Codeine use for cough and cold restricted in children

Codeine is associated with a risk of respiratory side-effects in children, the MHRA has advised.

The MHRA received 26 Yellow Card reports of respiratory side-effects associated with the use of codeine in children up to 5th August 2014. | SCIENCE PHOTO LIBRARY
The MHRA received 26 Yellow Card reports of respiratory side-effects associated with the use of codeine in children up to 5th August 2014. | SCIENCE PHOTO LIBRARY

A European review has found limited evidence that codeine is effective for treating cough and cold symptoms in children.

Healthcare professionals are reminded that codeine-containing medicines used for cough and cold are:

  • contraindicated in children under 12 years of age
  • not recommended for adolescents (12 to 18 years of age) who have problems with breathing.

In addition, codeine must not be used in patients of any age known to be CYP2D6 ultra-rapid metabolisers or in breastfeeding mothers.

Further information

MHRA Drug Safety Update

The new guidance follows the 2013 Pharmacovigilance Risk Assessment Committee review of codeine for pain relief in children, which resulted in several recommendations, including:

  • use restricted to those aged over 12 years with acute moderate pain that cannot be relieved by other analgesics eg ibuprofen or paracetamol
  • use contraindicated in children under 18 years undergoing tonsillectomy or adenoidectomy to treat obstructive sleep apnoea.
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