NSAID Use in Adolescents

First-Line NSAIDs for Acute Pain and Fever

• The American Academy of Pediatrics recommends ibuprofen as the first-line NSAID for adolescents aged 12-17 years, with a dose appropriate for body weight 1
• Naproxen is the preferred alternative for chronic inflammatory conditions, with an established efficacy and safety profile 2, 3

Additional NSAIDs for Specific Indications

• For migraine in adolescents aged 12-17 years, multiple NSAIDs are approved for acute treatment, with ibuprofen remaining the first-line medication at weight-appropriate dosing 1
• Ketorolac can be used for severe acute pain at a dose of 60 mg IM every 15-30 minutes, with a maximum of 120 mg per day, and treatment not to exceed 5 days 5

NSAIDs to Avoid in Adolescents

• Aspirin is not recommended for children and adolescents due to the risk of Reye's syndrome, except in the case of Kawasaki disease treatment in combination with intravenous immunoglobulins 2

Important Safety Considerations

• NSAID-induced asthma history is a contraindication for NSAID use 5
• Monitoring requirements for chronic NSAID use include CBC, liver function tests, and renal function tests every 6-12 months, as well as blood pressure monitoring 3, 4

Clinical Pitfalls to Avoid

• Disease-modifying therapy, such as methotrexate, should not be delayed when NSAIDs are used for juvenile idiopathic arthritis, as NSAIDs are adjunct therapy only 2
• Chronic low-dose glucocorticoids should be avoided in adolescents with musculoskeletal pain 4