What is the most suitable nonsteroidal anti-inflammatory drug (NSAID) for an adolescent patient with no significant medical history?

Best NSAID for Adolescents

Ibuprofen is the first-line NSAID for adolescents with no significant medical history, recommended by the American Academy of Pediatrics due to its superior safety profile, established efficacy, and appropriate dosing for this age group. 1

Primary Recommendation

Ibuprofen should be used as the first-choice NSAID for adolescents because:

• It provides high analgesic effect at low doses with minimal anti-inflammatory activity, making it less ulcerogenic than other NSAIDs 2
• The American College of Gastroenterology specifically prefers ibuprofen for temporary painful conditions due to its favorable safety profile when used at low doses and for short periods 2
• It is the only NSAID approved for use in children aged ≥3 months and has the most extensive safety data in pediatric populations 3
• Ibuprofen has the lowest gastrointestinal toxicity among NSAIDs 4

When to Use Naproxen Instead

Naproxen is the preferred alternative for chronic inflammatory conditions in adolescents, particularly for:

• Juvenile idiopathic arthritis, where naproxen is specifically recommended due to its efficacy and safety profile in children and adolescents 2, 5
• Conditions requiring longer-acting anti-inflammatory coverage 2
• The American College of Rheumatology recommends naproxen over other NSAIDs for chronic inflammatory conditions based on its established efficacy and safety profile in children 5

Critical Safety Considerations

Absolute contraindications in adolescents:

• NSAID-induced asthma history 1
• Active dehydration, vomiting, or diarrhea (risk of renal damage) 3, 4
• Varicella infection or persistent asthma/wheezing 3
• Known hypersensitivity to NSAIDs 3

Aspirin must be avoided in children and adolescents due to Reye's syndrome risk, except for Kawasaki disease treatment 1

Monitoring Requirements for Chronic Use

If NSAIDs are used chronically (beyond acute pain episodes):

• CBC, liver function tests, and renal function tests every 6-12 months 1
• Blood pressure monitoring 1
• Ensure adequate trial period of at least 8 weeks for inflammatory conditions like juvenile idiopathic arthritis 5

Important Clinical Pitfalls to Avoid

Never combine NSAIDs with:

• Aspirin, anticoagulants, or corticosteroids (dramatically increases bleeding risk) 2

Do not use ibuprofen as routine antipyretic:

• Ibuprofen should not be used as an antipyretic except in rare cases 3
• It remains the drug of first choice specifically for inflammatory pain in children 3

For inflammatory arthritis:

• NSAIDs are adjunct therapy only; disease-modifying therapy (such as methotrexate) should not be delayed 1
• Chronic low-dose glucocorticoids should be avoided in adolescents with musculoskeletal pain 1

Dosing Approach

• Use the lowest effective dose to minimize adverse effects 2
• Dose should be appropriate for body weight 1
• For severe acute pain requiring stronger analgesia, ketorolac can be used at 60 mg IM every 15-30 minutes (maximum 120 mg/day, not exceeding 5 days) 1