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Paediatric Drugs Jan 2021Metamizole, which has antipyretic and pain-relieving properties, is generally used to treat fever in children who do not respond to paracetamol treatment. The most...
PURPOSE
Metamizole, which has antipyretic and pain-relieving properties, is generally used to treat fever in children who do not respond to paracetamol treatment. The most remarkable side effect of metamizole is that it causes myelotoxicity independently of dose. In this study, we aimed to present the clinical features of paediatric patients who developed agranulocytosis after the use of metamizole and draw attention to this side effect.
METHODS
The patients who were admitted to Eskişehir Osmangazi University Faculty of Medicine Hospital, Pediatric Infectious Diseases and Pediatric Hematology Service, between January 1, 2015, and December 31, 2018, with a diagnosis of secondary agranulocytosis to metamizole use were examined retrospectively.
RESULTS
In all, 12 patients were included in the study; oral metamizole was used in these patients for fever reduction. The mean absolute neutrophil count was 225/mm ± 226 (0-600/mm) at admission, and the neutrophil value of 11 patients was < 500/mm. The mean length of hospitalisation of the patients was 9.92 ± 8 (3-28) days. Eight patients received intravenous antibiotic therapy and four patients received at least one of the following treatments: intravenous immunoglobulin, granulocyte colony-stimulating factor and methylprednisolone. Bone marrow aspiration examination showed neutrophil/band maturation delaying in the myeloid series with normocellular bone marrow in three patients. Hypocellularity in the bone marrow and decrease in myeloid precursors were observed in three patients. There were no fatal cases.
CONCLUSION
The development of agranulocytosis after the use of metamizole causes long-term hospitalisation and may require the use of medications in treatment management. Considering the availability of alternative options to treat fever and pain, and given the side-effect profile of metamizole, it should not be the preferred, first-line antipyretic treatment in children.
Topics: Adolescent; Agranulocytosis; Anti-Inflammatory Agents, Non-Steroidal; Antipyretics; Child; Child, Preschool; Dipyrone; Female; Humans; Infant; Male; Pain; Retrospective Studies
PubMed: 33247375
DOI: 10.1007/s40272-020-00431-1 -
Current Drug Metabolism 2017Fever or Pyrexia means abnormal rise in body temperature above the usual range of normal in response to a variety of infectious, immunological and neoplastic stimuli. To... (Review)
Review
Fever or Pyrexia means abnormal rise in body temperature above the usual range of normal in response to a variety of infectious, immunological and neoplastic stimuli. To normalize these febrile conditions, several synthetic agents are in clinical practice such as acetaminophen, ibuprofen, and aspirin. However, they are having many side effects which sometimes challenge their applications. The various sources are under investigation worldwide to overcome issues of unwanted effects and to better therapeutic response. In this scenario botanicals such as alkaloids, the most widely distributed and studied plant secondary metabolites, could effectively produce the molecules with better antipyretic effect and safety profile. The current review deals with 21 isolated alkaloids from 14 plants species having some antipyretic effect in preliminary screening/preclinical studies with the possible mechanism and structural edges. Therefore, these alkaloids of plant origin are candidates for further detail studies to ascertain their mechanism(s) and clinical utility or as lead compounds for future drugs.
Topics: Alkaloids; Animals; Antipyretics; Drug Industry
PubMed: 28093998
DOI: 10.2174/1389200218666170116102625 -
Hong Kong Medical Journal = Xianggang... Aug 2017Antipyretics are commonly prescribed drugs and hypersensitivity occurs at rates of 0.01% to 0.3%. Hypersensitivity can be due to immune mechanisms that include type I to... (Review)
Review
Antipyretics are commonly prescribed drugs and hypersensitivity occurs at rates of 0.01% to 0.3%. Hypersensitivity can be due to immune mechanisms that include type I to IV hypersensitivity. Type I hypersensitivity results from specific immunoglobulin E production following sensitisation on first exposure. Subsequent exposures elicit degranulation of mast cells, culminating an immediate reaction. Non-type I hypersensitivity is a delayed reaction that involves various effector cells, resulting in maculopapular rash, fixed drug eruptions, drug reaction with eosinophilia and systemic symptoms, and Stevens-Johnson syndrome/toxic epidermal necrolysis. Antipyretics also cause non-immune hypersensitivity via cyclooxygenase inhibition. Apart from hypersensitivity to parent compounds, hypersensitivity to excipient has been reported. Clinical manifestations of antipyretic hypersensitivity involve the skin, mucosa, or multiple organs. Diagnosis of hypersensitivity requires a detailed history taking and knowledge of any underlying disorders. Differential diagnoses include infection, inflammatory conditions, and antipyretics acting as co-factors of other allergens. Investigations include specific immunoglobulin E assays, lymphocyte transformation test, basophil activation test, and skin prick test. Lack of standardisation and a scarcity of available commercial reagents, however, limit the utility of these tests. A drug provocation test under close supervision remains the gold standard of diagnosis. A trial of the culprit drug or other structurally different antipyretics can be considered. Patients with confirmed hypersensitivity to antipyretics should consider either avoidance or desensitisation. Other theoretical options include subthreshold or low-dose paracetamol, cyclooxygenase-2 inhibitors, pre-medication with antihistamines with or without a leukotriene receptor antagonist, co-administration of prostaglandin E2 analogue, traditional Chinese medicine, or desensitisation if antipyretics are deemed desirable. Safety and efficacy of unconventional treatments warrant future studies.
Topics: Antipyretics; Desensitization, Immunologic; Disease Management; Drug Hypersensitivity; Histamine Antagonists; Humans; Premedication
PubMed: 28684647
DOI: 10.12809/hkmj166186 -
Der Anaesthesist Jul 2017Antipyretics are among the most widely prescribed drugs in German hospitals. Despite this widespread use, their role for treatment of critically ill patients still... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Antipyretics are among the most widely prescribed drugs in German hospitals. Despite this widespread use, their role for treatment of critically ill patients still remains unclear. In particular, the questionable positive effects of reducing fever are discussed.
OBJECTIVES
In this review we aimed to summarize and discuss current study results covering the use of antipyretics in critically ill patients. Suspected effects with regard to fever reduction and lethality should be considered.
MATERIALS AND METHODS
A selective literature search was carried out in the PubMed database. We reviewed the bibliographies of all work considered relevant.
RESULTS
There are only a few studies on the use of antipyretics in intensive care patients, which are difficult to compare systematically due to different designs, protocols and endpoints. All in all, the decrease in temperature was very low (0.3 °C) and showed even adverse effects on 28-days mortality in sepsis. In patients with sepsis and ASS medication, a decreased mortality has been shown in retrospective analysis.
CONCLUSIONS
The benefit of fever control using antipyretics in intensive care patients with regard to endpoints like lethality remains unclear. Randomized controlled trials with suitable protocols and endpoints are needed to provide a solid base for development of guidelines.
Topics: Acetaminophen; Antipyretics; Critical Care; Critical Illness; Fever; Humans; Sepsis
PubMed: 28364306
DOI: 10.1007/s00101-017-0301-9 -
Canadian Family Physician Medecin de... Mar 2017A child with a history of asthma came to my clinic with acute fever. I have heard that acetaminophen might be associated with exacerbation of asthma. Is it safe if I... (Review)
Review
A child with a history of asthma came to my clinic with acute fever. I have heard that acetaminophen might be associated with exacerbation of asthma. Is it safe if I recommend acetaminophen for this child? Most studies suggest an association between acetaminophen use in children and development of asthma later in childhood. However, several confounding factors in study design might contribute to this positive correlation, and without a prospective controlled trial, confirming this finding is challenging. If children have a known history of asthma, it is likely safe to administer a single dose of acetaminophen without concern of precipitating adverse respiratory symptoms. Regular use of acetaminophen to relieve fever or pain does not seem to exacerbate asthma in children more than ibuprofen does.
Topics: Acetaminophen; Age Factors; Antipyretics; Asthma; Child; Child, Preschool; Disease Progression; Dose-Response Relationship, Drug; Humans; Infant; Risk Factors
PubMed: 28292797
DOI: No ID Found -
Chinese Journal of Integrative Medicine Jun 2016Mahuang-Shigao herb-pair is a famous formula composed of Ephedra and Gypsum. The herb-pair is frequently used for treating cold symptoms and bronchial asthma in the...
OBJECTIVE
Mahuang-Shigao herb-pair is a famous formula composed of Ephedra and Gypsum. The herb-pair is frequently used for treating cold symptoms and bronchial asthma in the clinical practice of Chinese medicine (CM). In the present study, we evaluated evidence for the benefit of combined use of Ephedra and Gypsum by analyzing the antipyretic and anti-asthmatic activities of Ephedra-Gypsum.
METHODS
The antipyretic effects of Ephedra-Gypsum were evaluated in yeast-induced hyperthermia test. Thirty male Wistar rats were randomly divided into 5 groups, including control group, standard aspirin group, and 3 Ephedra- Gypsum groups of different doses (6, 12, 24 g/kg). Ephedra-Gypsum extract and asprin were administered orally 6 h after the injection of yeast solution and body temperature was measured every 1 h for 8 h. The antiasthmatic effects of Ephedra-Gypsum were evaluated using an ovalbumin (OVA)-induced asthmatic rat model. Thirty-six male SD rats were randomly divided into 6 groups. Rats were alternately sensitized and OVA+Al(OH) challenged by exposure to mists of ovalbumin. Ephedra-Gypsum extracts (6, 12, 24 g/kg) or dexamethasone were administered 45 min prior to the allergen challenge for 8 days. Latent period and the weight of wet to dry ratio of lung were determined. In addition, the eosinophils in blood and white blood cell (WBC) were counted by an YZ-Hemavet Analyzer.
RESULTS
The Ephedra-Gypsum extracts at test dose (6, 12, 24 g/kg) significantly and dose-dependently attenuated yeast-induced fever in rats. The Ephedra-Gypsum extracts also prolonged the latent period, reduced OVA-induced increases in eosinophils and WBC, and decreased the wet and dry weight ratio of the lungs in the anti-asthmatic test.
CONCLUSIONS
These findings indicate that the Ephedra-Gypsum extract has antipyretic and anti-asthmatic properties. Hence, the results support additional scientific evidence in prescriptions.
Topics: Alkaloids; Animals; Anti-Asthmatic Agents; Antipyretics; Asthma; Calcium Sulfate; Drugs, Chinese Herbal; Ephedra; Fever; Lung; Male; Organ Size; Ovalbumin; Plant Extracts; Rats, Sprague-Dawley; Rats, Wistar
PubMed: 25399307
DOI: 10.1007/s11655-014-1952-x -
Journal of Ethnopharmacology Oct 2022Houttuynia cordata Thunb. (H. cordata) is a well-known folk traditional Chinese medicine that is renowned for its use in the management of inflammatory respiratory...
ETHNOPHARMACOLOGICAL RELEVANCE
Houttuynia cordata Thunb. (H. cordata) is a well-known folk traditional Chinese medicine that is renowned for its use in the management of inflammatory respiratory diseases and pneumonia. Its essential oils have demonstrated their anti-inflammatory efficacy in vitro, however, their in vivo biological effects via inhalation have not been elucidated.
AIM OF THE STUDY
This study aims to evaluate the anti-inflammation and toxicology of H. cordata essential oil-containing formulation, H16 aerosol in vivo.
MATERIALS AND METHODS
A laser diffraction particle size analyser and a Next Generation Impactor were used to measure the mass median aerodynamic diameter (MMAD) of the H16 aerosol. The anti-inflammatory and antipyretic effects of the H16 aerosol were evaluated in the xylene-evoked ear oedema and Brewer's yeast-induced fever models, respectively. The biological safety of the H16 aerosol was evaluated by acute toxicity and local toxicity tests in animal models.
RESULTS
Our data showed that the MMAD of the bioactive aerosol was 3-5 μm, which implied tracheal and pharyngeal deposits. Significant anti-inflammatory and antipyretic effects were also observed in the animal models treated with H16 aerosol. The maximum tolerable dose of H16 in rats was >2.5 mL/kg. Irritation was not found on respiratory tract mucosa in the local toxicity test.
CONCLUSIONS
Taken together, the present study suggested that H16 could be delivered in the form of aerosol and possessed its antipyretic and anti-inflammatory effects. This study provides a new perspective for the development of a new herbal aerosol therapy and herbal modernization.
Topics: Animals; Anti-Inflammatory Agents; Antipyretics; Houttuynia; Oils, Volatile; Plant Extracts; Rats
PubMed: 35872291
DOI: 10.1016/j.jep.2022.115541 -
NPJ Primary Care Respiratory Medicine Sep 2022Early in the COVID-19 pandemic, anecdotal reports emerged suggesting non-steroidal anti-inflammatory drugs (NSAIDs) may increase susceptibility to infection and... (Review)
Review
Early in the COVID-19 pandemic, anecdotal reports emerged suggesting non-steroidal anti-inflammatory drugs (NSAIDs) may increase susceptibility to infection and adversely impact clinical outcomes. This narrative literature review (March 2020-July 2021) attempted to clarify the relationship between NSAID use and COVID-19 outcomes related to disease susceptibility or severity. Twenty-four relevant publications (covering 25 studies) reporting original research data were identified; all were observational cohort studies, and eight were described as retrospective. Overall, these studies are consistent in showing that NSAIDs neither increase the likelihood of SARS-CoV-2 infection nor worsen outcomes in patients with COVID-19. This is reflected in current recommendations from major public health authorities across the world, which support NSAID use for analgesic or antipyretic treatment during COVID-19. Thus, there is no basis on which to restrict or prohibit use of these drugs by consumers or patients to manage their health conditions and symptoms during the pandemic.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antipyretics; COVID-19; Humans; Pandemics; Retrospective Studies; SARS-CoV-2
PubMed: 36127354
DOI: 10.1038/s41533-022-00300-z -
Current Pharmaceutical Biotechnology 2023Pyrexia itself is not a terminal condition. Basically, it occurs with mild to serious diseases affecting alarge population of the world. Other than a high body... (Review)
Review
Pyrexia itself is not a terminal condition. Basically, it occurs with mild to serious diseases affecting alarge population of the world. Other than a high body temperature, pyrexia is accompanied by several sickness behaviors, changes in physiological and metabolic characteristics of the body system, and alterations in the immune responses. Various allopathic drugs are available to treat pyrexia by targeting the symptom or the pathogen itself. Drug-resistance has made control and treatment of vectors more difficult. However, many marginal people are obligated to utilize locally available medicinal plants for the treatment of various diseases due to limited access to synthetic drugs. Developments in the field of nanotechnology and phytochemical research towards the discovery of new antimicrobial agents have also drawn the interest of researchers towards the synthesis of green nanoparticles from plant extracts due to their several benefits over the other methods. Thus, the present report discusses the use of ethnomedicinal plants, phytocompounds, and the application of green nanoparticles synthesized from plant extracts to treat pyrexia.
Topics: Humans; Plants, Medicinal; Antipyretics; Plant Extracts; Nanoparticles; Fever
PubMed: 35352658
DOI: 10.2174/1389201023666220330005020 -
Antipyretic and anti-inflammatory activities of Thais luteostoma extracts and underlying mechanisms.Chinese Journal of Natural Medicines Mar 2015Thais luteostoma has been utilized as a crude drug whose shell and soft tissue have been widely used for the treatment of heat syndrome in China for thousands of years....
Thais luteostoma has been utilized as a crude drug whose shell and soft tissue have been widely used for the treatment of heat syndrome in China for thousands of years. The present study was designed to investigate the antipyretic and anti-inflammatory activities of T. luteostoma. T. luteostoma was divided into shell (TLSH) and soft tissue (TLST) samples in the present study. The rat model of yeast-induced fever was used to investigate their antipyretic effects; and the rat model of hind paw edema induced by carrageenan was utilized to study their anti-inflammatory activities, and at the same time, the concentration variations of the central neurotransmitter [prostaglandin E2 (PGE2) and cyclic adenosine monophosphate (cAMP)], inflammatory mediators [tumor necrosis factor (TNFα), interleukin-1β (IL-1), interleukin-2 (IL-2) and interleukin-6 (IL-6)] and ion (Na(+) and Ca(2+)) were also tested. The results showed that TLSH and TLST extracts significantly inhibited yeast-induced pyrexia in rats (P < 0.05), and exhibited more lasting effects as compared to aspirin, and TLSH had the better antipyretic activity than TLST, and that TLSH and TLST could significantly prevent against carrageenan induced paw edema in rats (P < 0.05); and markedly reduced levels of PGE2, cAMP, TNFα, IL-1β, IL-2, IL-6, and Na(+)/Ca(2+). In fever model, TLST could significantly reduce the levels of PGE2 (P < 0.01) in rats' homogenate and TNFα (P < 0.05), IL-1β (P < 0.01) in the plasma than TLSH, whereas TLSH could reduce the content of IL-2 (P < 0.01) and IL-6 (P < 0.01) in plasma and increase the content of Ca(2+) (P < 0.01) in plasma and homogenate more significantly than TLST. In conclusion, T. luteostoma extract has antipyretic and anti-inflammatory activities, which may be mediated through the suppression of production of PGE2, cAMP, Na(+)/Ca(2+), TNFα, IL-1β, IL-2, and IL-6.
Topics: Animal Shells; Animals; Anti-Inflammatory Agents; Antipyretics; Carrageenan; Complex Mixtures; Edema; Fever; Hindlimb; Inflammation Mediators; Male; Rats; Rats, Sprague-Dawley; Saccharomyces cerevisiae; Snails
PubMed: 25835363
DOI: 10.1016/S1875-5364(15)30004-2