Medicines containing codeine should no longer be given to children under 12 for coughs and colds or to adolescents between the ages of 12 and 18 who have respiratory problems, according to new rules from the European Medicines Agency (EMA).

Following an EU-wide review of the use of codeine for coughs and colds, the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) concluded that the risk of side effects outweighed the benefits. The rate at which codeine is converted into morphine in the blood is more variable and unpredictable in children under 12, increasing the risk of side effects such as breathing difficulties. In addition, coughs and colds are self-limiting conditions and there is little evidence that codeine is effective at treating them in children.

Due to the association with breathing problems, codeine-containing cough medicines are also contraindicated in all children with respiratory conditions such as asthma, as well as breastfeeding mothers and patients of any age who are known to convert codeine into morphine at a faster rate than normal. Endorsing the advice, the Medicines and Healthcare products Regulatory Agency (MHRA) stated:

“This is important advice about the use of codeine to treat cough and cold in children. Whilst codeine is not commonly used in children, the evidence is clear that there is a risk of side effects. If anyone has any questions, they should speak to their GP or pharmacist, who can best advise on alternative treatments.”