Beware giving pain meds to young children
DEAR DOCTOR: The Food and Drug Administration recently said parents shouldn’t give their kids medicine with codeine or tramadol. How dangerous are these drugs? What should parents use instead?
DEAR READER: Codeine and tramadol are medications that are widely used to treat pain. However, not everyone reacts to these drugs the same way. Some individuals metabolize codeine and tramadol very quickly, which results in unsafe levels of the drugs in the body. This puts them at risk of breathing problems severe enough that they can lead to death. As a result, the FDA amplified an existing warning in April regarding the use of tramadol and codeine when treating children.
Manufacturers of drugs that contain codeine or tramadol are now required by the FDA to change their labels to include a plainly stated warning against their use in anyone under the age of 12 and by nursing mothers. An additional warning cautions against giving codeine or tramadol to adolescents between the ages of 12 and 18 who are obese, or who have sleep apnea, lung disease or any other condition that can affect breathing.
Both drugs belong to a class of medications called opiate analgesics. Codeine is approved to treat pain and, because it also belongs to a class of medications called antitussives, it is used to treat cough. Antitussives don’t cure a cough, but rather suppress the command from the brain that tells the body to cough. Codeine and tramadol reduce pain in a similar fashion, by acting on neural pathways.
The problems arise in certain individuals whose bodies absorb and metabolize the drugs very quickly. An enzyme variant in their livers causes them to convert the medications so rapidly that they wind up with unsafe levels of active opioids in their bloodstream. This affects the part of the brain that regulates breathing and can lead to death.
As for what you should use instead, in most cases, over-the-counter medications like Tylenol or ibuprofen should do the trick.
Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health.
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