Can naproxen and domperidone be given to a 13-year-old?

Safety of Naproxen and Domperidone in a 13-Year-Old

Naproxen can be safely used in a 13-year-old, but domperidone should only be used with caution in children over 12 years of age for short-term treatment of nausea and vomiting.

Naproxen Use in 13-Year-Olds

Naproxen is approved for use in pediatric patients over 2 years of age, with established safety and efficacy data for juvenile arthritis 1. The FDA-approved dosing guidelines state:

• For children over 2 years: 2.5-5 mg/kg as a single dose
• Total daily dose should not exceed 15 mg/kg/day
• Naproxen suspension is typically used for precise pediatric dosing

Safety considerations for naproxen in adolescents:

• Well-tolerated in pediatric patients over 2 years of age
• Primarily excreted by the kidney, so renal function should be monitored
• As with all NSAIDs, there are risks of gastrointestinal effects, though these are less common in younger patients compared to elderly patients 1

Domperidone Use in 13-Year-Olds

Domperidone use in pediatric patients requires more caution:

• Current guidelines restrict its use to relief of nausea and vomiting in children older than 12 years for a short period of time 2
• Since the patient is 13 years old, they meet the minimum age requirement, but careful consideration is needed

Safety concerns with domperidone:

• Cardiac safety issues have been identified, including QT prolongation and potential arrhythmias 3
• In 2014, safety warnings were issued in multiple countries regarding cardiac risks in children 4
• Should not be administered to patients with:
  • Pre-existing QT prolongation
  • Patients receiving CYP3A4 inhibitors
  • Electrolyte abnormalities
  • Other risk factors for QT prolongation 3

Evidence for Efficacy in Pediatrics

• A 2019 randomized controlled trial found that low-dose domperidone (0.25 mg/kg three times daily) was not significantly better than placebo for treating nausea and vomiting in children with acute gastroenteritis 5
• For gastroesophageal reflux disease (GERD) in children, a Cochrane review found no significant benefit of domperidone 6

Recommendations for Clinical Practice

If considering domperidone for a 13-year-old:

1. Use only for short-term treatment of nausea and vomiting (not for GERD or other off-label indications)
2. Prescribe the lowest effective dose (0.25 mg/kg three times daily)
3. Limit duration to less than 7 days 4
4. Screen for cardiac risk factors and drug interactions before prescribing
5. Monitor for adverse effects, particularly cardiac symptoms

For naproxen in a 13-year-old:

1. Use appropriate weight-based dosing (2.5-5 mg/kg per dose)
2. Do not exceed 15 mg/kg/day total daily dose
3. Monitor for gastrointestinal symptoms
4. Consider using with food to minimize GI effects

Key Cautions

• Domperidone is used off-label in many countries for GERD and gastroparesis, but evidence for efficacy in children is limited 2
• Cardiac safety concerns have led to restricted use of domperidone in pediatric patients
• Naproxen is generally safe in adolescents but should be used at the lowest effective dose for the shortest duration needed

When prescribing these medications for a 13-year-old, the benefits must clearly outweigh the risks, particularly for domperidone given its cardiac safety profile and limited evidence of efficacy in pediatric patients.