FDA Adds Stronger Warning on Codeine and Tramadol

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FDA says it is restricting the use of codeine and tramadol medicines in children due to ongoing concern about serious risks, including slowed or difficult breathing and death, which appear to be a greater risk in children younger than 12 years. The medicines should also be limited in some older children, a MedWatch notice says. “Single-ingredient codeine and all tramadol-containing products are FDA-approved only for use in adults. FDA is also recommending against the use of codeine and tramadol medicines in breastfeeding mothers due to possible harm to their infants,” it says. The following label changes are being ordered to medicines containing these drugs:

  • A contraindication added to the drug labels of codeine and tramadol alerting that codeine should not be used to treat pain or cough and tramadol should not be used to treat pain in children younger than 12 years.
  • A contraindication to the tramadol label warning against its use in children younger than 18 years to treat pain after surgery to remove the tonsils or adenoids.
  • A new warning to the drug labels of codeine and tramadol to recommend against their use in adolescents between 12 and 18 years who are obese or have conditions such as obstructive sleep apnea or severe lung disease, which may increase the risk of serious breathing problems.
  • A strengthened warning to mothers that breastfeeding is not recommended when taking codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants.

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