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The European Medicines Agency recommends that children under the age of 12 ban the use of codeine drugs to treat children with coughs and colds; children and adolescents between the ages of 12 and 18 who have respiratory problems should not use codeine to treat coughs and colds.

Recently, the State Drug Administration of China issued an announcement: All relevant contents of the “Contraindications” containing the Codex Vaccine drug manual were revised to “Disabled for children under 18 years of age”.

All “children under the age of 18”, disable “all drugs containing codeine cold”!

The common cold is a viral infection, which is a disease that can heal itself. Eating cold medicine does not shorten the course of the cold.

At present, all the non-prescription compound cold medicines are only used to relieve the symptoms of fever, runny nose and the like accompanying a cold.

In early 2008, the United States and the United Kingdom suggested that over-the-counter cold cough medicines should not be used in children under the age of two because they are potentially dangerous and may be life-threatening.

In December 2008, Health Canada requested that the label for over-the-counter cold cough be modified to indicate that it cannot be used for children under 6 years of age.

In order to ensure the safety of children’s medication, children under the age of 2 should be restricted from using over-the-counter compound cold medicine.

Why should a codeine-containing cold medicine be banned for children?

First, codeine can cause morphine poisoning

For most adults, about 10% of codeine is converted to morphine by the liver drug enzyme CYP2D6.

In children, the conversion of codeine to morphine is variable and unpredictable, and even a regular dose of codeine may rapidly convert to morphine, causing morphine poisoning.

Morphine can inhibit breathing, and the respiratory rate can be reduced to 2~3 times/min during acute poisoning. Because children are more sensitive, there are reports of death due to respiratory depression.

Second, codeine may not be effective against viral cough

Codeine, as a component of cold medicine, is mainly used for antitussive. A cold is an upper respiratory tract infection caused by a virus, but codeine has no evidence of clinical effectiveness for viral cough.

In addition, codeine can inhibit the secretion of bronchial glands, making the sputum sticky and difficult to cough up, and should not be used in patients with multiple sputum.

What should adults pay attention to?

For most adults, only about 10% of codeine is converted to morphine by the liver drug enzyme CYP2D6.

A small number of adults have high expression and high activity of the liver drug enzyme CYP2D6. Even if the recommended dose of codeine is taken, it may be rapidly converted to morphine, causing morphine poisoning.

How to judge whether you are the CYP2D6 ultra-fast metabolizer?

In addition to genotyping, indirect methods can be used to avoid accidents:

Patients with codeine-containing drugs should stop taking the medicine immediately and seek medical attention if symptoms such as decreased levels of consciousness, lethargy, fatigue, lack of appetite, nausea and vomiting, constipation, and difficulty in breathing occur.

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