Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Prescribing Patterns of Codeine among Children under Aged 12 in Korea

건강보험자료를 이용한 12세 미만 소아에서 코데인 처방양상평가

  • Park, Hyo-Ju (Korea Institute of Drug Safety and Risk Management) ;
  • Shin, Han-Na (Review and Assessment Research Institute, Korea Health Insurance Review and Assessment Service) ;
  • Shin, Ju-Young (Department of Epidemiology, Biostatistics, and Occupational Health, McGill University)
  • 박효주 (한국의약품안전관리원) ;
  • 신한나 (건강보험심사평가원 심사평가연구소) ;
  • 신주영 (맥길대학교 역학.통계 및 직업환경의학과)
  • Received : 2015.11.11
  • Accepted : 2015.12.02
  • Published : 2015.12.31
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Abstract

Objective: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. Method: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were subclassified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. Results: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). Conclusion: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

Keywords

References

  1. Madadi P, Koren G. Pharmacogenetic insights into codeine analgesia: implications to pediatric codeine use. Pharmacogenomics 2008;9(9): 1267-84. https://doi.org/10.2217/14622416.9.9.1267
  2. D.G. Williams, D.J. Hatch, R.F. Howard. Codeine phosphate in paediatric medicine. Br J Anaesth 2001;86(3):413-21. https://doi.org/10.1093/bja/86.3.413
  3. Takahama K, Shirasaki T. Central and peripheral mechanisms of narcotic antitussives: codeine-sensitive and -resistant coughs. Cough 2007; 3:8. (Published online 2007 Jul 9. doi: 10.1186/1745-9974-3-8).
  4. World Health Organization. Cancer Pain Relief and Palliative Care in Children Geneva: World Health Organization; 1998.
  5. Tremlett M, Anderson BJ, A. W. Pro-con debate: is codeine a drug that still has a useful role in pediatric practice? Paediatr Anaesth 2010; 20(2):183-94. https://doi.org/10.1111/j.1460-9592.2009.03234.x
  6. de Lima J, Lloyd-Thomas AR, Howard RF, Sumner E, TM. Q. Infant and neonatal pain: anaesthetists' perceptions and prescribing patterns. BMJ 1996;313(7060):787. https://doi.org/10.1136/bmj.313.7060.787
  7. Neubert A, Verhamme K, Murray ML, et al. The prescribing of analgesics and non-steroidal anti-inflammatory drugs in paediatric primary care in the UK, Italy and the Netherlands. Pharmacol Res 2010; 62(3):243-8. https://doi.org/10.1016/j.phrs.2010.04.006
  8. Matthys H Fau - Bleicher B, Bleicher B Fau - Bleicher U, Bleicher U. Dextromethorphan and codeine: objective assessment of antitussive activity in patients with chronic cough. J Int Med Res 1983;11(2):92-100. https://doi.org/10.1177/030006058301100206
  9. Ciszkowski C, Madadi P, Phillips MS, et al. Codeine, ultrarapid-metabolism genotype, and postoperative death. N Engl J Med 2009;361(8): 827-8. https://doi.org/10.1056/NEJMc0904266
  10. Kelly LE, Rieder M, van den Anker J, et al. More codeine fatalities after tonsillectomy in North American children. Pediatrics 2012; 129(5):1343-7. https://doi.org/10.1542/peds.2011-2538
  11. World Health Organization. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses 2012. Available at: http://whqlibdoc.who.int/publications/2012/978924154-8120_Guidelines.pdf. (accessed on Mar 11, 2015).
  12. European Medicines Agency. Restrictions on use of codeine for pain relief in children - CMDh endorses PRAC recommendation. Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Codeine-containing_medicines/human_referral_prac_000008.jsp&mid=WC0b01ac05805c516f. (accessed on Feb 11, 2015).
  13. Medicines and Healthcare Products Regulatory Agency. Codeine for analgesia: restricted use in children because of reports of morphine toxicity. Available at: https://www.gov.uk/drug-safety-update/codeine-foranalgesia-restricted-use-in-children-because-of-reports-of-morphinetoxicity. (accessed on Feb 11, 2015).
  14. Health Canada. Health Canada's review recommends codeine only be used in patients aged 12 and over 2013. Available at: http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/33915a-eng.php.(accessed on Mar 11, 2015).
  15. Kim LG, Kim JA, Kim SH. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014;36: e2014008. (Published online 2014 Jul 30. doi: http://dx.doi.org/10.4178/epih/e2014008).
  16. American Academy of Pediatrics. Use of codeine- and dextromethorphan-containing cough remedies in children. American Academy of Pediatrics. Committee on Drugs. Pediatrics 1997;99(6):918-20. https://doi.org/10.1542/peds.99.6.918
  17. Friedrichsdorf SJ, Nugent AP, Strobl AQ. Codeine-associated pediatric deaths despite using recommended dosing guidelines: three case reports. J Opioid Manag 2013;9(2):151-5. https://doi.org/10.5055/jom.2013.0156
  18. Geneva: World Health Organization. WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses. (WHO Guidelines Approved by the Guidelines Review Committee.). 2012.
  19. Kaiser SV, Asteria-Penaloza R, Vittinghoff E, et al. National patterns of codeine prescriptions for children in the emergency department. Pediatrics 2014;133(5):1139-47. https://doi.org/10.1542/peds.2013-3171
  20. Lasky T, Ernst FR, Greenspan J, et al. Estimating pediatric inpatient medication use in the United States. Pharmacoepidemiol Drug Saf 2011;20(1):76-82. https://doi.org/10.1002/pds.2063
  21. World Health Organization. Dept. of Child and Adolescent Health and Development. Cough and cold remedies for the treatment of acute respiratory in young children. 2001.
  22. J C de Jongste, Shields MD. $Cough^{\circ}{\S}2$: Chronic cough in children. Thorax 2003;58:998-1003. https://doi.org/10.1136/thorax.58.11.998
  23. Bolser DC, Davenport PW. Codeine and cough: an ineffective gold standard. Curr Opin Allergy Clin Immunol 2007;7(1):32-6. https://doi.org/10.1097/ACI.0b013e3280115145
  24. Goldman RD. Codeine for acute cough in children. Can Fam Physician 2010;56(12):1293-4.
  25. Kelley LK, Allen PJ. Managing acute cough in children: evidencebased guidelines. Pediatr Nurs 2007;33(6):515-24.
  26. R Jhaj VB, R Uppal, S Lekha, et al. Use of cold medications for upper respiratory tract infections in children. Pharmacoepidemiol Drug Saf 2001;10:323-7. https://doi.org/10.1002/pds.617
  27. Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2014;3. (Published online 2014 Mar 10. doi: DOI: 10.1002/14651858.CD006088.pub4).
  28. Sen EF, Verhamme KM, Felisi M, et al. Effects of safety warnings on prescription rates of cough and cold medicines in children below 2 years of age. Br J Clin Pharmacol 2011;71(6):943-50. https://doi.org/10.1111/j.1365-2125.2010.03860.x
  29. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):260S-83S. https://doi.org/10.1378/chest.129.1_suppl.260S