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COMMENTS ON PUBLISHED ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 1  |  Page : 83  

Need to replace codeine for management of paediatric post operative pain


Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India

Date of Submission24-Sep-2019
Date of Decision27-Oct-2019
Date of Acceptance28-Oct-2019
Date of Web Publication7-Jan-2020

Correspondence Address:
Dr. Aditi Jain
House No. 8H/4, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_696_19

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How to cite this article:
Jain A, Bhardwaj N. Need to replace codeine for management of paediatric post operative pain. Indian J Anaesth 2020;64:83

How to cite this URL:
Jain A, Bhardwaj N. Need to replace codeine for management of paediatric post operative pain. Indian J Anaesth [serial online] 2020 [cited 2020 Dec 2];64:83. Available from: https://www.ijaweb.org/text.asp?2020/64/1/83/275228



Sir,

We read the review 'Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting'[1] with great interest and found it to be very informative.

We would like to bring to the readers' attention that while codeine has regularly been used for management of post-operative pain and has been mentioned as safe for children more than 3 years in this review, on April 20, 2017 the FDA issued its strongest warning – a contraindication for its use for pain in children less than the age of 12.[2] This has resulted from drug surveillance and reports of life-threatening respiratory depression associated with codeine over the past two decades. A number of organisations including the world health organisation (WHO) in 2011, Health Canada in 2013, and European Medicines Agency in 2015 have also issued warnings against the use of codeine in the paediatric population.[3]

Codeine is a prodrug that is metabolised via the P450 CYP2D6 to morphine and its metabolites. Due to genetic polymorphism and a large number or alleles coding for the enzyme there is a wide range in the level of enzyme activity.[4] Clinically this translates to a spectrum where on one end there are children who are poor metabolisers and are deprived of adequate analgesia. The other extreme is more concerning as it comprises children who are ultrarapid metabolisers and have supratherapeutic levels of morphine, which leads to severe respiratory depression.

Hence we would like to caution the readers against the use of codeine for routine post-operative analgesia and urge them to use alternative modalities for the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mehrotra S. Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting. Indian J Anaesth 2019;63:763-70.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
U.S. Food and drug administration. FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. 2017. Available from: https://www.fda.gov. [Last accessed on 2019 Nov 07].  Back to cited text no. 2
    
3.
Tobias JD, Green TP, Cote CJ. Section on anesthesiology and pain medicine, Committee on drugs. Codeine: Time to say 'No'. Pediatrics 2016;138:e20162396.  Back to cited text no. 3
    
4.
Tremlett MR. Wither codeine? Pediatric Anesthesia 2013;23:677-83.  Back to cited text no. 4
    




 

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