News: Ibuprofen in chickenpox - to recommend or not to recommend?!
Those of you who are active on Facebook may be aware of the controversy surrounding the use of ibuprofen in chickenpox. Ibuprofen has traditionally been recommended as part of the mainstay of chickenpox treatment (alongside paracetamol, antihistamines and topical antipruritic/cooling preparations) but recently there have been reports of adverse skin reactions and even septicaemia associated with the use of ibuprofen in chickenpox. The potential for ibuprofen to cause skin reactions, such as necrotising fascilitis, has been demonstrated in clinical trials from the 90s, but the association between ibuprofen and the development of skin reactions in Varicella infection is yet to be fully understood. None-the-less, there appears to have been a significant increase in the number of reported cases of adverse skin reactions when ibuprofen is used for the treatment of chickenpox and as a result, NICE has recommended that ibuprofen should no longer be used for this indication.
Considering that this medication has seen extensive use for OTC treatment of chickenpox over several decades, ensuring that patients and their caregivers are aware of the new recommendations is of paramount importance to prevent unnecessary complications. Moreover, in the event that a patient has taken ibuprofen for treatment of their condition, pharmacists and doctors should remain vigilant when assessing their presentation to prevent secondary infections and septicaemia (symptoms of which include nausea and vomiting, abdominal pain, diarrhoea, shortness of breath, rapid heart rate and rapid breathing). Whilst NSAIDs should be avoided completely according to the new guidelines, paracetamol should still be recommended first-line in the treatment of chickenpox for its pain relieving and antipyretic properties.