ירחון החברה הישראלית לפדיאטריה אמבולטורית (חיפ"א) גיליון 2018-1

6 Drug Safety We have 2 articles that discuss the safety of drugs in relation to asthma: Apparently, acetaminophen does not increase asthma risk (or at least, not any more than ibuprofen), and Salmeterol, when used with Fluticasone, does not increase risk, either. Acetaminophen does not raise the risk of asthma exacerbation (any more than Ibuprofen). In the New England Journal of Medicine, Sheehan, et al 1 , investigated the truth behind assumptions that Acetaminophen (e.g.: Acamol, Novimol) causes asthma exacerbations, by comparing to Ibuprofen (e.g.: Nurofen, Adex). In a randomized controlled trial in multiple locations, they compared children with persistent asthma, aged 12-59 months, who received acetaminophen (15mg/kg/dose) vs ibuprofen (9.4 mg/kg/dose), every 6 hours, prn for fever or pain for 48 weeks. Children were monitored for exacerbations and use of medications. No significant differences were found between the 2. Whereas the study had no placebo group, it can not absolutely rule out a link. Perhaps both drugs are implicated equally in asthma exacerbation, perhaps neither 2,3 . Also, this study does not include prenatal exposure or early infancy. Bottom line: whereas we can’t rely on this study completely, it does reassure our use of acetaminophen in asthmatic children. 1. Sheehan WJ, Mauger DT, Paul IM, et al. Acetaminophen versus ibuprofen in young children with mild persistent asthma. N Engl J Med 2016;375:619-630. 2. Uzoigwe and Ali. Acetaminophen versus Ibuprofen in Mild Persistent Asthma. [Letter to the Ed] N Engl J Med 2016; 375:2099-2100. DOI: 10.1056/NEJMc1612164 3. AAP Grand Rounds Nov 2016; 36:5