Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Over the Counter Drugs May Have Dangerous Side Effects

Category: Child Care


Dr. Phillip Walson, director of pharmacology at Children's Hospital in Columbus, Ohio, gave a three hour seminar at the recent American Academy of Pediatrics convention about the dangers of over-the-counter medicines. He began talking about Tylenol. Even Tylenol, as safe as it is, can cause dangerous side effects if used improperly or in overdosage.

In general, Tylenol is the recommended medicine for pain and fever and is considered the safest medicine ahead of ibuprophen and aspirin. There are times when Tylenol can be dangerous. Smokers have a greater chance of getting liver damage from high doses repeated over a long period of time. Also, Tylenol is not very effective when pain or fever is caused by an inflammatory condition. An example would be rheumatoid arthritis or osteoarthritis or severe muscle strain or sprain from an athletic injury. In these cases, the anti-inflammatory properties of medicines like ibuprophen (trade names include Advil, Nuprin, Motrin) would be better.

Ibuprophen is a prescription drug for children but is an over-the-counter form for older kids and adults. In small children, it is called Children's Advil or Pediaprophen and has been approved for use against fever, pain and inflammatory conditions in children under a year of age. Dr. Walson felt that it was best used for specific inflammatory conditions in which Tylenol is ineffective.

This is because of its greater risk of side effects, particularly GI irritation, possible allergic reactions (which are much higher than with Tylenol); Tempra or acetomionphen. Besides GI side effects, ibuprophen has also been associated (rarely) with serious kidney and pulmonary side effects. For this reason, Dr. Walson recommended not using ibuprophen in children with any known kidney disease.

Finally, aspirin which, when I was a child was the mainstay of treatment for fever, pain and inflammation, has taken a bad position because of it's known association with Reye's Syndrome. Rye's Syndrome is a deadly disease and is closely linked with use of aspirin particularly after chicken pox or influenza. For this reason, pediatricians are very wary of using aspirin at any time and particularly at any time in which a child may come down with Chicken Pox. There are a few specific cases in which aspirin is an effective drug and will be prescribed by your pediatrician such as certain types of arthritis which don't respond well to other medicines and occasionally as an anti-itch medicine for short term use for severe eczema or other rashes. When used for these specific conditions, a parent should be very careful that their children either have already had Chicken Pox or are not exposed to it during the time they are on the aspirin. Also they would not use aspirin during a flu epidemic. This should be carefully discussed with your pediatrician. Parents should never use aspirin on their own for any condition without first checking with their doctor.