iStock/Thinkstock(NEW YORK) — Clinicians should avoid prescribing the painkiller/cough medicine codeine to children, according to a new editorial published by a group of physicians in Pediatrics.

The authors argue that because of the way codeine is metabolized in the body, it can have variable and potentially dangerous effects for children, leading to respiratory depression, even death.

Codeine is a “prodrug,” meaning  it has to be converted to an active form by your body to have its effects. The enzyme responsible for this conversion can work differently in people, so some children don’t get any relief from the drug, while others may experience profound effects.

Codeine is currently prescribed to more than 800,000 children younger than 11 years old – more than any other opioid.

A review of adverse events by the Food and Drug Administration (FDA) found that from 1965 to 2015, there were 64 cases of severe respiratory depression and 24 codeine-related deaths in children. In the past five years, several health organizations including the World Health Organization (WHO) and the FDA have recommended greater caution when prescribing codeine to children.

This editorial builds on other recommendations to exercise greater caution when prescribing opioids, especially for children. The authors argue for use of several alternative agents, including oxycodone and non-opioid medicines, which do not require enzymatic conversion in the body.

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