Skip to Main Content
Skip Nav Destination
Liquid medication syringe

Codeine still prescribed to children despite contraindications

March 1, 2022

Although the Food and Drug Administration (FDA) has issued warnings and contraindications regarding the use of codeine-containing medicines in children since 2013, the drugs still were being prescribed to youths in 2019, a recent study showed.

Codeine is metabolized in the liver to morphine. Ultrarapid metabolizers, especially children with a history of obstructive sleep apnea, can produce enough morphine to cause respiratory depression and death.

In 2013, the FDA issued a boxed warning and contraindication for the use of codeine to manage pain in children younger than 18 after tonsillectomy and/or adenoidectomy. In 2017, the agency contraindicated codeine for the treatment of pain and cough in children younger than 12 years. In 2018, it contraindicated the use of codeine-containing cough and cold medicines in children under 18.

Researchers conducted a retrospective study to look at codeine prescribing in privately insured patients under 18. Using a pharmacy claims database, they identified children who received one or more prescriptions for codeine, opioids other than codeine and cough and cold medicines that don’t contain opioids.

They identified more than 24 million person-years of coverage from 2010 through 2019. During that time, prescriptions for codeine decreased 97% for children under 12 (from 3,760 to 106 per 100,000 person years) and 79% for those 12-17 (from 4,433 to 934 per 100,000 person years).  

The decrease in codeine prescriptions was greater than the decrease in other opioids for both age groups and for non-opioid cough and cold medicines for those under 12 (prescriptions for those ages 12-17 increased).

The biggest single-year decrease in codeine prescriptions for both age groups was from 2017-’18.

The authors concluded that efforts should continue to eliminate the use of codeine in pediatric patients.

Close Modal

or Create an Account

Close Modal
Close Modal