Some Drugs Manifesting Differing Toxicity in Children
Drug | Clinical Syndrome | Mechanism | Comments |
|---|---|---|---|
Anesthetics, topical (eg, benzocaine, mixture of lidocaine and prilocaine)Anesthetics, topical (eg, benzocaine, mixture of lidocaine and prilocaine) | Cyanosis | Formation of methemoglobin (ferrous iron oxidized to ferric iron) | Incidence rare |
CeftriaxoneCeftriaxone | Bilirubin displaced from albumin | Caution in neonates | |
Codeine*Codeine* | Respiratory depression Death | Ultrarapid metabolization of codeine to morphine | Genetic variant, avoid use without pharmacogenomic testing Deaths have occurred after surgery and in a breastfed infant whose mother took codeine |
Diphenoxylate | Respiratory depression Death | CNS depression (in immature CNS) | Overdose syndrome, usually in children < 6 years |
Fluoroquinolones | Cartilage toxicity, joint pain | Unknown | Suspected based on animal studies, but adverse effects in humans not well documented; short-term use or use when there is no alternative may be safe |
Lindane (topical)Lindane (topical) | Seizures CNS toxicity | Probably enhanced absorption in children | Should not be used in children < 50 kg (alternative should be used) |
PropofolPropofol | Propofol-related infusion syndrome† | Unknown, possibly related to mitochondrial dysfunction | Higher risk in children than adults, especially with extended duration of use and high doses |
Selective serotonin reuptake inhibitors | Suicidal ideation | Unknown | Increased incidence of suicidal ideation in children and adolescents |
Sulfonamides (eg, sulfamethoxazole) | Kernicterus | Bilirubin displaced from albumin | Should not be given in neonates and infants < 2 months |
TetracyclineTetracycline | Discoloration and pitting of tooth enamel | Chelation with calcium in growing teeth | Not given to children < 8 years |
* See also the American Academy of Pediatrics' clinical report about codeine metabolism in children. | |||
† Propofol-related infusion syndrome is a rare, potentially fatal complication of prolonged (> 48 hours), high-dose propofol infusions that cause severe metabolic acidosis, hyperkalemia, and cardiac failure.-related infusion syndrome is a rare, potentially fatal complication of prolonged (> 48 hours), high-dose propofol infusions that cause severe metabolic acidosis, hyperkalemia, and cardiac failure. | |||
CNS = central nervous system. | |||