Analgesics, Antipyretics (cont.)
Pregnancy/Lactation: Regular aspirin consumption during pregnancy
has been
associated with side effects in the pregnant mother, including
bleeding and
complications during labor. It is unclear if aspirin taken in the
first two
trimesters poses a risk to the fetus. However, when taken during the
third
trimester, aspirin may increase the risk of bleeding in the newborn.
Although
very little aspirin is secreted into milk, most authorities recommend
that
nursing mothers avoid using aspirin.
Viral infections in children: Because aspirin causes Reye's
syndrome (a
potentially fatal liver disease that occurs almost exclusively in
persons under
the age of 15 years), aspirin should not be given to children when a
viral
infection is suspected.
Drug Interactions: High doses of aspirin can increase the activity
of
valproic acid (Depakene; Depakote), an effect which can cause
drowsiness or
behavioral changes. High doses of aspirin also can enhance the effect
of some
sugar-lowering medications used in diabetes, e.g. glyburide (Diabeta),
glipizide (Glucotrol), and tolbutamide (Orinase), which can possibly
lead to
hypoglycemia (low blood sugar). The effects of probenecid (Benemid)
are
reversed by aspirin. Aspirin can increase the toxicity of
methotrexate and the
risk of bleeding with warfarin (Coumadin).
Salicylates other than Aspirin
There are three other OTC salicylates; choline salicylate,
magnesium
salicylate, and sodium salicylate. The advantage of these drugs over
aspirin is
their shorter effect on the platelets that promote bleeding.
Choline salicylate (Arthropan) is available as a liquid. It is
absorbed more
quickly, but its onset of action is no different than that of
aspirin. Some
people find choline salicylate fishy. Fortunately, it can be mixed
with juice
or soda prior to ingestion. It is less effective at reducing fevers
in children
than either aspirin or acetaminophen.
Magnesium salicylate (Arthriten; Backache) is as effective as
aspirin at
reducing pain. Patients with chronic kidney disease should avoid
magnesium
salicylate, since the magnesium may accumulate in their bodies.
Sodium salicylate (Scot-Tussin Original) and aspirin are equally
effective
in the long-term treatment of rheumatoid arthritis, but sodium
salicylate is
less effective at reducing pain or fever.
Acetaminophen
Formulations: Acetaminophen comes in various oral formulations,
including
different types (elixirs or syrups) and flavors of liquids, capsules,
tablets,
caplets, and suppositories. The capsules contain tasteless granules
that can be
emptied onto a teaspoon containing a small amount of drink or soft
food, and
can then be swallowed. However, the granules should not be mixed in a
glass of
liquid since the granules will stick to glass itself. The amount of
acetaminophen that is absorbed from rectal suppositories is about
half that of
the oral formulations.
Side Effects: Acetaminophen generally is safe to use, and few
people develop
side effects. In high doses, however, it can cause liver damage and
doses of
4000mg (4 grams) per day should not be exceeded.
Pregnancy/Lactation: Acetaminophen has no known harmful effects on
the
mother, fetus, or infant and, therefore, can be used safely during
pregnancy
and during lactation.
Drug Interactions: It has been reported that patients with HIV-
related
diseases (e.g., AIDS) who take AZT (zidovudine; Retrovir) and
acetaminophen are
at an increased risk of developing suppression of their bone marrow.
Such
patients develop lower white and red blood cell and platelet counts
and,
therefore, are more susceptible to infection, anemia, and bleeding.
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
There are three OTC NSAIDs--ibuprofen, naproxen sodium, and
ketoprofen. All
have pain relieving (analgesic), fever reducing (antipyretic), and
anti-inflammatory properties. Additionally, NSAIDs are more effective
than
aspirin or acetaminophen for cramps associated with the menstrual
cycle
(dysmenorrhea).
Formulations: Ibuprofen is available in tablets as well as in a
pediatric
suspension. Naproxen sodium is available in tablets. Ketoprofen is
available as
tablets and caplets.
Pregnancy/Lactation: NSAIDs are safe for use during the first or
second
trimesters of pregnancy, but should not be taken during the third
trimester,
since they can prolong labor and delay birth, increase bleeding in
the mother
following birth, and can cause cardiac (heart) and vascular (blood
vessels)
complications in the newborn. Ibuprofen and naproxen sodium also are
safe for
use by nursing mothers. Due to insufficient data, ketoprofen is not
recommended
for use by nursing mothers.
Side effects: The most frequent side effect of NSAIDs is damage to
the
lining of the stomach and duodenum that can lead to abdominal pain,
nausea, and
loss of appetite. NSAIDs also can cause ulcers and bleeding from the
stomach
and duodenum, but less frequently and less severely than occurs with
aspirin
use. NSAIDs, like aspirin, affect platelets and can inhibit the
formation of
blood clots, and, therefore, they should be discontinued at least 24
hours
before surgery or dental procedures. Because alcohol intensifies the
effect of
NSAIDs on bleeding, alcohol should not be taken with NSAIDs. NSAIDs
also can
cause kidney damage, particularly in the elderly or patients with
high blood
pressure, diabetes, atherosclerosis, or who take diuretic medications
("water pills"). Patients who are allergic to aspirin
should not take
NSAIDs since they are likely to be allergic to NSAIDs as well. NSAIDs
may cause
fluid retention in persons with congestive heart failure, and,
therefore should
not be used in this setting.
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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