Practice Guidelines

Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List

 

Am Fam Physician. 2021 May 15;103(10):633-636.

Related editorial: The KIDs List: Medications That Are Potentially Inappropriate in Children

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• The KIDs List includes a limited number of medications to avoid or use with caution in children older than one year. More medications are included for infants and neonates.

• Medications such as fluoroquinolones and antidepressants are not included because there are no effective alternatives for some indications.

• Aspirin and other salicylates should be used with caution in suspected viral respiratory illness but may be necessary for other indications.

From the AFP Editors

Adverse drug reactions are responsible for approximately 4% of admissions to children's hospitals. Up to 18% of hospitalized children experience at least one adverse drug reaction. Approximately one-half of pediatric adverse drug reactions affect children between one and 10 years of age, with the other half evenly split between infants and children older than 10 years. Because one-half of medications are not currently labeled for children, off-label prescriptions are common. The Pediatric Pharmacy Association produced a list of key potentially inappropriate drugs in pediatrics, or the KIDs List, to guide physicians who treat children.

Potentially Inappropriate Medications

The panel defined potentially inappropriate medications as medications or medication classes that generally should be avoided in children younger than 18 years because they pose an unnecessarily high risk and for which a safer alternative is available. Some medications on the list include a caveat if there is an indication for which this medication may be required.

Similar to the Beers criteria for older patients, two recommendation levels were included, avoid and use with caution. Avoid recommendations signify that most children should not receive the medication. They are either strong recommendations based on high-quality evidence or have potential adverse effects that are life-threatening or life-altering. Recommendations to use with caution signify the medication may be used, especially if there is a clear therapeutic need. These weak recommendations are based on low-quality evidence of potential adverse effects.

Medications were identified through a systematic literature review, U.S. Food and Drug Administration communications, and pharmacology databases. Included medications are commercially available in the United States, have a documented adverse effect in children that is more common or severe than that in adults, and have a safer alternative treatment. Allergic reactions, teratogenicity, and breastfeeding exposures were not considered to be adverse events.

KIDs List

For children one year or older, the group identified eight medications or medication classes, some simply restricted by age or weight, that should be avoided and 10 that should be used with caution (Table 1). They identified more than 30 medications or medication classes to be avoided in infants and 12 to be used with caution (Table 2). Fourteen of these medication recommendations apply only to newborns. Although some of the drugs are considered by the World Health Organization to be essential medicines for children, acceptable alternatives are readily available in the United States.

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TABLE 1.

KIDs List for Children One Year and Older

AgeDrugRiskStrengthEvidence quality

Avoid

< 3 years or 10 kg (22 lb)

Darunavir (Prezista)

Seizures, death

Strong

Very low

< 6 years

Diphenoxylate/atropine (Lomotil)

Respiratory depression, death

Strong

Moderate

Linaclotide (Linzess)

Death from dehydration

Weak

Very low

Plecanatide (Trulance)

Death from dehydration

Weak

Very low

< 10 years or 50 kg (110 lb)

Lindane

Seizure, spasm

Moderate

Low

All children

Indinavir (Crixivan)

Nephrolithiasis

Strong

High

Paregoric

Gasping syndrome, seizures, central nervous system depression, hypoglycemia

Strong

High

Propofol (Diprivan; avoid more than 4 mg per kg per hour for > 48 hours)

Infusion syndrome

Strong

Moderate

Caution

< 6 years

Valproic acid

Pancreatitis, fatal hepatotoxicity

Strong

High

< 8 years

Tetracyclines

Enamel hypoplasia, tooth discoloration

Strong

High

All children

Camphor

Seizures

Weak

Low

Dopamine antagonists*

Dystonia, respiratory depression, death

Strong

Moderate

Lamotrigine (Lamictal)

Serious skin rashes

Strong

High

Meperidine (Demerol)

Respiratory depression

Strong

High

Olanzapine (Zyprexa; concern for use > 24 weeks)

Metabolic syndrome

Strong

High

Opium tincture

Respiratory depression

Strong

High

Salicylates (if suspicion of viral illness)

Reye syndrome

Weak

Very low

Tramadol

Respiratory depression

Weak

Low


KIDs = key potentially inappropriate drugs in pediatrics.

*—Specific dopamine antagonists include chlorpromazine, fluphenazine, haloperidol, metoclopramide (Reglan), perphenazine, pimozide, prochlorperazine, promethazine, trifluoperazine, and trimethobenzamide (Tigan).

Adapted with permission from Meyers RS, Thackray J, Matson KL, et al. Key potentially inappropriate drugs in pediatrics: the KIDs List. J Pediatr Pharmacol Ther. 2020;25(3):181–184.

TABLE 1.

KIDs List

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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