Educate Yourself About Risky Meds in Children

You’ll hear about the new “KIDs List” of Key potentially Inappropriate Drugs in pediatrics…from the U.S. Pediatric Pharm Assn.

Think of these guidelines as analogous to the Beers Criteria of potentially inappropriate meds in the elderly.

Use the KIDs List as a starting point to think twice about using certain meds in children under 18.

But inform colleagues that the list isn’t all-inclusive.

For example, it doesn’t address OTC cough and cold meds, due to limited evidence of toxicity at recommended doses…or suicide risk with antidepressants, because of few alternatives.

Continue to individualize care based on risks and benefits.

Antiemetics. Advise caution with all forms of dopamine blockers (prochlorperazine, promethazine, etc) in kids…and avoid in those under age 2…due to respiratory depression or dyskinesia.

When an antiemetic is needed, lean toward ondansetron instead.

Pain meds. Generally avoid codeine or tramadol in kids.

Both are metabolized by CYP2D6…codeine to morphine and tramadol to an active metabolite.

This can lead to erratic blood levels and risk of respiratory depression or death…since some kids are ultrarapid 2D6 metabolizers.

Be careful with oxycodone too. It’s also metabolized by 2D6…but so far isn’t linked to toxicity in kids.

For most kids with mild to moderate pain, recommend acetaminophen, ibuprofen, or both if needed. If an opioid is necessary, consider short-acting morphine…it isn’t metabolized by 2D6.

OTCs. Tell parents to avoid topical anesthetics (benzocaine, etc) for teething pain…due to risk of methemoglobinemia. Recommend a cool teething ring or wet cloth to chew on instead.

Try to limit topical steroids in infants…due to risk of systemic effects. If needed for severe diaper rash, suggest a low-potency steroid (hydrocortisone 1%, etc) BID for up to 2 weeks.

Discourage loperamide in kids…it can cause intestinal obstruction, lethargy, and rarely death…especially under age 3. Encourage hydration and electrolytes for infectious diarrhea.