OTC Analgesic Toxicity Common Among Children
According to poison control data, many children aged 0 to 17 experience toxicity from over-the-counter analgesics like ibuprofen and acetaminophen.
Over-the-counter (OTC) analgesics, particularly ibuprofen and acetaminophen, contribute to a significant amount of toxicity cases in the pediatric population, according to a study published in the Journal of the American Pharmacists Association.1 In younger children, cases of toxicity were most often due to unintentional exposure or therapeutic error, but in older children, toxicity was commonly linked to suicide attempts.
OTC Analgesic Toxicity Common Among Children / MichaelVi - srtock.adobe.com
In the United States, analgesics are one of the most common classes of medications purchased OTC in pharmacies. However, there are limited studies that examine the effect of analgesic toxicity on the pediatric population.
READ MORE: Complementary, Alternative OTC Drugs Pivotal in the Treatment of Acute Pain
The study included data from the National Poison System in Ohio, targeting pediatric patients aged 0 to 17 years who experienced toxicities from OTC analgesic medications between 2018 and 2022. The researchers categorized the data into three age groups: 0 to 6 years, 7 to 12 years, and 13 to 17 years old. The researchers looked at the medications used, reasoning for toxicity, and medical outcomes.
Out of 18,766 cases, 9070 (48.3%) were due to ibuprofen alone, 6785 (36.2%) were due to acetaminophen alone, and 1167 (6.2%) were due to acetaminophen products that contained another medication.
The most common reasons for toxicity were unintentional general (10,055 cases; 53.6%), unintentional therapeutic error (4194 cases; 22.3%), and intentional suspected suicide (3944 cases; 21%).
The most common medical outcomes were minor effects (2104 cases; 11.2%), not followed—judged as nontoxic (2871 cases; 15.3%), not followed—minimal clinical effects (7142 cases; 38.1%), and no effect (5255 cases; 28%).
The researchers further broke down the results by age. In the age 0 to 6 group, ibuprofen and acetaminophen were the most commonly involved medications (52.7% and 35%, respectively). Most cases were due to general unintentional exposure (74.2%) and unintentional therapeutic error (25.4%). The medical effects in this group were minimal clinical effect (48.4%), not followed—judged as nontoxic (19.8%), and no clinical effect (27.3%).
In the 7 to 12 years age group, there were 1113 total cases, with 44.9% from ibuprofen and 38.5% from acetaminophen. The most common cause of toxicity was unintentional therapeutic error, which accounted for 44.8% of cases. Suspected suicide made up 30.1% of cases. The medical outcomes from this group included not followed—minimal clinical effects (35.5%), no effect (23.4%), minor effect (15.5%), and not followed—judged as nontoxic (15.4%).
There were 4440 cases in the 13 to 17 years age group, with ibuprofen and acetaminophen accounting for 36.3% and 38.9% of cases, respectively. Unlike the other age groups, the most common cause for exposure in this group was intentional suspected suicide (81.3%). The 3 most common medical outcomes were minor effect (38.2%), no effect (31.2%), and moderate effect (11.6%). This was the only age group where toxicities caused moderate clinical effects.
The researchers did not find any cases of severe outcomes causing harm in their analysis.
“Our data suggest that preventable analgesic toxicity is occurring in Ohio and strides must be made in educating parents and children on proper use of OTC medications as well as to monitor for suicidal signs in teenagers,” the researchers wrote.
READ MORE: OTC Resource Center
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