Do not use aspirin, nimesulide, or metamizole for a child's fever; do not give minors cold remedies containing metamizole
Avoid these three medicines for childhood fever. Aspirin is associated with Reye's syndrome, which damages the brain and liver. About three in ten affected children died in US surveillance, and reported cases fell by over 90% after warnings were issued. Under the cited Chinese restrictions, nimesulide is contraindicated below age 12, and metamizole below age 18.
What it takes
Nothing. Check the generic name and ingredients when buying a fever reducer.
What you may gain
Reye's syndrome causes encephalopathy and fatty degeneration of the liver, usually after influenza or chickenpox. US national surveillance recorded 1,207 cases in people under 18 between 1981 and 1997. Salicylate, the substance associated with medicines such as aspirin, was detectable in the blood of 82% of affected children. The overall case-fatality rate was 31%. Warnings about salicylates began in 1980, the peak year, when 555 cases were reported. From 1987 onward, no more than 36 cases were reported annually. In 2011, China's drug regulator prohibited oral nimesulide preparations for children under 12. In 2020, the National Medical Products Administration made metamizole tablets contraindicated for children and adolescents under 18. The same restriction applies to the metamizole-containing products Compound Qinghao Analgin Tablets, Zhongganling Tablets, and Zhongganling Capsules.
Context & considerations
Metamizole, also called dipyrone or analgin and labeled 安乃近 in Chinese, is not a first-choice medicine for adults either. Its labeling warns of agranulocytosis, aplastic anemia, and anaphylactic shock, and reserves short-term use for urgent, severe illness when no other effective medicine is available. Zhongganling sounds like an ordinary cold remedy, but it contains metamizole. Ask a pediatrician or pharmacist which fever medicine is appropriate for a child and what weight-based dose to use. A baby under three months with a temperature of 38°C should be taken directly for medical care; see entry 20-8. The evidence is rated B because the Reye's syndrome figures come from surveillance and a before-and-after relationship with warnings, not a controlled trial. The benefit is rated large because annual reported cases fell from 555 to 36 or fewer after the warnings.
Research & references
Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377–1382. https://doi.org/10.1056/NEJM199905063401801; China's Notice on Strengthening the Administration of Oral Nimesulide Preparations, Guo Shi Yao Jian An [2011] No. 209. https://www.nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20110515145101552.html; National Medical Products Administration, Announcement on Revisions to the Labeling of Metamizole-Related Products (No. 34 of 2020), Attachments 1–3. https://www.nmpa.gov.cn/directory/web/nmpa/xxgk/ggtg/ypggtg/ypshmshxdgg/20200317171201660.html