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FDA health advisories linked to lower rates of codeine among postpartum mothers

Following public health advisories from both the FDA and Health Canada, the rate of codeine prescriptions being filled among postpartum women declined significantly.

“Some patients are ultrarapid metabolizers of codeine. Nursing mothers who take codeine may be putting their infant at risk if they carry the polymorphisms for elevated activity of CYP2D6. High levels of morphine in breast milk may lead to infant death from drug-induced respiratory depression,” Kate Smolina, PhD, Centre for Health Services and Policy research at the University of British Columbia, and colleagues wrote.

To assess the efficacy of the FDA and Health Canada’s advisories, Smolina and colleagues evaluated 225,532 women who delivered between 2002 and 2011 in British Columbia.

In total, 320,351 live births were recorded. During 47,095 postpartum periods, at least one codeine prescription was filled.

After the FDA advisory, the monthly average of postpartum women filling at least one codeine declined from 16.7% to 9.1%; a relative reduction of 45% over 4 years.

The researchers noted that an increase in tramadol, hydromorphone, oxycodone and morphine among postpartum women was seen during this same time period.  

The reduction in codeine prescriptions being filled could indicate that physicians are following the policy advisory recommendations, according to the researchers.

“Some of the reduction could also reflect changes in patient behavior, including not filling written prescriptions, not asking for codeine, or both,” Smolina and colleagues wrote. – by Casey Hower

Disclosures: The researchers report no relevant financial disclosures.