Medications to Avoid in Children
Several medication classes should be avoided in children due to safety concerns, including over-the-counter cough and cold medications in children under 6 years, certain antidepressants, and medications with narrow therapeutic indices that can be fatal with minimal exposure. 1, 2
Over-the-Counter Medications
- OTC cough and cold medications should be avoided in all children below 6 years of age due to lack of proven efficacy and potential toxicity 1
- Between 1969 and 2006, there were 54 fatalities associated with decongestants (pseudoephedrine, phenylephrine, and ephedrine) in children under 6 years, with 43 deaths occurring in children under 1 year 1
- During the same period, 69 fatalities were associated with antihistamines (diphenhydramine, brompheniramine, and chlorpheniramine) in children under 6 years 1
- Topical decongestants should be used with caution in children under 1 year due to the narrow margin between therapeutic and toxic doses, increasing the risk for cardiovascular and CNS side effects 1
Antibiotics and Antimicrobials
- Linezolid should be avoided in children with significant anemia, leukopenia, thrombocytopenia, or peripheral neuropathy 1
- Clofazimine should be avoided in children with a baseline QTc interval greater than 500 ms that does not correct with medical management 1
- Unnecessary antibiotics, such as those prescribed for viral infections, should be withheld to prevent adverse effects 3
Antidepressants and Psychiatric Medications
- Selective serotonin reuptake inhibitors (SSRIs) like paroxetine should not be used in patients with major depression who are under 18 years of age due to an elevated risk of suicidal thoughts and acts 1
- Venlafaxine has shown increased rates of harmful outcomes including hostility, suicidal ideation, and self-harm in children compared to placebo 1
- Tricyclic antidepressants have been shown to lack efficacy in children and can be fatal with minimal exposure 1, 2
Potentially Fatal Medications with Minimal Exposure
- Tricyclic antidepressants, antipsychotics, quinine derivatives, calcium channel blockers, opioids, and oral hypoglycemics can kill a toddler with just 1-2 dose units 2
- These high-risk medications were responsible for 40% of toddler fatalities reported to poison control centers between 1990-2000 2
- Amoxicillin overdosages of less than 250 mg/kg are generally not associated with significant clinical symptoms, but higher doses can cause interstitial nephritis and crystalluria 4
Medications Requiring Special Monitoring
- Medications with QTc prolongation risk require baseline and monthly ECG monitoring in children, including clofazimine and certain antituberculosis drugs 1
- Linezolid requires monthly screening for peripheral neuropathy and complete blood counts 1
- Flunarizina should be started at lower doses (5 mg/day) in older patients due to risk of extrapyramidal symptoms 5
Age-Specific Considerations
- Children are not "small adults" regarding drug safety because their growth and development affect their ability to sense and self-report drug side effects 6
- Pharmacokinetic and pharmacodynamic parameters of drugs often differ between children and adults and must be considered before prescribing 3
- Children at different developmental stages may have unique vulnerabilities to cardiovascular effects of medications 7
Prevention of Medication Errors
- Parents and caregivers should receive training in proper use, storage, and administration of all drugs 3
- Special attention should be paid to medications that can be fatal with minimal exposure, particularly in households with young children 2
- Monitoring for adverse effects requires vigilance and education from prescribers to parents 6
Remember that medication safety in children requires consideration of age-specific risks, appropriate dosing, and careful monitoring for adverse effects. The KIDs List has been developed as a standard reference for potentially inappropriate medications in pediatric patients 8.