Should Codeine, Dextromethorphan or Hydrocodone be Prescribed?
AAP Committee on Drugs, Pediatrics June 1997 Introduction: Pediatricians often feel that they need to prescribe something when a patient comes to the office. Of course, the primary cause of cough – if present – needs to be identified and treated: eg allergy, GE Reflux, asthma, irritants such as cigarette smoke, dust and wood heat. Even if one of these etiologies is found, codeine, dextromethorphan, hydrocodone are often prescribed to give symptomatic treatment to children. What will you recommend when you are in private practice? 1. Codeine • Mechanism of action: suppress artificially and disease-related cough through CNS action • Dosage usually used: 1 mg/kg/day in 4 divided doses up to 60 mg/day. • Side Effects: respiratory depression and obtundation; can be addictive. • < 2 mg/kg/day: unlikely to have any side effects • 3-5 mg/kg/day: somnolence, ataxia, miosis, vomiting, rash, facial swelling, itching • > 5 mg/kg/day: 3% require mechanical ventilation; 2 deaths. • Interactions with
