2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics
KIDs List (2025)
NAV Top A B C D E F G H I K L M N O P Q R S T U V X Z

Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics Reference
A generic (Brand)CautionAvoid
 acetaminophen-traMADol (Ultracet)12-18 yr12-18 yr< 12 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug opioids
Risk/Rationale Respiratory failure, death
Recommendation 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 pharmacogenetic testing
 Quality of evidence: Low, Strength of Recommendation: Weak
 AlOH/diphenhyd/lidocaine/MgOH/simeth (Magic Mouthwash with lidocaine)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug ester local anesthetics
Risk/Rationale Central nervous system depression, seizures, arrhythmia, death
Recommendation Avoid oral application in younger than 2 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 amcinonide (Cyclocort)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 ARIPiprazole (Abilify)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
  Aristocort - see triamcinolone acetonide
  Arthropan - see choline salicylate
 asenapine (Saphris)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 aspirin≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Atacand - see candesartan
 atazanavir (Reyataz)< 3 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug atazanavir
Risk/Rationale Kernicterus
Recommendation Caution in younger than 3 mo unless pharmacogenetic testing is used
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Avapro - see irbesartan
 azilsartan (Edarbi)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 azithromycin (Zithromax)< 1 mo< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug macrolides
Risk/Rationale Hypertrophic pyloric stenosis (risk greater for erythromycin > azithromycin)
Recommendation Avoid in younger than 1 mo except for Bordetella pertussis (azithromycin) or Chlamydia trachomatis pneumonia (azithromycin and erythromycin).
Caution in younger than 1 mo for Ureaplasma (azithromycin)
 Quality of evidence: High, Strength of Recommendation: Strong
B generic (Brand)CautionAvoid
  Bactrim - see sulfamethoxazole-trimethoprim
  Banalg - see methyl salicylate
  Benicar - see olmesartan
  Bentyl - see dicyclomine
 benzocaine, topical (Hurricaine)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug ester local anesthetics
Risk/Rationale Methemoglobinemia
Recommendation Avoid oral application in younger than 2 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 benzoid acid< 1 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) benzoid acid
Rationale Gasping syndrome
Recommendation Avoid exposure of >99 mg/kg/day in younger than 1 mo (with the exception of sodium phenylacetate/sodium benzoate used for the treatment of urea cycle disorders)
 Quality of evidence: High, Strength of Recommendation: Strong
 benzyl alcohol< 1 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) benzyl alcohol
Rationale Gasping syndrome
Recommendation Avoid exposure of >99 mg/kg/day in younger than 1 mo (with the exception of sodium phenylacetate/sodium benzoate used for the treatment of urea cycle disorders)
 Quality of evidence: High, Strength of Recommendation: Strong
 betamethasone topical (Diprolene, Diprosone)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (High/very high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 betamethasone-clotrimazole (Valisone)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 bismuth subsalicylate (Pepto bIsmol)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
 brexpiprazole (Rexulti)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
C generic (Brand)CautionAvoid
  Calan - see verapamil
 camphor, topical≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug camphor, topical
Risk/Rationale Seizures
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: Very low, Strength of Recommendation: Weak
 candesartan (Atacand)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Caplyta - see lumateperone
 carbinoxamine (Clistin, Karbinal)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug carbinoxamine
Risk/Rationale Death
Recommendation Avoid in younger than 2 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
 cariprazine (Vraylar)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 cefTRIAXone (Rocephin)< 3 wk
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug cefTRIAXone
Risk/Rationale Kernicterus
Recommendation Caution in younger than 3 wk except for one-time doses for gonococcal treatment
 Quality of evidence: Very low, Strength of Recommendation: Weak
 chloramphenicol (Chloromycetin)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug chloramphenicol
Risk/Rationale Gray baby syndrome
Recommendation Avoid in younger than 1 mo unless serum concentration monitoring is used
 Quality of evidence: High, Strength of Recommendation: Strong
 chlorhexidine, topical (Hibiclens)< 1 mo< 7 day and < 34 weeks gestation
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug chlorhexidine, topical
Risk/Rationale Chemical burn
Recommendation Caution with concentrations >0.5% in less than 7 days old and less than 34 weeks' gestation.
Caution with concentrations >2% in younger than 1 mo
 Quality of evidence: Low, Strength of Recommendation: Weak
  Chloromycetin - see chloramphenicol
 chlorproMAZINE (Thorazine)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
 choline magnesium trisalicylate (Trilisate)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
 choline salicylate (Arthropan)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Clistin - see carbinoxamine
 clobetasol propionate (Temovate)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (very high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 cloZAPine (Clozaril)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 codeine12-18 yr12-18 yr< 12 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug opioids
Risk/Rationale Respiratory failure, death
Recommendation 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 pharmacogenetic testing
 Quality of evidence: High, Strength of Recommendation: Strong
  Compazine - see prochlorperazine
  Covera - see verapamil
  Cozaar - see losartan
  Cutivate - see fluticasone
  Cyclocort - see amcinonide
  Cystex - see sodium salicylate
D generic (Brand)CautionAvoid
 darunavir (Prezista)< 3 yr or ≤ 10 kg
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug darunavir
Risk/Rationale Seizures, death
Recommendation Avoid in younger than 3 yr or ≤10 kg
 Quality of evidence: Very low, Strength of Recommendation: Strong
  Declomycin - see demeclocycline
 demeclocycline (Declomycin)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
  Demerol - see meperidine
  Depacon - see valproic acid
  Depakene - see valproate sodium
  Depakote - see divalproex
 desipramine (Norpramin)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tricyclic antidepressants
Risk/Rationale Sudden cardiac death
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 desoximetasone (Topicort)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 dicloxacillin (Dynapen)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug dicloxacillin
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 dicyclomine (Bentyl)< 6 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug dicyclomine
Risk/Rationale Apnea
Recommendation Avoid in younger than 6 mo
 Quality of evidence: Low, Strength of Recommendation: Strong
 diflorasone diacetate (Psorcon, Florone)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (very high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 difluprednate (Durezol)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug difluprednate
Risk/Rationale Increased intraocular pressure
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: Low, Strength of Recommendation: Weak
  Diovan - see valsartan
 diphenoxylate-atropine (Lomotil, Lonox)< 6 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug diphenoxylate - atropine
Risk/Rationale Respiratory failure, death
Recommendation Avoid in younger than 6 yr
 Quality of evidence: Moderate, Strength of Recommendation: Strong
  Diprivan - see propofol
  Diprolene - see betamethasone topical
  Diprosone - see betamethasone topical
  Disalcid - see salsalate
 divalproex (Depakote)2-6 yr< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug valproic acid and derivatives
Risk/Rationale Pancreatitis, fatal hepatotoxicity
Recommendation Avoid in younger than 2 yr
Caution in 2-6 yr
 Quality of evidence: High, Strength of Recommendation: Strong
  Doan's Pills - see magnesium salicylate
 droperidol (Inapsine)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Durezol - see difluprednate
  Dynapen - see dicloxacillin
E generic (Brand)CautionAvoid
  Edarbi - see azilsartan
  EES - see erythromycin
  Elocon - see mometasone furoate
  Entresto - see sacubitril-valsartan
 eravacycline (Xerava)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: Very low, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 erythromycin (EES, Ilotycin)< 1 mo< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug macrolides
Risk/Rationale Hypertrophic pyloric stenosis (risk greater for erythromycin > azithromycin)
Recommendation Avoid in younger than 1 mo except for Bordetella pertussis (azithromycin) or Chlamydia trachomatis pneumonia (azithromycin and erythromycin).
Caution in younger than 1 mo for Ureaplasma (azithromycin)
 Quality of evidence: High, Strength of Recommendation: Strong
 ethanol/ethyl alcohol (excluding ethanol lock)< 12 yr< 6 yr (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) ethanol/ethyl alcohol (excluding ethanol lock)
Rationale CNS depression, hypoglycemia
Recommendation Caution in younger than 6 yr: maximum 0.5% v/v ethanol with clinician supervision
Caution in younger than 12 yr: maximum of 5% v/v ethanol with clinician supervision
 Quality of evidence: Moderate, Strength of Recommendation: Strong
F generic (Brand)CautionAvoid
  Fanapt - see iloperidone
  Fleet - see sodium phosphate solution enema, rectal
  Florone - see diflorasone diacetate
 fluocinolone acetonide (Synalar)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 fluocinonide (Lidex)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (very high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 fluPHENAZine (Prolixin)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
 fluticasone topical (Cutivate)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
  Furadantin - see nitrofurantoin
G generic (Brand)CautionAvoid
  Gantanol - see sulfamethoxacole
 gentamicin ophthalmic ointment< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug gentamicin ophthalmic ointment
Risk/Rationale Severe ocular reactions
Recommendation Avoid in younger than 1 mo
 Quality of evidence: High, Strength of Recommendation: Strong
  Geodon - see ziprasidone
H generic (Brand)CautionAvoid
 halcinonide (Halog)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
  Haldol - see haloperidol
 halobetasol propionate (Ultravate, Halonate)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (very high potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
  Halog - see halcinonide
  Halonate - see halobetasol propionate
 haloperidol (Haldol)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Hibiclens - see chlorhexidine, topical
  Hurricaine - see benzocaine, topical
I generic (Brand)CautionAvoid
 iloperidone (Fanapt)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
  Ilotycin - see erythromycin
 imipramine (Tofranil)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tricyclic antidepressants
Risk/Rationale Sudden cardiac death
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: Moderate, Strength of Recommendation: Strong
  Imodium - see loperamide
  Inapsine - see droperidol
  Invega - see paliperidone
 irbesartan (Avapro)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 isopropyl alcohol, topical< 1.5 kg (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) isopropyl alcohol, topical
Rationale Chemical burn
Recommendation Caution in patients weighing less than 1,500 g
 Quality of evidence: Low, Strength of Recommendation: Weak
  Isoptin - see verapamil
K generic (Brand)CautionAvoid
  Karbinal - see carbinoxamine
  Kenalog - see triamcinolone acetonide
L generic (Brand)CautionAvoid
  Lagevrio - see molnupiravir
  LaMICtal - see lamoTRIgine
 lamoTRIgine (LaMICtal)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug lamoTRIgine
Risk/Rationale Skin rashes ranging in severity from benign to life-threatening
Recommendation Caution in 18 yr of age and younger; slow dose titration required
 Quality of evidence: High, Strength of Recommendation: Strong
  Latuda - see lurasidone
  Lidex - see fluocinonide
 lidocaine viscous, topical< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug ester local anesthetics
Risk/Rationale Central nervous system depression, seizures, arrhythmia, death
Recommendation Avoid oral application in younger than 2 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 linaclotide (Linzess)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug guanylate cyclase-c agonists
Risk/Rationale Death from dehydration
Recommendation Caution in younger than 2 yr
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Linzess - see linaclotide
  Lomotil - see diphenoxylate-atropine
  Lonox - see diphenoxylate-atropine
 loperamide (Imodium)< 3 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug loperamide
Risk/Rationale Ileus, lethargy
Recommendation Avoid in younger than 3 yr for acute infectious diarrhea
 Quality of evidence: High, Strength of Recommendation: Strong
 losartan (Cozaar)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 loxapine (Loxitane)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Loxitane - see loxapine
 lumateperone (Caplyta)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 lurasidone (Latuda)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
M generic (Brand)CautionAvoid
  Macrobid - see nitrofurantoin
  Macrodantin - see nitrofurantoin
  Magic Mouthwash with lidocaine - see AlOH/diphenhyd/lidocaine/MgOH/simeth
 magnesium salicylate (Doan's Pills)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
 malathion, topical (Ovide)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug malathion, topical
Risk/Rationale Organophosphate poisoning
Recommendation Caution in younger than 2 yr
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Mellaril - see thioridazine
  Mentholatum - see methyl salicylate
 meperidine (Demerol)≤ 18 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug opioids
Risk/Rationale Acute neurotoxicity (agitation, myoclonus, hyperreflexia, tremors, delirium, seizures)
Recommendation Avoid in younger than 1 mo
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 methyl salicylate (Salonpas, Mentholatum, Banalg)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
 methylparaben< 2 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) methylparaben
Rationale Kernicterus
Recommendation Caution in younger than 2 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 metoclopramide (Reglan)1-18 yr< 1 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in younger than 1 yr
Caution in 1-18 yr of age
 Quality of evidence: High, Strength of Recommendation: Strong
  Micardis - see telmisartan
 midazolam (Versed)< 1.5 kg
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug midazolam
Risk/Rationale Severe intraventricular hemorrhage, periventricular leukomalacia, or death
Recommendation Caution in patients weighing less than 1,500 g
 Quality of evidence: Low, Strength of Recommendation: Weak
 mineral oil< 1 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug mineral oil
Risk/Rationale Lipid pneumonitis
Recommendation Avoid in younger than 1 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
  Minocin - see minocycline
 minocycline (Minocin)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 mirabegron (Myrbetriq)< 3 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug mirabegron
Risk/Rationale Increased blood pressure
Recommendation Caution in younger than 3 yr
 Quality of evidence: Very low, Strength of Recommendation: Weak
 molnupiravir (Lagevrio)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug molnupiravir
Risk/Rationale Bone and cartilage toxicity
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: Very low, Strength of Recommendation: Weak
 mometasone furoate (Elocon)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 montelukast (Singulair)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug montelukast
Risk/Rationale Sleep disturbances
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Mycolog - see nystatin-triamcinolone
  Myrbetriq - see mirabegron
N generic (Brand)CautionAvoid
 naloxone (Narcan)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug naloxone
Risk/Rationale Seizures
Recommendation Avoid in neonates for postpartum resuscitation
 Quality of evidence: High, Strength of Recommendation: Strong
  Narcan - see naloxone
  Navane - see thiothixene
 nitrofurantoin (Furadantin, Macrobid, Macrodantin)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug nitrofurantoin
Risk/Rationale Hemolytic anemia
Recommendation Avoid in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Norpramin - see desipramine
  Nuzyra - see omadacycline
 nystatin-triamcinolone (Mycolog)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
O generic (Brand)CautionAvoid
 OLANZapine (ZyPREXA)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 olmesartan (Benicar)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 omadacycline (Nuzyra)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: Very low, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 opium tincture (Paregoric)≤ 18 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug opioids
Risk/Rationale Respiratory failure
Recommendation Avoid in younger than 1 mo
Caution in 18 yr of age and younger
 Quality of evidence: Low, Strength of Recommendation: Weak
  Orap - see pimozide
  Ovide - see malathion, topical
P generic (Brand)CautionAvoid
 paliperidone (Invega)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
  Paregoric - see opium tincture
  Pepto bIsmol - see bismuth subsalicylate
 perphenazine (Trilafon)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Phenadoz - see promethazine
  Phenergan - see promethazine
 phenylalanine≤ 18 yr (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) phenylalanine
Rationale Cognitive and behavioral problems
Recommendation Avoid in 18 yr of age and younger with an unknown phenylketonuria test
 Quality of evidence: High, Strength of Recommendation: Strong
 pimozide (Orap)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
 plecanatide (Trulance)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug guanylate cyclase-c agonists
Risk/Rationale Death from dehydration
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: Very low, Strength of Recommendation: Weak
 polysorbate 80< 1 mo< 1 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) polysorbate 80
Rationale Vasculopathic hepatotoxicity (E-Ferol syndrome)
Recommendation Avoid exposure of ≥72 mg/kg/day in younger than 1 mo
Caution exposure of >1.4 mg/day in younger than 1 mo
 Quality of evidence: High, Strength of Recommendation: Strong
  Prezista - see darunavir
 prochlorperazine (Compazine)≤ 18 yr< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in younger than 2 yr
Caution in ≤18 years of age
 Quality of evidence: Moderate, Strength of Recommendation: Strong
  Prolixin - see fluPHENAZine
 promethazine (Phenadoz, Phenergan)2-18 yr< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists
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
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 propofol (Diprivan)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug propofol
Risk/Rationale Propofol-related infusion syndrome
Recommendation Avoid doses >4 mg/kg/hr for greater than 48 hr in 18 yr of age and younger
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 propylene glycol1 mo-5 yr< 1 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) propylene glycol
Rationale Lactic acidosis, CNS depression, hypoglycemia, hemolysis, seizure
Recommendation Avoid >1 mg/kg/day in younger than 1 mo
Avoid >50 mg/kg/day in 1 mo of age or older to younger than 5 yr
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 propylparaben< 2 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) propylparaben
Rationale Kernicterus
Recommendation Caution in younger than 2 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Psorcon - see diflorasone diacetate
Q generic (Brand)CautionAvoid
 QUEtiapine (SEROquel)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
R generic (Brand)CautionAvoid
  Reglan - see metoclopramide
  Rexulti - see brexpiprazole
  Reyataz - see atazanavir
 ribavirin (oral inhalation) (Virazole)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug ribavirin (oral inhalation)
Risk/Rationale Sudden respiratory deterioration
Recommendation Caution in younger than 2 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
  RisperDAL - see risperiDONE
 risperiDONE (RisperDAL)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
  Rocephin - see cefTRIAXone
S generic (Brand)CautionAvoid
 sacubitril-valsartan (Entresto)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 salicylic acid (topical)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Salonpas - see methyl salicylate
 salsalate (Disalcid)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Saphris - see asenapine
 sarecycline (Seysara)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
  Septra - see sulfamethoxazole-trimethoprim
  SEROquel - see QUEtiapine
  Seysara - see sarecycline
  Silvadene - see silver sulfadiazine, topical
 silver sulfadiazine, topical (SSD, Silvadene)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sulfonamides
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Singulair - see montelukast
 sodium benzoate< 1 mo (* EXCIPIENT *)
Excipients With Known or Potential Harms When Used in Pediatric Patients (Table 2)
Excipient (Systemic Administration Unless Otherwise Specified) sodium benzoate
Rationale Gasping syndrome
Recommendation Avoid exposure of >99 mg/kg/day in younger than 1 mo (with the exception of sodium phenylacetate/sodium benzoate used for the treatment of urea cycle disorders)
 Quality of evidence: High, Strength of Recommendation: Strong
 sodium phosphate solution enema, rectal (Fleet)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sodium phosphate solution enema, rectal
Risk/Rationale Electrolyte abnormalities, acute kidney injury, arrhythmia, death
Recommendation Avoid in younger than 2 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 sodium polystyrene sulfonate (SPS)< 1.5 kg
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sodium polystyrene sulfonate
Risk/Rationale Colonic perforation
Recommendation Caution in patients weighing less than 1,500 g
 Quality of evidence: Low, Strength of Recommendation: Weak
 sodium salicylate (Cystex, Uro-Pain Dual Action)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug salicylates
Risk/Rationale Reye syndrome
Recommendation Caution in 18 yr of age and younger with suspicion of viral illness (influenza and varicella)
 Quality of evidence: Very low, Strength of Recommendation: Weak
  SPS - see sodium polystyrene sulfonate
  SSD - see silver sulfadiazine, topical
  Stavzor - see valproic acid
  Stelazine - see trifluoperazine
 sulfadiazine< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sulfonamides
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 sulfamethoxacole (Gantanol)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sulfonamides
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 sulfamethoxazole-trimethoprim (Bactrim, Septra)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sulfonamides
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Sumycin - see tetracycline
  Synalar - see fluocinolone acetonide
T generic (Brand)CautionAvoid
  Tarka - see trandolapril-verapamil
 telmisartan (Micardis)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
  Temovate - see clobetasol propionate
 tetracycline (Sumycin)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 thioridazine (MEllaril)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
 thiothixene (Navane)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Thorazine - see chlorproMAZINE
  Tigan - see trimethobenzamide
 tigecycline (Tygacil)< 8 yr< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug tetracyclines
Risk/Rationale Retardation of skeletal development and bone growth
Recommendation Caution in younger than 1 mo
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Tooth discoloration
Recommendation Caution in younger than 8 yr
 Quality of evidence: Low, Strength of Recommendation: Strong
 
Drug tetracyclines
Risk/Rationale Enamel hypoplasia
Recommendation Caution in younger than 8 yr
 Quality of evidence: High, Strength of Recommendation: Strong
  Tofranil - see imipramine
  Topicort - see desoximetasone
 traMADol (Ultram)12-18 yr12-18 yr< 12 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug opioids
Risk/Rationale Respiratory failure, death
Recommendation 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 pharmacogenetic testing
 Quality of evidence: Low, Strength of Recommendation: Weak
 trandolapril-verapamil (Tarka)< 1 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug verapamil
Risk/Rationale Cardiovascular collapse
Recommendation Caution in younger than 1 yr
 Quality of evidence: Low, Strength of Recommendation: Weak
 triamcinolone acetonide (Kenalog, Aristocort)< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug corticosteroids, topical (medium potency)
Risk/Rationale Cushing syndrome, adrenal suppression
Recommendation Avoid in younger than 2 yr for diaper dermatitis
 Quality of evidence: Low, Strength of Recommendation: Strong
 trifluoperazine (Stelazine)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
  Trilafon - see perphenazine
  Trilisate - see choline magnesium trisalicylate
 trimethobenzamide (Tigan)≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: Low, Strength of Recommendation: Strong
  Trulance - see plecanatide
  Tygacil - see tigecycline
U generic (Brand)CautionAvoid
  Ultracet - see acetaminophen-traMADol
  Ultram - see traMADol
  Ultravate - see halobetasol propionate
  Uro-Pain Dual Action - see sodium salicylate
V generic (Brand)CautionAvoid
  Valisone - see betamethasone-clotrimazole
 valproate sodium (Depakene)2-6 yr< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug valproic acid and derivatives
Risk/Rationale Pancreatitis, fatal hepatotoxicity
Recommendation Avoid in younger than 2 yr
Caution in 2-6 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 valproic acid (Depacon, Depakote, Stavzor)2-6 yr< 2 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug valproic acid and derivatives
Risk/Rationale Pancreatitis, fatal hepatotoxicity
Recommendation Avoid in younger than 2 yr
Caution in 2-6 yr
 Quality of evidence: High, Strength of Recommendation: Strong
 valsartan (Diovan)< 1 mo
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug angiotensin receptor blockers
Risk/Rationale Renal tubular dysgenesis
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
 verapamil (Calan, Covera, Isoptin)< 1 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug verapamil
Risk/Rationale Cardiovascular collapse
Recommendation Caution in younger than 1 yr
 Quality of evidence: Low, Strength of Recommendation: Weak
  Versed - see midazolam
  Virazole - see ribavirin (oral inhalation)
  Vraylar - see cariprazine
X generic (Brand)CautionAvoid
  Xerava - see eravacycline
Z generic (Brand)CautionAvoid
 ziprasidone (Geodon)≤ 18 yr≤ 18 yr
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Withdrawal emergent dystonia/dyskinesia
Recommendation Avoid rapid discontinuation in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale 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)
Recommendation Avoid use of OLANZapine for a duration of >12 wk in 18 yr of age and younger
Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug DOPamine antagonists: 2nd generation antipsychotics
Risk/Rationale Hyperprolactinemia (risk greater for paliperidone > risperiDONE > OLANZapine)
Recommendation Caution in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
  Zithromax - see azithromycin
  ZyPREXA - see OLANZapine

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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