Parents often ask about over-the-counter (OTC) medications. Many of these were once prescription only,
but in their infinite wisdom, the F.D.A. (Food and Drug Administration) determined these drugs are pretty safe in the
pediatric population and thus can be used without a doctor’s blessing.
Most OTC medications will have age-based and sometimes
weight-based dosing. Below is a summary
of of when and how these medications are used and dosing based on body weight. I provided the generic name first, and trade
name(s) italicized in parentheses.
For weight-based dosing, I
listed milliliter (ml) dosing, but for certain medications, you can measure it
by “teaspoons”; just be certain you’re using a teaspoon and not a tablespoon
(this is the reason it’s best to use milliter dosing, as it’s more accurate and
less prone to error). If a measuring cup
or syinge with milliliter markings is not available with the product, you
should be able to purchase on in the pharmacy and medication section of the
store. I also use kilogram for weight,
since this is standard in medical practice.
The conversion for this is: one kilogram (kg) = 2.2 pounds. So simply divide the child’s weight in pounds
by 2.2 (i.e., a child weighing 33 lbs, divided by 2.2 would equal 15 kg). So if you want to calculated the dose of say
ibuprofen, then multiply the child’s weight (in kg) by the dose per weight for
ibuprofen, which is up to 10mg/kg. The
calculation is for this instance is: 15kg x 10mg/kg = 150mg of ibuprofen.
Now if you are using a liquid
(ie, a suspension or elixir) you need to do a little more calculating. So for ibuprofen and if your are using the
100mg/5ml suspension (which is interpreted as “100 milligrams per 5 milliliters”)
multiple the dose in mg by the inverse of the concentration of the
liquid medication. In this example, 150mg
of ibuprofen suspension is multiplied by 5ml/100mg, or 150mg x 5ml/100mg. Doing a little simple algebra to arrive at
the amount of suspension to use in milliliters:
150mg x 5ml/100mg = 150mg
x 5ml/100mg = 150 x 5ml/100 = 150 x
.05ml = 7.5ml
And you thought you’d never
use that math you learned in high school.
ANALGESICS (PAIN
MEDICATIONS)
OTC pain medications are also
often used nowadays for pain control after surgery, especially in children. The following medications also are used to bring
down fevers as well
Of note, the doses below are
maximal doses per weight, and you can use less (but not more) than the listed
dosing, particularly for pain medication.
For example, with the dosing for ibuprofen, one can use 5mg/kg first,
and if not effective then going up to the maximal dose.
Acetaminophen (Tylenol):
Dose for children: 10mg per
kilogram (kg) every 4-6 hours (or 5mg per pound).
Comes in liquid form with
concentration 160mg/5ml.
Ibuprofen (Motrin, Advil)
Dose for children: 10mg/kg
every 6-8 hours (or 5mg per pound).
Comes in elixir or suspension
(liquid) of 100mg/5 ml or more concentrated at 40mg/ml. Also comes in chewable tablets.
MUCOUS THINNER,
EXPECTORANT
Used to thin mucous and
secretions from nose, throat and chest.
Guaifenesin (Robitussin,
Mucinex).
Dose for children (2-3 years
old): 50-100mg every 4 hours as needed for thick mucous, cough. Make sure to take it with plenty of water.
Comes in elixir (liquid)
usually of 100mg/5ml. (½ to one TEASPOON
every 4 hrs as needed)
Note: Guaifenesin also is
combined with other medications labelled with a “D” (for decongestant) or “DM”
(dextromethorpham). For instance:
Robitussin-DM or Mucinex-D. Typically
the plain versions where guaifenesin is the only active ingredient are more
suitable for children.
ANTIHISTAMINES
Antihistamines are used for
allergy or common cold symptoms such as runny nose, sneezing, itching, nasal
congestion or nasal stuffiness. They also
can be used for urticaria (hives from environmental, food or drug
allergies). Loratadine and fexofenadin
are considered nonsedating, while diphenhydramine will make one really
sleepy. Cetirizine causes sedation in
some people and much less so than diphenhydramine.
Loratadine (Claritin)
Comes in 1mg/ml liquid, or
10mg ODT (oral disintegrating tablet), 5mg chewables
Dose for children:
2-6 yrs old: 5mg (5ml or one
teaspoon) once a day
Older than 6 years: 10mg
(two teaspoons) once a day, or one ODT per day.
Fexofenadin (Allegra)
Comes in suspension 30mg/5ml
2-11 years old: 30mg every 12
hours
12 years and older: 60mg
every 12 hours
Cetirizine (Zyrtec)
Comes in 1mg/ml liquid, 5mg
and 10mg chewables.
Dose for children:
2-5 years old: 2.5mg (2.5ml
or ½ teaspoon) per day
6-11 years old: 5mg (5ml or
one teaspoon) per day
12 and older: 5 to 10mg (5ml
to 10ml or 1-2 teaspoons) per day.
Diphenhydramine (Benadryl)
Comes in 12.5mg/5ml liquid or
25mg and 50mg tablets. Caution: can case
drowsiness and sleepiness.
Dose for children:
2-5 years old: 6.25mg (2.5ml
of the liquid form) every 4-6 hours as needed; 37.5mg maximum per day.
6-11 years old: 12.5-25mg
(5-10ml of the liquid form) every 4-6 hours as needed; 150mg maximum per day.
12 and older: 25-50mg
(10-20ml of the liquid form) every 4-6 hours as needed; 300mg maximum per day.
DECONGESTANTS
Used for nasal
congestion/stuffiness. It’s works by vasoconstriction
(narrowing of blood vessels) and thus reducing blood flow to stuffy, nasal
tissue.
Pseudoephedrine (Sudafed).
Comes in 15mg/5ml or 30mg/5ml
liquid
Dose for children:
2-5 years old: 15mg every 4-6
hours as needed.
6-11 years old: 30mg every
4-6 hours as needed.
12 and older: 60mg every 4-6
hours as needed.
Caution: decongestants can
cause insomnia, increased heart rate, irritability.
NASAL SALINE SPRAYS
Saline solution is a natural product that is similar
to what your nose normally produces. “Saline”
means salt, which is naturally found throughout your body as well as your nasal
secretions. The level of salt is
balanced to be “physiologic” (a fancy medical term loosely meaning “in tune
with your body”).
Nasal saline (ie, Ocean,
Ayr, Neil Med saline kit, Neti Pot): 1-2 sprays each nostril 2-3 or more
times a day, or if using an irrigation device, gently squirt some of the
solution into each nostril.
Nasal gel (ie, Ocean, Ayr):
apply pea-size amount twice a day to nose on both sides with clean finger or
qtip. This can be purchased over the
counter.
NASAL STEROID SPRAYS
Used for nasal stuffiness/congestion, to improve nasal
breathing, sometimes can help with nasal drainage.
Fluticasone (brands are Flonase, Allerflo (Kirkland-Costco
brand)):
Ages 4-11 years old:
1 spray each nostril once a day
Ages 12 years
and older: 2 sprays each nostril once a
day
Triamcinolone
(brand is Nasacort):
Ages 2-11 years old:
1 spray each nostril once a day
Ages 12 years
and older: 2 sprays each nostril once a
day
NOTE (for any of the above nasal steroid
sprays): Use the spray for at least two weeks consecutively; it will not
work right away. May decrease to one
spray a day afterwards if it is still helpful in keeping the nose open or ever
other day in younger kids. If one spray
a day works well, you may then try decreasing it to every other day.
NOTE: To best deliver the nasal
steroid spray to the nose, direct the spray a little towards to outside (ie,
place nozzle gently in the nose and point it roughly in the direction of the
outer corner of the eye) or if the child is able deliver the spray him/herself,
then use the opposite hand to spray the opposite nose (i.e., right hand for the
left nose, left hand for the right).
Reminder: use nasal saline. I can’t stress this enough. Some of the side effects of the nasal steroid
sprays include nasal dryness, nose bleeds, sore throat, headaches. Use nasal saline spray (as discussed
above) just prior to using the nasal steroid and several times a day after to
keep the nose moist and cleansed.
So there we have in a nutshell—okay, a multi-page, mega-nutshell. And hopefully this erases any first-impression
of me being a drug-dealing perv.
©Randall S. Fong, M.D.
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