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The non-steroidal anti-inflammatory drugs and acetaminophen 

The non-steroidal anti-inflammatory drugs and acetaminophen
The non-steroidal anti-inflammatory drugs and acetaminophen

Brian J. Anderson

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date: 29 July 2021

The non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (N-acetyl-p-aminophenol, APAP) are the commonest analgesic drugs used in childhood. Although both drugs act through inhibition of prostaglandin H2 synthetase (PGHS), acetaminophen lacks the anti-inflammatory effects of the NSAIDs. Neonatal acetaminophen hepatic clearance is reduced in premature neonates (5–10% adult rates) and increases to 30% adult rates in neonates born at term; adult rates (approximately 16–20 L/h/70 kg) are reached within the first year of life. NSAID clearance maturation, mostly through cytochrome P450 mixed oxidases, is more rapid. Concentration–response relationships suggest a maximum pain reduction of 5 or 6 on a 10-point scale for both drugs. Combination therapy does not increase this maximum effect but does prolong duration of analgesia. While both drugs have good safety profiles, dosing of both drug groups is tempered by concerns about toxicity. Acetaminophen hepatotoxicity is associated with single doses (〉250 mg/kg in preschool children, 〉150 mg/kg in adults) and therapy duration longer than 3 to 5 days (〉90 mg/kg/day).The most common minor adverse events in NSAID recipients are nausea, dizziness, and headache. More concerning is the potential of NSAIDs to cause gastrointestinal irritation, blood clotting disorders, renal impairment, neutrophil dysfunction, and bronchoconstriction. These adverse effects are uncommon provided care is taken with drug dose, duration of therapy, and recognition of contraindications.

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