Breaking News
February 23, 2018 - Beetroot may reduce kidney failure risk after heart x-ray, research reveals
February 23, 2018 - Sleep disruptions in menopause correlated with hot flashes and depression
February 23, 2018 - Scientists discover new treatment approach to curb severe myocarditis
February 23, 2018 - ‘Click chemistry’ approach may improve disease-fighting properties of drugs
February 23, 2018 - NIGHTSEA and EMS team up to offer KEY Award in fluorescence stereo microscopy
February 23, 2018 - Tobacco Kills, No Matter How It’s Smoked: Study
February 23, 2018 - Q&A: Avindra Nath, MD | Medpage Today
February 23, 2018 - Adherence to sleep apnea treatment affects risk of hospital readmission
February 23, 2018 - Zika virus could be alternative for treatment of aggressive brain cancer
February 23, 2018 - Carbon monoxide enhances efficacy of antibiotic against stomach infection
February 23, 2018 - MSD and Ferring Pharmaceuticals Complete Largest Ever Clinical Trial in Postpartum Haemorrhage
February 23, 2018 - Portable ultrasound can help better detect fluid in the lungs of patients with end-stage kidney disease
February 23, 2018 - Postnova AF2000 system offers reliable characterization of trace metal colloid distribution in the environment
February 23, 2018 - Pioneering study may pave way for effective painkillers to treat neuropathic pain
February 23, 2018 - Research opens up new avenue to minimize risks of transplants
February 22, 2018 - Cabozantinib Active in Advanced Thyroid Cancer
February 22, 2018 - Polluted air may pollute our morality
February 22, 2018 - New data from VOYAGE 2 trial shows promising results for Janssen’s guselkumab treatment
February 22, 2018 - Bank loans signed in the hospital leave patients vulnerable
February 22, 2018 - Researchers identify new nanostructure inside sperm tails
February 22, 2018 - Catheter-based procedure increases treatment options for mitral valve disease
February 22, 2018 - Sage Therapeutics Receives FDA Breakthrough Therapy Designation for SAGE-217 for the Treatment of Major Depressive Disorder
February 22, 2018 - Larger Endocarditis Vegetations More Likely to Embolize, Kill
February 22, 2018 - Parenting behavior in adoptive families
February 22, 2018 - Researchers discover new weakness in sleeping sickness parasites
February 22, 2018 - Research project aims to find new ways to identify and treat most aggressive brain cancers
February 22, 2018 - Researchers explore how people with Alzheimer’s disease use end-of-life medical services
February 22, 2018 - Stroke survivors and carers feel marginalized due to lack of support from primary care
February 22, 2018 - Neuroscientists discover novel mechanism of action behind schizophrenia
February 22, 2018 - After shooting, ‘honor how kids want to deal with their feelings’
February 22, 2018 - U.S., EU and Japan Health Authorities Accept Regulatory Submissions For Review Of Pfizer’s Third-generation ALK Inhibitor Lorlatinib
February 22, 2018 - At-Home Genetic Test Might Change Medicine
February 22, 2018 - Many second hand plastic toys could pose a risk to children’s health, study suggests
February 22, 2018 - Study shows that two different brain systems cooperate during learning
February 22, 2018 - Liquefied brain tissue after stroke may harm surviving brain, UA study finds
February 22, 2018 - New intervention improves communication behaviors in couples affected by dementia
February 22, 2018 - Clinical trial shows safety of promising TSRI stroke drug
February 22, 2018 - Researchers discover new interaction mechanism of unstructured proteins
February 22, 2018 - A Patient’s Journey: Can I Kill the Glucose Monster?
February 22, 2018 - The Problem That Piles Up
February 22, 2018 - Kids can roll up their sleeves—again—for mumps protection
February 22, 2018 - Scientists find significant amounts of toxic metals in e-cigarette vapors
February 22, 2018 - 3D Signatures reports positive results of new Telo-HL test for Hodgkin’s lymphoma
February 22, 2018 - Scientists reveal development of improved medicine to fight addiction
February 22, 2018 - USC-led researchers release dataset of brain scans from stroke patients
February 22, 2018 - Antibiotic-producing bacterium releases more metabolites than assumed
February 22, 2018 - Flu Season Shows First Signs of Slowing
February 22, 2018 - Nonstick Chemicals May Disrupt Metabolic Function in Women
February 22, 2018 - Calcium may play a role in the development of Parkinson’s disease
February 22, 2018 - Scientists visualize insulin receptor activation for the first time
February 22, 2018 - UC San Diego Health now offers new treatment option for people with refractory epilepsy
February 22, 2018 - First African child vaccinated with new typhoid conjugate vaccine
February 22, 2018 - BetterYou named as ‘Most Innovative Brand’ at FGB Awards 2018
February 22, 2018 - Assaults Among Young People Fall to Lowest Rate in 15 Years
February 22, 2018 - What do you know about Parkinson’s disease?
February 22, 2018 - Researchers discover five new genetic changes that may increase pancreatic cancer risk
February 22, 2018 - Gout medication may help improve heart function in adult patients
February 22, 2018 - Bioactive compound limits collateral damage in the kidneys after heart attack
February 22, 2018 - Study reveals HCT as effective treatment for NHL patients regardless of age
February 22, 2018 - Father’s age can affect offspring lifespan, mice study shows
February 22, 2018 - Opiant Pharmaceuticals Announces Publication of New Pre-Clinical Data Supporting Potential of OPNT005 as a Heroin Vaccine
February 22, 2018 - Make the Diagnosis: Strange Rash Surfaces
February 22, 2018 - Isolated sulfite oxidase deficiency – Genetics Home Reference
February 22, 2018 - Scientists identify weight loss ripple effect
February 22, 2018 - Smoking at record lows in New York
February 22, 2018 - Scientists pinpoint fertility hormone that could support early pregnancy
February 22, 2018 - Aggressive cancer stem cells can now be isolated successfully in a scientific breakthrough
February 22, 2018 - Researchers find high risk of suicide among unaccompanied refugee minors
February 22, 2018 - Protein levels linked to posture and gait problems in Parkinson’s
February 22, 2018 - Biomedical engineers create 3D hydrogel scaffolds  to transform cells into muscle
February 22, 2018 - Study employs novel approach to uncover new biomarker for CHD
February 22, 2018 - Study finds strong connection between midwifery and birth outcomes
February 22, 2018 - Verastem Submits NDA to FDA for Duvelisib for the Treatment of Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Follicular Lymphoma
February 22, 2018 - Low BP Associated With Risk in HFpEF
February 22, 2018 - More U.S. women obese before pregnancy, experts sound the alarm
February 22, 2018 - Study aims to examine effects of PTSD symptoms in police officers
February 22, 2018 - Study reveals increased disease risk after early heart surgery
February 22, 2018 - Women with Type 1 diabetes come across unique challenges
February 22, 2018 - Researchers target abnormal epigenetic mechanisms involved in childhood cancers
February 22, 2018 - Wine polyphenols may be good for oral health
Kids Still Getting Risky Painkiller After Tonsillectomy: MedlinePlus Health News

Kids Still Getting Risky Painkiller After Tonsillectomy: MedlinePlus Health News

image_pdfDownload PDFimage_print

HealthDay news image

THURSDAY, Nov. 16, 2017 (HealthDay News) — Despite safety warnings from drug regulators, some U.S. children are still being given a risky painkiller after having their tonsils removed, a new study finds.

At issue is the opioid painkiller codeine. In 2013, the U.S. Food and Drug Administration issued a “black box” warning, advising doctors against prescribing codeine to children to control tonsillectomy pain.

That came after an investigation into reports of children overdosing on codeine prescriptions — including some who died from respiratory distress.

The new study, published online Nov. 15 in Pediatrics, looked at how well U.S. doctors are following the FDA warning.

The good news, the researchers said, is that post-tonsillectomy codeine prescriptions have declined. However, by December 2015 — almost three years after the black box warning was issued — 5 percent of kids were still getting the drug.

Medical experts said there’s no acceptable reason for that.

“That figure should be down to zero,” said Dr. Kao-Ping Chua, the lead researcher on the study. “Codeine carries a small but catastrophic risk for children. Plus, there are alternatives — like Tylenol [acetaminophen] and ibuprofen.”

Dr. Alyssa Hackett, an otolaryngologist at Mount Sinai Beth Israel in New York City, agreed.

“There’s no appropriate reason to prescribe codeine to these children,” said Hackett, who was not involved in the study.

Why is the medication such a concern?

Codeine itself is “inert,” explained Chua, a pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital in Ann Arbor. Once codeine is ingested, he said, the body converts it into morphine.

The problem is that people vary in how they metabolize codeine, based on their genes. Some people are “ultra-metabolizers,” which means they can develop dangerously high morphine levels in the blood.

There’s no way of knowing whether a child fits that category, “so every time you prescribe codeine, you’re basically rolling the dice,” Chua said.

For the study, his team analyzed a national database of health insurance claims. The researchers focused on nearly 363,000 children who had a tonsillectomy, adenoidectomy or both between 2010 and 2015. (Adenoids are tissues near the tonsils.)

In January 2010, 31 percent of kids who’d had such surgery were given a codeine prescription after their operation. The rate steadily declined thereafter, and then accelerated after the FDA warning was issued.

Codeine was already falling out of favor before the official warning, Chua said, because many doctors were aware of the safety concerns. By December 2015, the percentage of kids receiving a codeine prescription had fallen to 5 percent.

It’s not clear why some doctors continued to prescribe the drug. Chua said he does not think it’s lack of awareness, because black box warnings are clear.

He suspects there’s some “inertia” — doctors continuing to do what they’re comfortable with — and possibly a lack of trust that other painkillers are effective.

Both Chua and Hackett said acetaminophen or ibuprofen should be the go-to for children after tonsillectomy.

“Most kids are resilient and do very well with those medications,” Hackett said.

There are other opioid drugs that are not as risky as codeine — such as hydrocodone (the active ingredient in Vicodin) and oxycodone (OxyContin). But according to Chua, they should be a last resort, in cases where a child does not get relief from the over-the-counter options.

“The default position should be, ‘let’s avoid opioids,’ ” Chua said.

Hackett agreed, saying she does not prescribe any opioids to children younger than 12.

The codeine issue goes beyond post-tonsillectomy pain, however, Chua said. Codeine is also found in some cold-and-cough products, and treatment guidelines now say that kids younger than 18 should not take those medications.

In fact, the American Academy of Pediatrics has said codeine has no place in pediatrics at all.

“This isn’t just about tonsillectomy,” Chua said. “We shouldn’t be using codeine for any reason in children.”

SOURCES: Kao-Ping Chua, M.D., Ph.D., assistant professor and pediatrician, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor; Alyssa Hackett, M.D., assistant professor, otolaryngology, Mount Sinai Beth Israel, New York City; Nov. 16, 2017, Pediatrics, online

News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.

Tagged with:

About author

Related Articles