What nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for adolescents?

NSAIDs Recommended for Adolescents

Ibuprofen is the first-line NSAID for adolescents aged 12-17 years, with naproxen as the preferred alternative for chronic inflammatory conditions. 1

First-Line NSAIDs for Acute Pain and Fever

Ibuprofen is the primary recommended NSAID for adolescents:

• Approved for use in children ≥3 months of age and is the only NSAID with this broad pediatric approval 2
• Dose should be appropriate for body weight 1
• Superior safety profile compared to other NSAIDs in the pediatric population 2
• Effective for acute pain, fever, and inflammatory conditions 3, 2

Naproxen is the preferred NSAID for chronic inflammatory conditions:

• Specifically recommended by the American Academy of Pediatrics for juvenile idiopathic arthritis due to established efficacy and safety profile 4, 5
• Better-established safety profile than alternatives like diclofenac, with FDA/EMA approval for pediatric use 5
• Can be used as adjunct therapy for pain and inflammation 4, 6

Additional NSAIDs for Specific Indications

For migraine in adolescents aged 12-17 years:

• Multiple NSAIDs are approved for acute migraine treatment 1
• Ibuprofen remains first-line medication at weight-appropriate dosing 1

Ketorolac for severe acute pain:

• 60 mg IM every 15-30 minutes, maximum 120 mg per day, treatment not to exceed 5 days 1
• Reserved for severe postoperative pain in adolescents ≥1 year 3
• Controversy exists regarding use after tonsillectomy due to bleeding risk 3

Diclofenac can be considered:

• May be used at physician discretion, though naproxen is preferred 5
• Requires baseline monitoring: blood pressure, serum creatinine, liver enzymes, and CBC before prescribing 5

NSAIDs to Avoid in Adolescents

Aspirin (acetylsalicylic acid):

• Not recommended for children and adolescents due to risk of Reye's syndrome 4
• Associated with more adverse effects compared to other NSAIDs 3
• Exception: Kawasaki disease treatment in combination with intravenous immunoglobulins 3

Important Safety Considerations

Contraindications across all NSAIDs:

• Dehydration, diarrhea, or vomiting (increases renal damage risk) 2
• Known sensitivity to NSAIDs 2
• Wheezing, persistent asthma, or active varicella infection 2
• NSAID-induced asthma history 1

Common adverse effects to monitor:

• Gastrointestinal upset (diarrhea, nausea, constipation, abdominal pain) 3
• Headache, dizziness, rash 3
• Renal impairment (especially with dehydration) 2

Monitoring requirements for chronic NSAID use:

• CBC, liver function tests, and renal function tests every 6-12 months 6
• Blood pressure monitoring 5

Clinical Pitfalls to Avoid

• Do not use ibuprofen primarily as an antipyretic except in rare cases; it should be reserved for inflammatory pain 2
• Do not delay disease-modifying therapy (like methotrexate) when NSAIDs are used for juvenile idiopathic arthritis—NSAIDs are adjunct therapy only 4
• Avoid chronic low-dose glucocorticoids in adolescents with musculoskeletal pain 6
• Never administer NSAIDs to dehydrated patients or those with active gastrointestinal symptoms 2