NSAIDs children

Although extraordinary in its powers, aspirin is also more dangerous than commonly believed. Only about 15 g can be fatal to a small child, and aspirin can cause stomach bleeding and allergic reactions in long-term users. Even more serious is a condition called Reye s syndrome, a potentially fatal reaction to aspirin sometimes seen in children recovering from the flu. As a result of these problems, numerous other NSAIDs have been developed in the last several decades, most notably ibuprofen and naproxen. 

Pseudoporphyria is a photodistributed bullous disorder with clinical and histological features similar to those of porphyria cutanea tarda, but without accompanying abnormalities of porphyrin metabolism. Drugs, in particular NSAIDs and sulfur-containing diuretics, often cause pseudoporphyria (193). Pseudoporphyria associated with naproxen (15 mg/kg/day) has been reported in a child (194). 

Although the newer NSAIDs are aU secreted into mUk, the amounts are probably too small to affect the breastfed infant. However, serious adverse effects in breast-fed children have been described with pyrazolones and indo-metacin (SEDA-10, 78). The choice of NSAID, if it is indispensable, should therefore be directed to compounds that have short half-lives. In order to reduce the quantity of drug reaching the child, the mother should take the drug at the time of breast feeding or immediately afterwards, so that the next feed occurs after a time equivalent to the half-life of the drug. 

NSAIDs sometimes reduce renal function in individual patients, which is reflected in serum creatinine level rises and possibly in changes in ciclosporin levels, but concurrent use can also be uneventful Diclofenac serum levels can be doubled by ciclosporin. There is an isolated report of colitis in a child treated with ciclosporin and diclofenac or indometacin. 

A child with rheumatoid arthritis taking ciclosporin 10 mg/kg daily developed colitis when diclofenac was given. The NSAID was stopped and her symptoms resolved while the ciclosporin was continued. ... 

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