1.2. Pediatrics
NSAID safety and efficacy in children have not been established for all available agents. Ibuprofen is FDA-approved for short-term management of fever and mild to moderate pain and long-term management of JRA/JIA/JA in pediatric patients; meloxicam and naproxen are FDA-approved for use in children as young as 2 years of age 1,2,24,25,29,37. Indomethacin is not FDA-approved in those less than 15 years of age, but JRA/JIA/JA patients between 2 and 14 years of age who have experienced toxicity/lack of benefit from other medications, may receive indomethacin up to a maximum dose of 3 mg/kg/day (no more than 200 mg/day orally)1,2,17,38. Aspirin, while FDA-approved for use in fever and pain for adolescents, should not be given for fever and muscle aches seen in viral illness due to the potential for Reye’s syndrome1,2,38. Aspirin in combination with acetaminophen and caffeine is FDA-approved for use in adolescent patients for mild to moderate pain, while naproxen/esomeprazole (Vimovo) is approved for use in adolescents weighing at least 38 kg diagnosed with juvenile idiopathic arthritis at increased risk for NSAID associated gastric ulcers1,2,36 . NSAID dosages for pediatric indications are summarized in Tables 3 and 4. Dosages exceeding these recommendations will be reviewed.
Drug Name | Dosage Form/Strength | Treatment Indication | Maximum Recommended Daily Dosage |
---|---|---|---|
aspirin* | 81 mg chewable/EC tablets; 325 mg, 500 mg regular/EC tablets | fever/pain |
|
diclofenac potassium (Zipsor, generics) | 25 mg capsule | pain (mild to moderate) | greater than 12 years of age: 100 mg/day in divided doses |
diclofenac epolamine (Flector) | 1.3% topical patch/system | acute pain (due to minor strains, sprains, and contusions) | Greater than 6 years of age: 1 patch twice daily |
diflunisal (generics) | 500 mg tablets | osteoarthritis |
|
pain (mild/moderate) |
| ||
rheumatoid arthritis |
| ||
etodolac extended-release (ER) (generics) | 400 mg, 500 mg, 600 mg ER tablets | JIA/JRA |
|
diflunisal (generics) | 500 mg tablets | osteoarthritis |
|
pain (mild/moderate) |
| ||
rheumatoid arthritis |
| ||
etodolac extended-release (ER) (generics) | 400 mg, 500 mg, 600 mg ER tablets | JIA/JRA |
|
ibuprofen (Motrin, generics) | 50 mg/1.25 ml oral drops | fever, pain (mild to moderate) |
|
ibuprofen (Advil, Motrin, generics) | 100 mg/5 ml suspension | fever, pain (mild to moderate) |
|
ibuprofen (Advil, generics) | 100 mg chewable tablets | fever, pain (mild to moderate) |
|
ibuprofen (Advil, generics) | 200 mg caplets, capsules, or tablets | fever, pain (mild to moderate) |
|
ibuprofen (Advil, Motrin, generics) | chewable tablets, suspension, tablets | JIA/JRA |
|
indomethacin IR+ (generics) | 25 mg, 50 mg IR capsules; 25 mg/5 mL suspension | arthritic disorders |
|
50 mg rectal suppository |
| ||
indomethacin ER+ (generics) | 75 mg ER capsules |
| |
magnesium salicylate (Doans, generics) | 580 mg extended-release caplets | pain (mild to moderate) |
|
meclofenamate (generics) | 50 mg, 100 mg capsules | dysmenorrhea |
|
JIA/JRA |
| ||
pain (mild/moderate) |
| ||
mefenamic acid (generics) | 250 mg capsules | pain (mild/moderate, including dysmenorrhea) |
|
meloxicam (generics) | 7.5 mg tablets; 7.5 mg orally disintegrating tablets (ODT) | JIA/JRA |
|
7.5 mg/5 mL suspension |
| ||
naproxen (Aleve, Naprosyn, generics) | 220 mg IR capsule; 220 mg, 250 mg, 275 mg, 375 mg, 500 mg IR tablets; 125 mg/5 mL IR suspension | JIA/JRA |
|
pain (mild to moderate including dysmenorrhea) |
| ||
oxaprozin (Daypro, generics) | 600 mg tablets | JIA/JRA |
|
oxaprozin (Coxanto, generics) | 300 mg capsules | JIA/JRA |
|
Legend:
- *Do not use in children less than 12 years of age with flu-like symptoms or chickenpox due to risk of Reye syndrome
- +indomethacin not recommended in pediatric patients 2-14 years of age unless adverse effects/lack of efficacy with other NSAIDs justifies risk; maximum dose is 4 mg/kg/day or 200 mg/day, whichever is less1-24
Drug Name | Dosage Form/Strength | Treatment Indication | Maximum Recommended Daily Dosage |
---|---|---|---|
acetaminophen/aspirin/caffeine (Excedrin, generics) | 250 mg/250 mg/65 mg tablets | pain, including headache | 12-17 years of age: 8 tablets/24 hours in divided doses |
acetaminophen/aspirin/caffeine (Goody’s) | 260 mg/ 520 mg/ 32.5 mg powders | 12-17 years of age: 4 powders/24 hours in divided doses | |
naproxen/esomeprazole (Vimovo, generic) | 375 mg/20 mg, 500 mg/20 mg delayed-release tablet | juvenile rheumatoid arthritis/ juvenile idiopathic arthritis in patients at risk of developing NSAID-associated ulcers |
|