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Don't Mix Motrin And Tylenol In Tykes

Posting Date: 04/22/2002

Q. I am a pediatrician concerned about parents? use of two over-the-counter medications. I often feel like a ?one-woman army? trying to combat simultaneous use of acetaminophen (Tylenol) and ibuprofen (Motrin, etc) for children with fever.

Parents sometimes alternate doses as often as every two hours. Some parents are giving these medications together to bring down a fever.

Clearly, fever is a physiologic function that helps the body fight infections. I try to educate parents about this, but there seems to be an almost irrational fear of fever in our culture.

I am also alarmed about recent case reports of kidney failure in children who had received this combination. I am very concerned that as this practice spreads, so will the incidence of kidney failure.

A. ?Fever phobia? is a concern of many pediatricians. A mild elevation in temperature is part of an immune reaction to infection. Lowering such a fever may be counterproductive.

There is no evidence that alternating acetaminophen and ibuprofen or administering both drugs together lowers fever faster or helps children recover more quickly. You are not the only pediatrician who has expressed concern that this combination may increase the risk of toxicity, such as kidney damage.

Q. We?ve recently been buying grapefruit by the box from a truck that comes up from Florida. They are incredibly delicious, but my neighbor says they interact with lots of drugs. Where do I find a list of medicines that are affected by eating grapefruit daily?

A. Fresh grapefruit is a mouth-watering treat, but your neighbor is correct. Grapefruit interacts with dozens of drugs to increase blood levels and the risk of side effects. Certain blood pressure medications, hormone replacement therapies, cholesterol-lowering drugs, sleeping pills and anti-anxiety agents, and the epilepsy medicine Tegretol are affected by grapefruit.