Do not give children aspirin, nimesulide, or metamizole for fever; cold medicines containing metamizole should also be avoided in minors.

2. Do not give children aspirin, nimesulide, or metamizole for fever; cold medicines containing metamizole should also be avoided in minors.

Cost: No cost involved. Simply check the generic name and ingredient list when buying fever reducers.

In plain terms: For reducing a child’s fever, none of these three drugs should be used. Aspirin is linked to Reye’s syndrome, a condition that damages the brain and liver; in U.S. statistics, around 30% of affected children died, though cases dropped by over 90% after warnings were issued. Nimesulide is prohibited for children under 12, while metamizole is banned for anyone under 18.

Benefit: Reye’s syndrome can lead to brain disease and fatty liver degeneration, typically occurring after influenza or chickenpox infections. Nationwide monitoring in the U.S. from 1981 to 1997 recorded 1,207 cases among children under 18; 82% of these had detectable salicic acid in their blood, a key component of aspirin-like drugs. The overall mortality rate was 31%. Warnings about salicylate-containing drugs began in 1980, when 555 cases were reported — the peak figure; since 1987, annual cases have stayed under 36. China’s drug regulator prohibited oral nimesulide formulations for children under 12 in 2011, and banned metamizole tablets for anyone under 18 in 2020. This ban also applies to compound Qinghao Metamizole Tablets, Chongganling Tablets, and Chongganling Capsules, all of which contain metamizole.

Evidence grade: B

Sources: 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>; Notice on strengthening the management of the use of nimesulide oral preparations (State Food and Drug Administration [2011] No. 209). <https://www.nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20110515145101552.html>; Announcement of the State Food and Drug Administration on revising the instructions for metamizole related varieties (2020 No. 34) and Attachments 1 to 3. <https://www.nmpa.gov.cn/directory/web/nmpa/xxgk/ggtg/ypggtg/ypshmshxdgg/20200317171201660.html>

Notes: Metamizole is not a first-choice treatment even for adults. Its package insert notes it may cause agranulocytosis, aplastic anemia, and anaphylactic shock, so it is only used short-term for severe conditions when no other effective drugs are available. Despite its name, Chongganling is not a regular cold medicine — it contains metamizole as well. For appropriate fever reducers and correct dosages based on body weight, consult a pediatrician or pharmacist. Infants under 3 months with a fever should be taken to a hospital immediately, as noted in Section 20, Item 8 (fever above 38°C requires immediate medical care). This B rating reflects that Reye’s syndrome statistics derive from monitoring reports, and the drop in cases after warnings is a correlative trend rather than evidence from controlled trials; the “significant benefit” rating is justified by the marked reduction in cases from 555 annually to under 36 after warnings were issued.