Which Medications Cause Reye's Syndrome? Understanding Salicylate Risks in Children

October 14, 2025 •

3 min read

Following widespread public health warnings in the 1980s, the incidence of Reye's syndrome declined dramatically, establishing a critical link between certain drugs and this rare but severe condition. This article explains which medications cause Reye's syndrome, emphasizing the particular risk of salicylates in children recovering from viral illnesses.

Quick Summary

Reye's syndrome is a rare but serious condition linked to using aspirin and other salicylates during viral illnesses in children and teenagers, causing brain swelling and liver damage. Avoiding these specific medications is the primary preventive measure.

Key Points

Salicylates are the main culprits: The use of aspirin and other salicylate-containing products, like bismuth subsalicylate (Pepto-Bismol), is the primary medication risk for Reye's syndrome.
Viral infections heighten the risk: Reye's syndrome is most commonly triggered when salicylates are given during or after viral illnesses, especially influenza and chickenpox.
Read medication labels carefully: Salicylates can be found under different names, such as acetylsalicylic acid or bismuth subsalicylate; always check product ingredients.
Use safe alternatives for children: Acetaminophen and ibuprofen are the recommended alternatives for treating fever and pain in children, depending on their age and health status.
Consult a healthcare provider: Always seek medical advice before giving any medication to a child or teenager during a viral illness to ensure it is safe.
Reye's is rare but serious: While the syndrome is now uncommon, it remains a medical emergency that can cause permanent brain damage or death if not treated early.

The Connection Between Salicylates and Reye's Syndrome

Reye's syndrome is a rare but life-threatening condition that causes acute brain swelling and fatty degeneration of the liver, primarily affecting children and teenagers. While the exact cause is not fully understood, there is a strong and well-established epidemiological link between the syndrome and the use of salicylates, most notably aspirin, during or shortly after a viral illness. This risk is so significant that, following public health warnings, the number of Reye's syndrome cases dropped dramatically in the United States and other countries.

The Role of Aspirin and Other Salicylates

The primary medication associated with Reye's syndrome is aspirin. The FDA requires aspirin-containing products to carry a warning about the risk of Reye's syndrome when used in children and teenagers. Salicylates to watch for on product labels include: Aspirin, Acetylsalicylic acid, Acetylsalicylate, Salicylic acid, and Bismuth subsalicylate.

Medications That Can Cause Reye's Syndrome or Reye-like Symptoms

While aspirin is the most commonly implicated medication, other drugs and substances have been linked to Reye's syndrome or Reye-like symptoms. Bismuth subsalicylate, found in medications like Pepto-Bismol, contains a salicylate and should not be given to children or teenagers, especially with a viral illness. Some NSAIDs and valproic acid have also been associated with Reye-like symptoms in isolated cases. Additionally, certain herbal remedies and toxins have been linked to Reye-like syndromes.

The Importance of the Viral Illness Connection

For Reye's syndrome to develop, the administration of salicylates typically occurs during or following a viral infection. The viruses most commonly associated with triggering the condition are influenza (the flu) and varicella-zoster (the virus that causes chickenpox). While the syndrome can sometimes occur with other viral illnesses, these are the most prominent associations. This is why annual flu vaccinations and the chickenpox vaccine are also important preventive measures.

How to Avoid Aspirin-Related Risks

The most effective prevention strategy is to avoid giving aspirin and salicylate-containing products to children and teenagers under 19, unless specifically prescribed by a healthcare provider for certain conditions like Kawasaki disease. Parents should check all medication labels for salicylates and opt for safer alternatives like acetaminophen or ibuprofen for fever and pain relief in children over the appropriate age, as recommended by a pediatrician. Consulting a healthcare professional is always advised if unsure whether a medication is safe for a child.

Comparison of Common Children's Medications for Fever and Pain


Feature	Aspirin and Salicylates	Acetaminophen	Ibuprofen
Associated Reye's Risk	High risk, especially with viral illness	No known risk	No known risk
Appropriate Age for Use	Generally avoided in children and teens under 19	Suitable for infants (check with pediatrician for <3 months)	Suitable for infants over 6 months old
Drug Class	Salicylate NSAID	Non-NSAID analgesic	NSAID
Active Ingredient Names	Aspirin, Acetylsalicylic Acid, Salicylate	Acetaminophen	Ibuprofen

Conclusion

The causal link between Reye's syndrome and salicylates, particularly aspirin, is a well-documented finding. Understanding which medications cause Reye's syndrome enables parents to make informed decisions. Safer alternatives like acetaminophen and ibuprofen are standard recommendations for fever or pain relief in children, but consulting a pediatrician or pharmacist is always recommended. For more detailed information on Reye's syndrome, consult the {Link: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255}.

Frequently Asked Questions

Salicylates are a class of drugs, with aspirin being the most well-known example. Other salicylates, such as acetylsalicylic acid and bismuth subsalicylate, are also found in various medications, including some cold remedies and stomach ailment treatments.

Yes, while Reye's syndrome most commonly affects children and teenagers, it can occur at any age. The risk associated with salicylate use during a viral illness is not exclusive to pediatric patients.

For children over the age of six months, both acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil, Motrin) are considered safe for reducing fever and pain when used as directed. Acetaminophen can be given to younger infants, but always consult a pediatrician for guidance.

No, Pepto-Bismol contains bismuth subsalicylate, a salicylate that carries the same risk for Reye's syndrome as aspirin. Therefore, it should not be given to children or teenagers, particularly during or after a viral illness.

The dramatic decline in Reye's syndrome cases is largely attributed to widespread public health education campaigns in the 1980s that warned against giving aspirin to children with viral illnesses. Increased awareness and the use of safer alternatives like acetaminophen and ibuprofen are key factors.

Yes, Reye's syndrome is most often associated with influenza (the flu) and chickenpox, although it can be triggered by other viral infections as well. This link is why aspirin should be avoided during or after any viral illness.

For certain chronic conditions, such as Kawasaki disease, a healthcare provider may prescribe aspirin. In these cases, it is critical to follow the doctor's specific instructions and discuss a plan for managing potential viral illnesses. Ensuring your child is up-to-date on vaccines can also help mitigate risk.

Reye's syndrome is a medical emergency that requires hospitalization, often in an intensive care unit. Treatment is supportive, focusing on reducing brain swelling and managing symptoms. Early diagnosis and treatment are crucial for improving outcomes.