Codeine for your child: is it safe?

By Drum Digital
03 June 2014

In South Africa codeine is available in medication for adults and children, but American paediatricians have issued a warning to parents on the metabolisation of codeine by children.

In South Africa codeine is available in medication for adults and children, but American paediatricians have issued a warning to parents on the metabolisation of codeine by children.

WebMD reports children may display a variety of reactions to the drug: they could process it normally or have difficulty processing it (undermetabolisation) and fail to experience pain relief, or they may process the drug unusually fast (overmetabolisation). The latter response can lead to a build-up of morphine in the system, which can be dangerous – and even fatal – for some children. This is why American doctors are recommending parents use alternatives for pain relief and coughing.

In South Africa the Community Pharmacy Sector (CPS) has determined people should produce their ID when buying codeine. Dr Johann Kruger, president of the Pharmaceutical Society of South Africa (PSSA), says the drug holds the same dangers for children as for adults.

“Codeine has its place as a medication – you can’t scrap it completely because of a few exceptions, but it is true that people react differently to it. The first rule is: never give a codeine-containing drug for anything other than pain, and stick to the prescribed dose. If you can, use less.”

Dr Kruger says children are more susceptible to overdoses and even to addiction. Codeine, which is in syrups such as Benylin and Stopayne, works the same way in children as it does in adults – it’s turned into morphine.

“Parents shouldn’t use it just to help their children sleep. The drug is meant for relief of pain and coughing and can affect a child’s breathing.”

Regarding undermetabolisation and overmetabolisation of codeine in children, parents should be alert to how their children respond to codeine, and use it responsibly.

“If your child falls asleep after taking a spoonful of syrup, discuss this with your pharmacist or doctor.”

If your children display the opposite response – still experience pain despite receiving the correct dose – they could be undermetabolisers of the drug. Your doctor will recommend something else, such as paracetamol or ibuprofen, depending on the type of pain being treated.

The correct dose

For adults the limit is 4 g of codeine a month a person. This is based on the weight of the average adult – about 70 kg. It’s because of this regulation that people must show their IDs when buying codeine-containing medications. The rule applies to children too.

“For children your doctor or pharmacist will calculate the correct dose, as well as the maximum you can give your child a month, according to the child’s weight and age. This is then registered on the child’s ID number or birth date. If you’re uncertain about the quantities, don’t hesitate to ask your pharmacist. That’s what they’re there for. It costs you nothing and will ensure your child is safe,” says Dr Kruger. Children under two shouldn’t be given any codeine-containing drug.

-Dalena Theron

Extra sources: webmd.com

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