PEBC MCQ Pain, Musculoskeletal & Rheumatology question: year old after a broken arm

PEBC MCQPain, Musculoskeletal & Rheumatology

A physician asks about prescribing codeine/acetaminophen for an 8 year old after a broken arm. Which of the following should the pharmacist advise?

a. Codeine is safe at half the adult dose in children of this age and weight
b. Codeine should not be used under age 12; suggest another option
c. Codeine is preferred because it causes less constipation
d. Codeine can be used if the child has no asthma

Show the answer and explanation

Answer: b. Codeine should not be used under age 12; suggest another option

Codeine is converted to morphine by CYP2D6, and ultra-rapid metabolisers can develop life-threatening morphine levels; after child deaths, Health Canada recommended in 2013 that codeine not be used in children under 12 for any indication, and in 2016 that prescription codeine not be used after tonsil or adenoid removal in patients under 18. Ibuprofen and acetaminophen are first-line for pediatric fracture pain, with other opioids only if needed under supervision. Source: Health Canada Summary Safety Reviews of codeine (2013, 2016); codeine product monograph (DPD, checked 2026).

Common mistake

Using codeine in children because of its 'mild' reputation.

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