Edward A. Bell, PharmD, BCPS

The use of stimulant medications has been an integral aspect for the pharmacotherapy of ADHD for more than 50 years. Numerous published studies have documented their efficacy to reduce symptoms of ADHD in children older than age 4 years. As with any medication, however, adverse effects occur, and these adverse effects must be balanced against the medication’s benefit for each individual patient. The potential for a negative adverse effect on growth from stimulant medications has been discussed in the literature for years.

Codeine is an opioid alkaloid naturally found in opium poppy resin, along with morphine and more than 20 distinct alkaloid chemicals. The opium poppy has been known for more than 2,000 years to have beneficial effects upon the human body, and its use is referenced in ancient writings dating back several thousand years. Codeine has been used medicinally for more than a century. Pediatric health care practitioners trained years ago likely were taught to prescribe codeine, especially acetaminophen plus codeine products, for many uses, namely for cough or mild-to-moderate pain. Post-tonsillectomy pain was a common indication for prescribing acetaminophen plus codeine. It is best, however, that these prescribing habits “die easy,” and not “die hard.”

In recent years, we have made significant strides in our understanding of the pathogenesis of asthma. As a result, specific new pharmacotherapies and therapeutic treatment strategies are now available.

The last Pharmacology Consult column, “Antihistamines for the common cold: Where’s the evidence?” (September 2019), reviewed recently published data suggesting that antihistamine product use may be increasing for the treatment of common cold symptoms. Because recent recommendations and regulations have decreased the use of cough/cold products in the pediatric population, pediatric health care providers may be turning to antihistamine-based products instead. Commonly used first-generation antihistamines have strong anticholinergic properties, and recently published data from the adult population have suggested that long-term use of these drugs may increase the risk for developing dementia. As summaries of these publications find their way to the lay media, it is understandable that parents may wonder about the long-term safety of using antihistamines in children. Although the diagnosis of dementia is certainly not associated with the pediatric population, parents may still express concern about the adverse effects and long-term safetyof antihistamines.

Recommendations for the treatment of common viral upper respiratory tract infections (URTIs) in children have undergone significant changes over the past 10 years. In 2008, the FDA and the AAP recommended avoiding over-the-counter products for the treatment of URTI symptoms, including cough/cold (C/C), in young children. These products should be avoided in children aged younger than 4 years, and the AAP cautions about their use in children aged 4 to 6 years and only when the child is receiving care from a provider.

The treatment of serious medical diseases affecting the pediatric population has seen significant advancements in recent years, with several gene therapies newly labeled for use in infants and children. Although these therapies offer tremendous hope to patients, their families and health care professionals, their availability brings many unanswered questions, including long-term clinical efficacy and concerns over reimbursement.

As readers of Infectious Diseases in Children are well aware, it is not uncommon to hear “penicillin” when parents are asked, “Does your child have any drug allergies?” However, many published studies of adults and children have demonstrated that the vast majority of patients who answer with “penicillin” — greater than 95% — are not “allergic” with respect to a demonstrable immunoglobulin E-mediated (eg, anaphylaxis) or T-lymphocyte reaction (eg, Stevens-Johnson syndrome). Most of these reported allergies are not likely to be clinically significant with repeated penicillin or beta-lactam antibiotic administration, or the reported adverse reactions were initially unrelated to penicillin administration (eg, a viral exanthem).

Supplements are described as a heterogenous group of products that are intended to supplement the diet. Supplements are not described as medicinal drugs or foods, although they are commonly used by consumers for a therapeutic effect (ie, to act as a drug).

Information describing the use of pharmacotherapies in the pediatric population is always welcomed. Data obtained from a 10-year period (2003-2014; n = 23,152) in the National Health and Nutrition Examination Survey, or NHANES, were recently published, describing prescription medication use among participants aged 19 years or younger. NHANES is a program of the National Center for Health Statistics and the CDC. Qato and colleagues reported that during the most recent sample period (2013-2014), 19.8% of children used at least one prescription medication. Additionally, more than 8% of concurrent users of prescription medications were at risk for potentially significant drug-drug interactions. Most of these potential drug-drug interactions resulted from psychotropic agents and risk for QT prolongation.

Essential oils are increasingly available in pharmacies, health food stores and grocery stores, and because they are often viewed as “natural,” parents may easily believe that their use is safe and effective for a wide variety of indications. Parents and caregivers of your patients may ask you: “Are essential oils safe to use, and are they effective?”