Mechanism of Action
- Inhibition of cyclooxygenase (COX) enzymes
- Reduction of prostaglandin synthesis
- Anti-inflammatory, analgesic, and antipyretic effects
- Variable COX-1/COX-2 selectivity
Primary Indications
- Acute and chronic musculoskeletal pain
- Inflammatory conditions
- Post-operative pain management
- Fever reduction
- Juvenile idiopathic arthritis
Common NSAIDs in Pediatrics
Ibuprofen
- Dosing:
- Anti-inflammatory: 30-40 mg/kg/day divided q6-8h
- Analgesic/antipyretic: 5-10 mg/kg/dose q6-8h
- Maximum: 2400 mg/day
- Age restrictions: ≥6 months
- Available forms: Oral suspension, tablets, chewables
- Onset of action: 30-60 minutes
Naproxen
- Dosing:
- Anti-inflammatory: 10-20 mg/kg/day divided q12h
- Maximum: 1000 mg/day
- Age restrictions: ≥2 years
- Longer half-life than ibuprofen
- Good for chronic conditions
Diclofenac
- Dosing: 2-3 mg/kg/day divided q8-12h
- Available forms: Oral, topical, suppository
- Particularly effective for musculoskeletal pain
- Higher GI risk compared to other NSAIDs
Ketorolac
- Dosing:
- IV/IM: 0.5 mg/kg/dose q6h
- Maximum: 30 mg/dose or 120 mg/day
- Limited to 5 days of use
- Useful in acute pain management
- Higher bleeding risk
Special Considerations
Age-Specific Considerations
- Neonates: Generally contraindicated
- Infants <6 months: Avoid ibuprofen
- Adolescents: Monitor compliance and proper dosing
Clinical Conditions Requiring Caution
- Asthma
- Bleeding disorders
- Renal dysfunction
- Gastric disorders
- Dehydration
Drug Interactions
- Anticoagulants
- Antihypertensives
- Corticosteroids
- SSRIs/SNRIs
- Methotrexate
Adverse Effects and Monitoring
Gastrointestinal Effects
- Nausea and dyspepsia
- Gastric erosions/ulcers
- Risk factors:
- High doses
- Prolonged use
- Concurrent steroids
Renal Effects
- Acute kidney injury
- Sodium retention
- Hyperkalemia
- Monitor:
- Urine output
- Serum creatinine
- Electrolytes
Hematologic Effects
- Increased bleeding time
- Platelet dysfunction
- Monitor CBC in chronic use
Clinical Practice Guidelines
Best Practice Recommendations
- Start with lowest effective dose
- Regular reassessment of need
- Use shortest duration necessary
- Consider gastroprotection for high-risk patients
Monitoring Protocol
- Baseline:
- Complete blood count
- Renal function
- Liver function
- Follow-up:
- Clinical response
- Adverse effects
- Lab monitoring frequency based on duration of use
Patient Education Points
- Proper dosing and timing
- Take with food
- Warning signs requiring medical attention
- Avoiding concurrent NSAID use
- Importance of adequate hydration
Further Reading
