KIDs List

Table 1 (T1)

Key potentially inappropriate drugs in pediatrics (KIDs) List: second edition

Table 2 (T2)

Excipient with know or potential harms when used in pediatric patients

Angiotensin receptor blockers (ARBs) (T1)

• Agents

  • Azilsartan

  • Candesartan

  • Irbesartan

  • Losartan

  • Olmesartan

  • Telmisartan

  • Valsartan

• Risk/Rationale

  • Renal tubular dysgenesis

Atazanavir (T1)

Kernicterus

Camphor, topical (T1)

Seizures

Ceftriaxone (T1)

Kernicterus

Chloramphenicol (T1)

Grey baby syndrome

Chlorhexidine, topical (T1)

Chemical burn

Corticosteroids, topical (medium, high, and very high potency) (T1)

Cushing syndrome, adrenal suppression

Darunavir (T1)

Seizures, death

Dicloxacillin (T1)

Kernicterus

Recommendation: Caution in younger than 1 month

Dicyclomine (T1)

Apnea

Diphenoxylate and atropine (T1)

Respiratory failure, death

Dopamine antagonists 1st generation (T1)

• Agents

  • Chlorpromazine

  • Droperidol

  • Fluphenazine

  • Haloperidol

  • Loxapine

  • Perphenazine

  • Pimozide

  • Thiothixene

  • Thioridazine

  • Trifluperazine

  • Prochlorperazine**

• Risks/rationale

  • Acute dystonic reactions (e.g. oculogyric crisis, torticollis)

  • Hyperprolactemia** NOT in Proclorperazine

Second generation antipsychotics (T1)

• Agents

  • Aripiprazole

  • Asenapine

  • Brexpiprazole

  • Cariprazine

  • Clozapine

  • Iloperisone

  • Lurasidone

  • Lumateperone

  • Olanzapine

  • Paliperidone

  • Quetiapine

  • Risperidone

  • Ziprasidone

• Risks/rationale

  • Withdrawal emergent dystonia/dyskinesia

  • Type 2 diabetes, weight gain, dyslipidemia and/or metabolic syndrome

    • risk greater for clozapine >/= olanzapine > quetiapine > risperidone, paliperidone, iloperidone > asenapine > aripiprazole, brexpiprazole > lurasidone, cariprazine > ziprasidone, lumateperone

  • Hyperprolactemia

    • risk greater for paliperidone > risperidone > olanzepine

Promethazine (T1)

Risk/rationale

• Respiratory failure, death

• Acute dystonic reactions (e.g. oculogyric crisis, torticollis)

Recommendation

• Avoid in younger than 2 yr

• Caution in 2-18 yr of age

Ester local anesthetics (T1)

• Benzocaine, topical

risks/rationale - methemoglobinemia

recommendation - avoid oral application in younger than 2 yr

Ester local anesthetics (T1)

• Lidocaine viscous, topical

risks/rationale - CNS depression, seizures, arrythmias, death

recommendations - avoid oral application in younger than 2 yr

Gentamicin opthalamic ointment (T1)

risks/rationale - severe ocular reaction

recommendation - avoid in younger than 1 month

Linaclotide (T1)

death from dehydration

Lamotrigine (T1)

skin rashes ranging from benign to life-threatening

Loperamide (T1)

risk/rationale - Illeus, lethargy

recommendation - Avoid in younger than 3 yr for for acute infectious diarrhea

Macrolides (T1)

• Agents

  • Azithromycin

  • Erythromycin

• Risks/rationale

  • hypertrophic pyloric stenosis

    • risk greater for erythromycin > azithromycin

• Recommendation

  • Avoid in younger than 1 month except for Bordetella pertussis (azithromycin) or Chlamydia trachomatis pneumonia (azithromycin and erythromycin)

  • Caution in younger than 1 month for Ureaplasma

Midazolam (T1)

severe intraventricular hemorrhage, periventricular leukomalacia, or death

Mineral oil (T1)

Lipid pneumonitis

Montelukast (T1)

Sleep disturbances

Caution in 18 yr of age and younger

Naloxone (T1)

Seizures

Nitrofurantoin (T1)

Hemolytic anemia

Avoid in younger than 1 month

Codeine (T1)

Respiratory failure, death

Avoid in younger than 12 yr; Avoid in 12-18 yr of age after surgery to remove tonsils and/or adenoids; Caution in 12-18 yr of age; Recommend pharmacogenetics testing

Meperidine (T1)

Acute neurotoxicity

• agitation, myoclonus, hyperreflexia, tremors, delirium, seizures

Tramadol (T1)

Respiratory failure, death

Propofol (T1)

Propofol-related infusion syndrome

Avoid doses > 4 mg/kg/day for greater than 48 hr in 18 yr of age and younger

Salicylates (T1)

• Agents

  • Aspirin

  • Bismuth subsalicylate

  • Salicylic acid (topical)

  • Salsalate

• Risks/rationale

  • Reye syndrome

• Rec

  • Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)

Sodium phosphate solution enema, rectal (T1)

Electrolyte abnormalities, AKI, arrythmia, death

Avoid in younger than 2 yr

Sodium polystyrene sulfonate (T1)

Colonic perforation

Sulfonmides (T1)

Agents

• Silver sulfadiazine, topical

• Sulfadiazine

• Sulfamethoxazole

Risks/rationale

• Kernicterus

Rec

• Caution in younger than 1 month

Tetracyclines (T1)

Agents

• Demeclocycline

• Eravacycline

• Minocycline

• Omadacycline

• Sarecycline

• Tetracycline

• Tigecycline

Risks/rationale

• tooth discoloration

• enamel hyperplasia (tetracycline)

• Retardation of skeletal development and bone growth (tetracycline)

Rec

• Caution in younger than 8 yr

Tricyclic antidepressants (T1)

Agents

• Desipramine

• Imipramine

Risks/rational

• Sudden cardiac death

Rec

• Avoid in 18 yr of age and younger

Valproic acid and derivatives (T1)

Pancreatitis, fatal

Verapamil (T1)

Cardiovascular collapse

Benzyl alcohol, sodium benzoate, benzoic acid (T2)

Gasping syndrome

Ethanol/ethyl alcohol (excluding ethanol lock) (T2)

CNS depression, hypoglycemia

Isopropyl alcohol, topical (T2)

Chemical burn

Methylparaben, propylparaben (T2)

Kernicterus

Phenylalanine (T2)

Cognitive and behavioral problems

Polysorbate 80 (T2)

Vasculopathic hepatotoxicity (E-ferol syndrome)

Propylene glycol

Lactic acidosis, CNS depression, hypoglycemia, hemolysis, seizure