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Safety of Ibuprofen in Children With G6PD Deficiency: A Systematic Review

Ashley N Pankey1, Ashwin Chandar2, Glenn Isaacson1,3

  • 1Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A.

The Laryngoscope
|September 21, 2021
PubMed

Insights

Ibuprofen is a low-risk option for pain management in children with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Evidence shows the risk of hemolytic anemia from ibuprofen in these children is extremely rare.

Area of Science:

  • Pediatric Otolaryngology
  • Pharmacology
  • Genetics

Background:

  • Ibuprofen is often listed as a medium-risk medication for inducing hemolysis in children with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
  • This poses a challenge for otolaryngologists managing perioperative pain in children undergoing procedures like tonsillectomy, as ibuprofen is a key alternative to opioids.

Purpose of the Study:

  • To systematically review the literature and national medication databases to evaluate the risk of hemolytic anemia and related complications associated with ibuprofen use in children with G6PD deficiency.

Main Methods:

  • Systematic literature review adhering to PRISMA methodology.
  • Inquiry of national drug adverse reaction databases.

Main Results:

  • Analysis of three studies (two retrospective case-series, one prospective) revealed no evidence of hemolysis from ibuprofen in high-risk children.
  • Population studies indicated an extremely low incidence of ibuprofen-related hemolysis (approx. 1/100,000 child-years).
  • Adverse drug reaction databases reported hematologic adverse reactions to ibuprofen at an approximate rate of 1/100 million child-years.

Conclusions:

  • Scant, low-quality evidence links ibuprofen to hemolytic anemia in children with G6PD deficiency; any association is exceedingly rare.
  • Drug-induced hemolytic anemias are identifiable and reversible upon medication cessation.
  • Ibuprofen is considered an appropriate choice for perioperative pain management in pediatric G6PD deficiency due to its low risk profile.
Abstract

Keywords:
G6PDG6PD deficiencyhemolytic anemiaibuprofenjaundicetonsillectomy

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