Adverse Drug Reactions of Acetaminophen and Ibuprofen in the Paediatric Population: Analysis of the Italian Spontaneous Reporting Database

Page: [64 - 71] Pages: 8

  • * (Excluding Mailing and Handling)

Abstract

Background: Acetaminophen and ibuprofen are the only antipyretics drugs approved in children, and are considered safe and well tolerated. However, data regarding the adverse drug reaction (ADR) profile of these drugs in children are scattered.

Aim: The aim of our study is to evaluate the ADRs of acetaminophen and ibuprofen through an observational study over a period of 15 years (January 2005-April 2020). Reports of suspected ADRs to the active substances ‘acetaminophen’ and ‘ibuprofen’ are listed and accessible through the Italian spontaneous reporting database (RAM system) by AIFA (Pharmacovigilance of the Italian Drug Agency).

Methods: Acetaminophen ADRs in paediatric populations were 15% of cases, with more frequent involvement of skin and soft tissue (54.36%) and gastrointestinal apparatus (44.09%); liver dysfunction accounts for 5.67%.

Results: Ibuprofen paediatric ADRs were 26%: skin and soft tissues in 63.16% of cases, gastrointestinal tract in 47.75%, hematemesis and melena in 6.38%; kidney injury in 2.25% of cases.

Conclusion: Children aged 2 to 11 are more frequently affected by ADRs than infants and adolescents. The risk of gastrointestinal and renal side effects is significantly higher with ibuprofen. Hepatobiliary side effects are more frequently linked to acetaminophen. Potentially fatal ADRs have been reported sporadically for both drugs.

Keywords: Acetaminophen, ibuprofen, adverse drug reactions, pharmacovigilance, fever, pediatric.

Graphical Abstract

[1]
NICE Guideline Updates Team (UK). Fever in under 5s: assessment and initial management. London: National Institute for Health and Care Excellence (UK) 2019.
[2]
Schmitt BD. Fever phobia: misconceptions of parents about fevers. Am J Dis Child 1980; 134(2): 176-81.
[http://dx.doi.org/10.1001/archpedi.1980.02130140050015] [PMID: 7352443]
[3]
Crocetti M, Moghbeli N, Serwint J. Fever phobia revisited: have parental misconceptions about fever changed in 20 years? Pediatrics 2001; 107(6): 1241-6.
[http://dx.doi.org/10.1542/peds.107.6.1241] [PMID: 11389237]
[4]
SIP. Linee guida della società italiana di pediatria. Gestione del segno/sintomo febbre in pediatria 2012. Available at https://www.sipps.it/pdf/editoriale/GestioneFebbreDolore.pdf.
[5]
Moffett BS, Gutierrez K, Davis K, Sigdel B, Strobel N. Antipyretic efficacy of acetaminophen and ibuprofen in critically Ill pediatric patients. Pediatr Crit Care Med 2019; 20(8): e386-93.
[http://dx.doi.org/10.1097/PCC.0000000000002072]
[6]
Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology 2017; 25(1): 1-9.
[http://dx.doi.org/10.1007/s10787-016-0302-3] [PMID: 28063133]
[7]
Chiappini E, Principi N, Longhi R, et al. Management of fever in children: summary of the Italian pediatric society guidelines. Clin Ther 2009; 31(8): 1826-43.
[http://dx.doi.org/10.1016/j.clinthera.2009.08.006] [PMID: 19808142]
[8]
Garrison LP Jr, Neumann PJ, Erickson P, Marshall D, Mullins CD. Using real-world data for coverage and payment decisions: the ISPOR real-world data task force report. Value Health 2007; 10(5): 326-35.
[http://dx.doi.org/10.1111/j.1524-4733.2007.00186.x] [PMID: 17888097]
[9]
AIFA. Available from: www.AIFA.gov.it/farmacovigilanza1
[11]
Clavenna A, Bonati M. Adverse drug reactions in childhood: a review of prospective studies and safety alerts. Arch Dis Child 2009; 94(9): 724-8.
[http://dx.doi.org/10.1136/adc.2008.154377] [PMID: 19531524]
[12]
Darnis D, Mahé J, Vrignaud B, Guen CG, Veyrac G, Jolliet P. Adverse drug reactions in pediatric emergency medicine. Ann Pharmacother 2015; 49(12): 1298-304.
[http://dx.doi.org/10.1177/1060028015602904] [PMID: 26324354]
[13]
Priyadharsini R, Surendiran A, Adithan C, Sreenivasan S, Sahoo FK. A study of adverse drug reactions in pediatric patients. J Pharmacol Pharmacother 2011; 2(4): 277-80.
[http://dx.doi.org/10.4103/0976-500X.85957] [PMID: 22025857]
[14]
Zucker I, Prendergast BJ. Sex differences in pharmacokinetics predict adverse drug reactions in women. Biol Sex Differ 2020; 11(1): 32.
[15]
Motola D, Vargiu A, Leone R, et al. Influence of regulatory measures on the rate of spontaneous adverse drug reaction reporting in Italy. Drug Saf 2008; 31(7): 609-16.
[http://dx.doi.org/10.2165/00002018-200831070-00006] [PMID: 18558794]
[16]
Cardile S, Martinelli M, Barabino A, et al. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol 2016; 22(5): 1877-83.
[http://dx.doi.org/10.3748/wjg.v22.i5.1877] [PMID: 26855547]
[17]
Balestracci A, Ezquer M, Elmo ME, et al. Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis. Pediatr Nephrol 2015; 30(10): 1873-8.
[http://dx.doi.org/10.1007/s00467-015-3105-7] [PMID: 25895445]
[18]
Rainsford KD. Ibuprofen: pharmacology, efficacy and safety. Inflammopharmacology 2009; 17(6): 275-342.
[http://dx.doi.org/10.1007/s10787-009-0016-x] [PMID: 19949916]
[19]
de Martino M, Chiarugi A, Boner A, Montini G, De’ Angelis GL. Working towards an appropriate use of ibuprofen in children: An evidence-based appraisal. Drugs 2017; 77(12): 1295-311.
[http://dx.doi.org/10.1007/s40265-017-0751-z] [PMID: 28597358]
[20]
Durrieu G, Maupiler M, Rousseau V, et al. Frequency and nature of adverse drug reactions due to non-prescription drugs in children: A retrospective analysis from the french pharmacovigilance database. Paediatr Drugs 2018; 20(1): 81-7.
[http://dx.doi.org/10.1007/s40272-017-0255-z] [PMID: 28766184]
[21]
Chhaya V Sharma, MB BS FRCA, Vivek Mehta, FRCA MD FFPMRCA. Paracetamol: mechanisms and updates. Contin Educ Anaesth Crit Care Pain 2014; 14(4): 153-8.