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Updated: May 20, 2025

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Acetaminophen and Acetaminophen-Opioid Combination Prescribing Trends Among Hospitalized Children, Adolescents, and

Cheryl L Mathis, Huong D Meeks, Kevin M Watt

    Medrxiv : the Preprint Server for Health Sciences
    |May 19, 2025
    PubMed

    Insights

    Acetaminophen (APAP) use remained stable in US children with cancer, but APAP-opioid combination prescriptions decreased nationally, with regional variations. Further research is needed to assess APAP exposure and liver health in this population.

    Area of Science:

    • Pediatric Oncology
    • Pharmacology
    • Public Health

    Background:

    • Acetaminophen (APAP) is a common analgesic and antipyretic in children, including those with cancer in the United States (US).
    • Previous studies evaluated US Food & Drug Administration (FDA) guidance on APAP prescribing in healthy children and adults, but patterns in pediatric cancer patients were unknown.
    • Children with cancer face heightened risks of liver injury, making APAP use patterns critical to understand.

    Purpose of the Study:

    • To examine the recent trends in acetaminophen (APAP) prescribing among children with cancer in the United States.
    • To analyze the evolution of APAP and APAP-opioid combination use in this vulnerable population.
    • To provide insights into pain management strategies and analgesic exposure in pediatric cancer patients.

    Main Methods:

    • A retrospective, multi-center analysis of APAP prescribing data from the Pediatric Health Information System (PHIS) database.
    • Inclusion criteria: children aged 0-26 years with a cancer diagnosis (ICD codes) receiving chemotherapy.
    • Assessment of APAP and APAP-opioid combination prescribing rates at national, regional, and hospital levels using the Mann-Kendall test.

    Main Results:

    • Data from 2004-2021 included 388,364 inpatient encounters for 50,779 unique patients; 87.3% received APAP.
    • APAP-opioid combination use was infrequent but more likely among patients receiving APAP (13.4%).
    • National APAP use was stable; regional APAP use increased in the Northeast. APAP-opioid combination use decreased nationally, with consistently elevated use in the South before 2014.

    Conclusions:

    • Acetaminophen (APAP) prescribing trends in children with cancer show national stability in APAP use but a decline in APAP-opioid combinations, albeit with regional differences.
    • These findings are crucial for clinicians to evaluate evolving pain management strategies and analgesic exposure in pediatric cancer patients.
    • Further research is warranted to assess the impact of APAP exposure on liver health in children undergoing cancer treatment.
    Abstract

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