Dosage of selected opioids for children
| DRUG (TRADE NAME) | DOSE | COMMENTS |
| Acetaminophen (paracetamol; Tylenol and other brands) | 10-20 mg/kg/dose every 4-6 hours not to exceed 5 doses in 24 hours | Available in drops (80 mg/0.8 ml),
elixir (160 mg/5 ml), tablets (80 mg), swallowable caplets (160 mg), and rectal
suppositories (several dosages) Nonprescription Higher dosage range may provide increased analgesia |
| Choline magnesium trisalicylate (Trilisate) | Children 37 kg or less: 50 mg/kg/day
divided into 2 doses Children over 37 kg: 2250 mg/day divided into 2 doses |
Available in elixir 500 mg/5 ml Prescription |
| Ibuprofen | ||
|
Children 6 months to 12 years: 5-10 mg/kg/dose
every 6-8 hours not to exceed 40 mg/kg/day for fever Children over 12 years: 200-400 mg/dose every 6-8 hours every 6-8 hours |
Available in suspension (100 mg/5 ml) Nonprescription Recommended for fever reduction in children 6 months to 12 years, but also indicated for juvenile rheumatoid arthritis and mild to moderate pain in children over 12 years |
|
Children 6 months and older: 5-10 mg/kg/dose every 6-8 hours not to exceed 40 mg/kg/day for fever | Available in suspension (100 mg/5 ml) Non-prescription Dosage recommendation is for juvenile rheumatoid arthritis and fever |
| Naproxen (Naprosyn) | Children over 2 years: 10 mg/kg/day divided into 2 doses | Available in elixir (125 mg/5 ml) Prescription |
| Tolmetin (Tolectin) | Children over 2 years: 20 mg/kg/day divided into 3 or 4 doses | Available in scored 200 mg tablets Prescription |
*All drugs except acetaminophen are nonsteroidal antiinflammatory drugs (NSAIDs).
Acetylsalicylic acid (aspirin) is also an NSAID but is not recommended for children because of its possible association with Reye syndrome. The NSAIDs in the table have no known association with Reye syndrome. However, caution should be exercised in prescribing any salicylate-containing drug (e.g., Trilisate) for children with known or suspected viral infection.
Ketorolac (Toradol) is the only NSAID that can be given intravenously. Although it is not approved for patients less than 16 years of age, it is used in children.
Side effects of ibuprofen, naproxen, and tolmetin include nausea, vomiting, diarrhea, constipation, gastric ulceration, bleeding, nephritis, and fluid retention.
Acetaminophen and choline magnesium trisalicylate are well tolerated in the gastrointestinal tract and do not interfere with platelet function. NSAIDs except acetaminophen should not be given to patients with allergic reactions to salicylates. All the NSAIDs should be used cautiously in patients with renal impairment.
March 15, 2002
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