Analgesics, Antipyretics (cont.)
Harmful effects of fever (for example, dehydration, changes in
consciousness, seizures, or coma) are most likely to occur at
temperatures
above 106 degrees. Lower fevers are dangerous in persons with heart
disease,
since fever increases the work of the heart because the pumping of
blood must
increase. Seizures occur in 2 to 4% of all children between the ages
of 6
months and 5 years (usually before age 3) with high fevers though
these
seizures generally last no more than 15 minutes. Children who
experience
febrile seizures have a higher risk of developing epilepsy later in
life.
What are the
different classes of pain relievers and fever reducers?
The three classes of OTC analgesic/antipyretic medications are:
In most circumstances, these medications all have very similar
analgesic
(pain- relieving) and antipyretic (fever-lowering) abilities. Their
onset of
action (the interval from the time of ingestion to the start of pain
relief)
also are similar. Naproxen sodium may have a somewhat longer duration
of pain
relief (analgesia) than the other NSAIDs or aspirin. At high doses,
salicylates
and NSAIDs suppress inflammation and are, therefore, particularly
useful in
treating inflammatory diseases such as arthritis. Acetaminophen does
not have
anti-inflammatory actions.
Many OTC analgesics are available in combination with other drugs.
There is
some evidence that caffeine and antihistamines enhance the effects of
analgesics. Thus, caffeine increases the pain-relieving effects of
aspirin and
ibuprofen, and the antihistamines orphenadrine and phenyltoloxamine
enhance the
pain- relieving effects of acetaminophen. Combinations of
decongestants with
analgesics are logical only when nasal or sinus congestion are
present, for
example, for sinus headaches.
Aspirin
Formulations of aspirin: Aspirin can damage the lining of the
stomach and
duodenum, thereby causing abdominal pain, bleeding, and/or ulcers. As
a result,
1 in 5 persons who take aspirin in a dose of 2.5 grams per day or
more develops
ulcers and about 1 in 6 will lose enough blood from gastrointestinal
bleeding
to develop anemia. In an attempt to reduce the potential for these
complications, some aspirin-containing tablets have been coated with
a special
coating that prevents the tablet from dissolving until it is past the
stomach
and duodenum. These "enteric-coated" aspirin products may
reduce the
frequency of abdominal pain, but not the bleeding or ulcers.
Moreover, the
onset of pain relief is delayed with enteric-coated aspirin because
it takes
more time for the tablets to dissolve. Other attempts to prevent
complications
have included aspirin-containing products that release the aspirin
slowly over
time (e.g., Zorprin; Measurin; Verin). Like enteric-coated products,
these
products are not ideal when prompt relief of pain is needed. They
also do not
prevent ulcers or bleeding. Buffered (e.g. Bufferin) and effervescent
(e.g.
Alka-Seltzer) aspirin products are absorbed more quickly from the
stomach and
intestine than aspirin, but they do not act more rapidly than regular
aspirin
and do not reduce the risk of bleeding or ulcers. Furthermore,
effervescent
aspirin products contain large amounts of sodium (salt) and should be
avoided
in persons with high blood pressure, heart failure, or certain kidney
diseases.
Side Effects: Aspirin prevents platelets from sticking together
and forming
blood clots. On the one hand, this effect can be used beneficially,
for
example, to prevent the blood clots that cause heart attacks or
strokes. On the
other hand, by preventing blood clots, aspirin can have the
detrimental effect
of promoting bleeding. Therefore, aspirin should not be used by
people who have
diseases that cause bleeding (e.g., hemophilia, severe liver disease)
or
diseases in which bleeding may occur as a complication (e.g., stomach
ulcers).
Moreover, since the effect of aspirin on platelets lasts for several
days,
people should not take aspirin for seven days before surgical or
dental
procedures because of the increased risk of bleeding after the
procedures. In
patients at risk for bleeding, acetaminophen can be an excellent
alternative to
aspirin since acetaminophen does not have an effect on platelets,
blood clots,
or bleeding. Like aspirin, other NSAIDs affect platelets, but the
duration of
the effect is less than with aspirin. Two aspirin-related,
salicylate-containing products (salsalate and choline magnesium
trisalicylate)
have no effect on the platelets, but they are available only by
prescription.
Although many people claim to be "allergic" to aspirin,
most
describe their "allergy" as abdominal pain or heartburn.
These common
side effects are not allergies, but rather reflect the irritating
effects of
aspirin on the lining of the stomach. True allergy to aspirin occurs
in fewer
than 1 out every 100 persons. True allergy may include hives, itching,
swelling, or difficulty breathing. Allergy to aspirin is more common
in persons
with asthma, allergic rhinitis, or nasal polyps. In such persons, the
risk of
an allergic reaction to aspirin may be as high as 1 to 3 persons out
of every
10. People with true aspirin allergy also may be allergic to other
compounds.
One such compound is tartrazine, or yellow dye #5. This dye is used
in many
medicines, foods (such as soft drinks), and candy or desserts. In
addition,
people with an allergy to aspirin often are allergic to other NSAIDs,
such as
ibuprofen.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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