Common pain reliever safe for children

(Philadelphia, PA) – Red blood cells in the human body are continually subjected to oxidative stress, in which highly reactive molecules damage cellular components. Blood cells have a mechanism in place to deal with this stress, an enzyme called glucose-6-phosphate dehydrogenase (G6PD). But in about 400 million people worldwide, G6PD is deficient, leaving blood cells vulnerable to oxidation and a destructive process known as hemolysis, which can lead to severe, life-threatening anemia.

Infection is the most common cause of hemolysis in people who are deficient in G6PD, but certain foods and medicines can precipitate the destruction of blood cells, especially in children. Ibuprofen, commonly used for pain relief in pediatric medicine, is on the list of drugs suspected of inducing hemolysis in children deficient in G6PD. But a recent review of the literature by researchers at the Lewis Katz School of Medicine at Temple University suggests that it should be taken off the list – ibuprofen very rarely causes hemolytic anemia in children with deficiency. in G6PD.

“Our finding that ibuprofen can be used safely in children with G6PD deficiency is important, especially given the important role ibuprofen plays in the management of pain and fever. pediatric “, explained Glenn Isaacson, MD, FAAP, professor of otolaryngology – head and neck surgery and pediatrics at the Lewis Katz School of Medicine, director of pediatric otolaryngology at Temple University Hospital and principal investigator of the new study.

The review was published online in the journal The Laryngoscope.

The most common defect in red blood cells is G6PD deficiency. It is particularly widespread in countries in Africa, the Mediterranean, the Middle East and Southeast Asia. In the United States alone, about 11 percent of men of African descent are affected by G6PD deficiency. Affected adults rarely show symptoms, but for newborns and young children, infections or exposure to drugs can lead to severe anemia and hyperbilirubinemia (excess bilirubin in the blood) and in rare cases , can lead to death.

“For many drugs believed to increase the risk of hemolysis in G6PD-deficient patients, there is actually very little evidence to support an association,” Dr. Isaacson explained. “Ibuprofen is a key alternative to opioid pain relievers, so it is important to know whether it can be used safely in children who lack G6PD.”

To assess the relationship between ibuprofen and hemolysis in children deficient in G6PD, Dr. Isaacson, Ashley N. Pankey, a fourth-year student at the Lewis Katz School of Medicine and lead author of the new report, and Ashwin Chandar, MD, assistant professor of medicine at the Lewis Katz School of Medicine, conducted a systematic review of the published literature. The review focused in particular on three studies, including one prospective study, which showed no evidence of a link between hemolysis and exposure to ibuprofen or other nonsteroidal anti-inflammatory drugs. in children deficient in G6PD. Two additional population studies from the Middle East implicated ibuprofen as a rare cause of hemolytic anemia.

The researchers also searched the adverse drug reaction databases for the United States Food and Drug Administration, the European Medicines Agency, and Health Canada. Reports of hemolytic reactions following exposure to ibuprofen in children were extremely rare, occurring in 0 to 1 in 100 million children.

“Our findings are encouraging. They suggest that ibuprofen is a safe treatment option for pain relief in children with G6PD deficiency, ”said Dr. Isaacson. “In addition, if symptoms do appear, they can be reversed when treatment with the triggering agent is stopped.”

“Since millions of children are affected by this disease around the world, our study will greatly contribute to future efforts to control pain and prevent unnecessary suffering in this population,” added Pankey.

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