Codeine Could Be Fatal to Children

Outpatient Surgery Editors


Codeine is prohibited for children following tonsillectomies and adenoidectomies.

If you're prescribing codeine to children after tonsil and adenoid surgery, stop. Some facilities apparently still are, despite the FDA's 2013 black box warning that prescribing the opioid to kids could be fatal. A study in Pediatrics ( last year showed that as many as 1 in 20 children were still receiving codeine. Some children rapidly convert codeine to morphine, resulting in a risk of overdose. Other children poorly metabolize codeine to morphine, resulting in no improvement in pain. Acetaminophen (Tylenol), ibuprofen (Advil) or hydrocodone (Vicodin) all control pain well.

Sheldon S, Sones, RPh, FASCP
Safe Medication Management for Ambulatory Service Facilities
Newington, Conn.

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