Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Abstract

Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

Diagnosis of Ibuprofen allergy through oral challenge

“…Ibuprofen is the most commonly used non‐steroidal anti‐inflammatory drug (NSAID) and is the only NSAID approved for use in infants less than three months of age 1 . It is available over‐the‐counter for the treatment of fever, inflammation and pain, and is often prescribed to treat inflammatory conditions.…”

“…It is available over‐the‐counter for the treatment of fever, inflammation and pain, and is often prescribed to treat inflammatory conditions. Over the past decade, there has been a reported shift towards Ibuprofen consumption as an over‐the‐counter drug, with 70% of ibuprofen being purchased without prescription in 2015, as well as an overall increase in consumption 1 . However, there has been a paralleled increase in reports of severe adverse reactions to NSAID, such as anaphylaxis, with Ibuprofen being the most common trigger of all NSAIDs 1,2 .…”

“…Over the past decade, there has been a reported shift towards Ibuprofen consumption as an over‐the‐counter drug, with 70% of ibuprofen being purchased without prescription in 2015, as well as an overall increase in consumption 1 . However, there has been a paralleled increase in reports of severe adverse reactions to NSAID, such as anaphylaxis, with Ibuprofen being the most common trigger of all NSAIDs 1,2 . Despite the obvious need, there is little research on the diagnosis and management of patients and in particular children with reported Ibuprofen reactions.…”

The Use of Codeine and Tramadol in the Pediatric Population—What is the Verdict Now?

“…However, recent literature refuted this fear, and more otolaryngologists now recommend using ibuprofen as an initial regimen to relieve pain in patients who do not have a history of opioid use (Tan & Tunkel, 2017). If ibuprofen is chosen as an analgesic option, the clinician needs to ensure that the patient is well hydrated, because recent literature has documented acute kidney injury related to nonsteroidal anti-inflammatory drug use in children (especially younger than 5 years) who are dehydrated or at risk of dehydration (de Martino, Chiarugi, Boner, Montini, & de Angelis, 2017;Misurac et al, 2013).…”

A possible case of exfoliative dermatitis due to ibuprofen in an Eleven-month-old infant

“…They include cardiovascular thrombotic events; gastrointestinal bleeding, ulceration, and perforation; hepatotoxicity; hypertension; heart failure and edema; renal toxicity and hyperkalemia; anaphylactic and anaphylactoid reactions; exacerbation of asthma related to aspirin sensitivity; serious skin reactions; premature closure of fetal ductus arteriosus; hematological toxicity; and masking of inflammation and fever. 2 Majority of the adverse effects of ibuprofen are due to nonspecific inhibition of cyclooxygenase (COX) enzyme…”