Pediatrics: Acetaminophen vs. Ibuprofen

[dgirlemmy]

Recently, one of the instructors at my nursing school told us that recent research had suggested that the max dose of tylenol should be less than the now recommended 4000mg. She did not state her source, and I cannot find any research that supports this. But my main question is this: In pediatrics is it safer to give Motrin rather than Tylenol for fever because of the adverse effects on the liver, or are the adverse effects about the same? I would just like some clarification on this subject or a nudge in the right direction to research it myself.

Thanks in advance!

[dgirlemmy]

Also, I am aware that the pediatric dose of tylenol is less than 4000mg, and is based on weight.

[iluvivt, BSN, RN]

Take a peek at this!

Pediatric Acetaminophen and Ibuprofen

Acetaminophen has always been known to cause liver damage in an over-dosage is given. There are been recent changes in the dosage recommendations for adults as an extra safety measure to prevent over-dosage that come from the manufacturer of Tylenol, In pediatrics it is weight based but regardless many still overdoses their child because of inadequate delivery systems , There have been changes made here as well. Check it out..it's about time. I never gave my daughter acetaminophen b/c my personal preference has always been to use motrin.

[bear14]

But with Motrin isnt there a risk for irritation to the stomach? I usually dont give that to my kids unless thier fever is really high and will only give Tylenol if absolutely necessary for same reason, liver risk.

[Esme12, ASN, BSN, RN]

Pain

Neonates Dose: 10-15 mg/kg PO q6-8h PRN; Max: 60 mg/kg/day from all sources

Infants/Children Dose: 10-15 mg/kg PO q4-6h PRN; Max: 75 mg/kg/day up to 1 g/4h and 4 g/day from all sources

>12 y/o Dose: 325-650 mg PO q4-6h PRN; Max: 1 g/4h and 4 g/day from all sources

Fever

Neonates Dose: 10-15 mg/kg PO q6-8h PRN; Max: 60 mg/kg/day from all sources

Infants/Children Dose: 10-15 mg/kg PO q4-6h PRN; Max: 75 mg/kg/day up to 1 g/4h and 4 g/day from all sources

>12 y/o Dose: 325-650 mg PO q4-6h PRN; Max: 1 g/4h and 4 g/day from all sources

Children 1-12 y/o PO : 102.5°F and less, recommended dose 5 mg/kg; more than 102.5°F, recommended dose 10 mg/kg; max daily dose 40 mg/kg.

The danger with Tylenol is that many OTC child cold prep contain acetaminophen so it is easy to OD a child.

[classicdame, MSN, EdD]

When I was a pedi nurse we would alternate motrin and tylenol. Of course, things might have changed.

[Esme12, ASN, BSN, RN]

They still do recommend that for fever control and pain.

The OP question remains....is it recommended now to be lower.....I have not found that caution is used with both meds. Tylenol is metabolized by the liver....ibuprofen.... the kidneys.

[nurseprnRN, BSN, RN]

I think the worry about ibuprofen "irritating the stomach" is waaaaay overblown. Certainly not a reason to withhold it unless you have already proof that THIS child doesn't tolerate it well.

[KelRN215, BSN, RN]

Ibuprofen is metabolized by the kidneys, tylenol by the liver. Both are perfectly safe for children if they are given in the correct doses... for tylenol 10-15 mg/kg, for ibuprofen 5-10 mg/kg. For certain patients (febrile seizures), we would give both q 6hr and alternate to they were getting something q 3hr to prevent them from spiking. In oncology patients, ibuprofen was avoided and parents were taught to only use tylenol for fever (and to call regardless for a fever of 38.5 x 1 or 38 x2) and to always take temp first if giving tylenol for pain since it can mask a fever.

[Sadala, ADN, RN]

I have seen articles since 2011 where J&J has recommended the max for acetaminophen be reduced from 4 g daily to 3 g daily, but I cannot find where this has actually become the new max. Sorry, what was the question? :X

[damrcngrl95]

I believe that ibuprofen is also metabolized by the liver. It also will cause people to have slow blood clotting times as well as being hard on the stomach. I think the reason that the dosage is being lowered for Tylenol is because it is found in so many children's medicine and unfortunately parents as a whole don't read the labels or in a tired bout of sleepless nights forget what each medication contains. So it is safer to just lower the dose. My pediatrician told me that parents over use fever reducers. She said as long as my child didn't have a high fever or was showing signs of pain that it was fine to let him have a low grade fever. Of course I kept an eye on him. I'm not a nurse, but I was told these things by a hematologist and my child's regular doctor.

[Esme12, ASN, BSN, RN]

All meds are essentially metabolized by the liver....Ibuprofen is concerted to metabolites that are then excreted by the kidneys.

Ibuprofen has an elimination half-life of approximately 2 hours. It is rapidly metabolized through oxidation and glucuronic acid conjugation with urinary excretion of the inactive metabolites usually complete within 24 hours.

It does not produce the toxic effect on the liver that Tylenol does.

The recommended dosage of Tylenol has not been changed.....but additional caution has been issued by the FDA due to the deleterious effects on the liver and it's prevalence in cold products that are OTC for children.