Solpadeine Dosing for 17-Year-Olds: Critical Safety Warning
Solpadeine (containing codeine) is contraindicated in all patients under 18 years of age according to current FDA and MHRA guidelines, particularly after any surgical procedure, and should not be prescribed to a 17-year-old. 1
Why Codeine is Contraindicated in Adolescents
The FDA issued explicit restrictions stating that codeine is contraindicated for: 1
- All children younger than 12 years for any indication
- All adolescents younger than 18 years after tonsillectomy/adenoidectomy
- All adolescents aged 12-18 years who are obese or have conditions increasing respiratory risk (obstructive sleep apnea, severe lung disease)
The same restrictions apply to tramadol, which shares similar metabolic pathways and respiratory depression risks. 1
The Metabolic Risk
Codeine is a prodrug requiring CYP2D6 enzyme conversion to morphine for analgesic effect. Approximately 1-7% of the population are ultra-rapid metabolizers, leading to: 2
- Unpredictably high morphine levels
- Life-threatening respiratory depression
- Multiple documented pediatric deaths, particularly post-tonsillectomy
This genetic variability cannot be predicted without pharmacogenetic testing, making codeine use in adolescents inherently dangerous. 1
Recommended Alternatives for a 17-Year-Old
For moderate pain in adolescents aged 12-17 years, the evidence-based approach is: 1, 3
First-Line Treatment
- Paracetamol (acetaminophen): 15 mg/kg every 4-6 hours (maximum 1000 mg per dose, maximum 4000 mg/24 hours) 3, 4
- Ibuprofen: Weight-appropriate dosing as per BNFC, typically 400 mg every 6-8 hours for adolescents 1, 3
Second-Line for Severe Pain
- Nasal sumatriptan or zolmitriptan (if migraine-related pain) - most effective formulations for adolescents aged 12-17 1
- Short-acting opioids under specialist supervision only (hydrocodone, oxycodone) if non-opioid combinations fail, with careful monitoring 2
Critical Prescribing Pitfalls to Avoid
Never prescribe based solely on age bands without considering actual body weight. Underweight adolescents at the 9th centile for weight can receive approximately twice the recommended paracetamol dose when age-based dosing is used, risking hepatotoxicity. 4, 5
For a 17-year-old, calculate paracetamol dose using actual body weight: 4, 6
- If overweight/obese: use ideal body weight (50th centile for age/height)
- Single dose: 15-20 mg/kg (maximum 1000 mg)
- Maximum daily: 75-90 mg/kg/day (absolute maximum 4000 mg/day)
- Doses exceeding 150 mg/kg/day cause severe hepatocellular necrosis; toxicity can occur at 75 mg/kg/day 6
Documentation Requirements
Every prescription must document: 6
- Patient's actual weight in kilograms
- Patient's height (to calculate ideal body weight if needed)
- Calculated mg/kg dose
- Maximum daily dose limit clearly stated
The BNFC age-based dosing system without weight documentation has been shown to result in inappropriate dosing in up to 16% of pediatric patients. 4, 5
Bottom Line
A 17-year-old should receive paracetamol 15 mg/kg every 4-6 hours (maximum 1000 mg per dose, 4000 mg/24 hours) calculated using actual body weight, or ideal body weight if obese. Codeine-containing products like Solpadeine are contraindicated due to unpredictable metabolism and respiratory depression risk. If paracetamol plus ibuprofen provides insufficient analgesia, specialist referral is required before considering any opioid therapy. 1, 3, 4