NSAIDs and Reye's Syndrome
Aspirin is associated with Reye's syndrome in children, but other NSAIDs are not linked to this condition. 1
Association Between Aspirin and Reye's Syndrome
- Aspirin (acetylsalicylic acid) should not be used in children due to the associated risk of Reye's syndrome and hepatotoxicity 1
- Reye's syndrome is a rare but potentially fatal disease characterized by encephalopathy with severe brain edema, increased intracranial pressure, hypoglycemia, and fatty infiltration of the liver 2
- The condition typically follows a viral infection with a disease-free interval of 3-5 days before symptoms appear 3
- Since government health warnings were added to aspirin-containing products, there has been a remarkable decline in Reye's syndrome cases 4
Safety of Non-Aspirin NSAIDs
- Non-aspirin NSAIDs (such as ibuprofen, naproxen, and indomethacin) have not been associated with Reye's syndrome 5
- For children requiring anti-inflammatory or antipyretic treatment, non-aspirin NSAIDs are considered safer alternatives regarding the risk of Reye's syndrome 5
- Ibuprofen, indomethacin, and naproxen are considered safe options for breastfeeding women 1
Clinical Recommendations for Pediatric Patients
- In children with fever or viral illnesses, acetaminophen should be the first-line antipyretic therapy due to its comparable efficacy and superior tolerability profile 5
- When anti-inflammatory effects are needed in pediatric patients, non-aspirin NSAIDs should be used instead of aspirin 1
- Special attention should be directed toward educating adolescents and parents about avoiding aspirin for treating influenza, upper respiratory infections, or varicella 2
- In countries where antipyretics are available without prescription, parents should be informed about possible complications of aspirin use, especially the risk of Reye's syndrome 6
Mechanism of Aspirin-Related Reye's Syndrome
- The biochemical explanation for Reye's syndrome involves a generalized disturbance in mitochondrial metabolism, resulting in metabolic failure in the liver and other tissues 3
- Recent in vitro findings have identified aspirin's site of action on the long chain hydroxyacyl-CoA dehydrogenase enzyme, impairing oxidation even at therapeutic concentrations in cells from patients who have recovered from the disorder 4
- The syndrome appears to result from aspirin acting as a co-factor in susceptible individuals with viral infections 4
Important Considerations
- The European Society of Cardiology specifically recommends against aspirin use in children due to the risk of Reye's syndrome 1
- No dose of aspirin is considered safe in the presence of a viral infection in susceptible individuals 4
- The risk of Reye's syndrome is particularly concerning during influenza outbreaks and varicella (chickenpox) infections 2, 6