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Codeine restricted use in children
The UK Medicines and Healthcare Products Regulatory Agency (MHRA) has restricted the use of codeine in children following the results of a European safety review. Codeine is now contraindicated in
all children 0–18 years undergoing tonsillectomy or adenoidectomy (or both) for obstructive sleep apnoea
all patients of any age known to be CYP2D6 ultra-rapid metabolisers.
Codeine should only be used to relieve acute moderate pain in children older than 12 years when other painkillers such as paracetamol or ibuprofen are inadequate. It should be given in divided doses up to four times a day at intervals of no less than 6 h and used at the lowest effective dose for a maximum of 3 days. The maximum daily dose should not exceed 240 mg/24 h.
Codeine is not recommended for use in children whose breathing might be compromised (eg, those with neuromuscular disorders, severe cardiac or respiratory conditions, upper respiratory or lung infections, multiple trauma or extensive surgical procedures) as the risk of morphine toxicity may be increased.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.