Antipyretic
Anantipyretic(/ˌæntipaɪˈrɛtɪk/,fromanti-'against' andpyretic'feverish') is a substance that reducesfever.[1]Antipyretics cause thehypothalamusto override aprostaglandin-induced increase intemperature.[citation needed]The body then works to lower the temperature, which results in a reduction in fever.
Most antipyretic medications have other purposes. The most common antipyretics in the US are usuallyibuprofenandaspirin,which arenonsteroidal anti-inflammatory drugs(NSAIDs) used primarily asanti-inflammatoriesandanalgesics(pain relievers), but which also have antipyretic properties; andparacetamol(acetaminophen), an analgesic without anti-inflammatory properties.[2]
There is some debate over the appropriate use of such medications, since fever is part of the body'simmune responseto infection.[3][4]A study published by theRoyal Societyclaims that fever suppression causes at least 1% moreinfluenzadeaths in the United States, or 700 extra deaths per year.[5]
Non-pharmacological treatment
[edit]Bathing or sponging with lukewarm or cool water can effectively reduce body temperature in those withheat illness,but not usually in those with fever.[6]The use of alcohol baths is not an appropriate cooling method, because there have been reported adverse events associated with systemic absorption of alcohol.[7]
Medications
[edit]The list of medications with antipyretic effects includes many common drugs that also have analgesic and anti-inflammatory activity, several of which are commonly soldover-the-counter(OTC).
- NSAIDs(non-steroidal anti-inflammatory drugs), a broad class of medications that in addition to their defining effect of reducing inflammation, also tend to be potent analgesics and antipyretics. The majority work by inhibiting the activity of thecyclooxygenase(COX) family of enzymes in the body.
- Nonselective COX enzyme inhibitors likeibuprofenandnaproxen.[8]
- Salicylates,includingaspirin(acetylsalicylic acid),magnesium salicylate,andsodium salicylate.These are also primarily nonselective COX inhibitors, but also work through other mechanisms including activatingAMP-activated protein kinase.[9]
- COX inhibitors that are relatively selective for theCOX-1enzyme, such asketoprofenandflurbiprofen.[8]
- Conversely, COX inhibitors that are relatively selective forCOX-2,includingnimesulide,diclofenacandcelecoxib.[8]
- Phenazone-like drugs (pyrazolones), many of which have been largely phased out of used owing to safety concerns in most countries (includingmetamizole,banned in over 30 countries for causingagranulocytosis), but remain available in some locations or for specific purposes such as for treatingotitis mediain the form ofear drops.
- Paracetamol(acetaminophen) class antipyretics, which have negligible anti-inflammatory activity. Apart from paracetamol itself, the medications in this class are mainly previously marketed drugs which were withdrawn owing to safety concerns, one example of this beingphenacetin.
- A few other medications have antipyretic effects of varying strength. While these medications tend to have too weak fever reducing effects or too many adverse effects to use primarily as antipyretics, their antipyretic effect may occasionally be useful. For example, there are theoretical reasons to believe,[10]as well as slight evidence from one human trial,[11]thatα2-adrenergic agonists,and particularlyclonidine(a common drug used to treathigh blood pressure,ADHD,spasticityand several other conditions), may have antipyretic effects, which if verified could potentially be useful in patients withseptic shockoracute respiratory distress syndrome.[12]
Use in children
[edit]The U.S.Food and Drug Administration(FDA) notes that improper dosing is one of the biggest problems in givingacetaminophen(paracetamol) to children.[13]The effectiveness of acetaminophen alone as an antipyretic in children is uncertain, with some evidence showing it is no better than physical methods.[14]Therapies involving alternating doses of acetaminophen andibuprofenhave shown greater antipyretic effect than either drug alone.[15]One meta-analysis indicated that ibuprofen is more effective than acetaminophen in children at similar doses when both are given alone.[16]
Due to concerns aboutReye syndrome,it is recommended that aspirin andcombination productsthat contain aspirin not be given to children or teenagers during episodes of fever-causing illnesses.[17][18]
Traditional medicine
[edit]Traditional use ofvascular plantswith antipyretic properties is a common worldwide feature of manyethnobotanicalcultures. In ethnobotany, a plant with naturally occurring antipyretic properties is commonly referred to as afebrifuge.[19]
References
[edit]- ^"Definition of antipyretic".Merriam-Webster Online Dictionary.Retrieved2007-12-19.
- ^"Acetaminophen",PubChem, National Center for Biotechnology Information, U.S. National Library of Medicine. Modified 2016-08-07, accessed 2016-08-16.
- ^"Fever treatment: Quick guide to treating a fever".Mayo Clinic.Archivedfrom the original on 2013-11-15.
- ^"Fever".MedlinePlus Medical Encyclopedia.
- ^Kupferschmidt, Kai (2014-01-21)."Fight the Flu, Hurt Society?".Science.Archivedfrom the original on 2023-02-12.
- ^"Fever in infants and children: Pathophysiology and management".
- ^Sullivan, J. E.; Committee On, H. C.; Sullivan, J. E.; Farrar, H. C. (2011)."Fever and Antipyretic Use in Children".Pediatrics.127(3): 580–587.doi:10.1542/peds.2010-3852.PMID21357332.
- ^abcCryer B, Feldman M (May 1998). "Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs".Am J Med.104(5): 413–21.doi:10.1016/s0002-9343(98)00091-6.PMID9626023.
- ^Hawley SA, Fullerton MD, Ross FA, Schertzer JD, Chevtzoff C, Walker KJ, et al. (May 2012)."The ancient drug salicylate directly activates AMP-activated protein kinase".Science.336(6083): 918–22.Bibcode:2012Sci...336..918H.doi:10.1126/science.1215327.PMC3399766.PMID22517326.
- ^Madden CJ, Tupone D, Cano G, Morrison SF (January 2013)."α2 Adrenergic receptor-mediated inhibition of thermogenesis".J Neurosci.33(5): 2017–28.doi:10.1523/JNEUROSCI.4701-12.2013.PMC3711400.PMID23365239.
- ^Mokhtari M, Sistanizad M, Farasatinasab M (January 2017). "Antipyretic Effect of Clonidine in Intensive Care Unit Patients: A Nested Observational Study".J Clin Pharmacol.57(1): 48–51.doi:10.1002/jcph.776.PMID27264198.S2CID3741978.
- ^Petitjeans F, Leroy S, Pichot C, Geloen A, Ghignone M, Quintin L (2018)."Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome?".Temperature (Austin).5(3): 224–256.doi:10.1080/23328940.2018.1453771.PMC6209424.PMID30393754.
- ^Reducing Fever in Children: Safe Use of Acetaminophen
- ^Meremikwu M, Oyo-Ita A (2002). Meremikwu MM (ed.)."Paracetamol for treating fever in children".The Cochrane Database of Systematic Reviews.2002(2): CD003676.doi:10.1002/14651858.CD003676.PMC6532671.PMID12076499.
Trial evidence that paracetamol has a superior antipyretic effect than placebo is inconclusive.
- ^E. Michael Sarrell, MD; Eliahu Wielunsky, MD; Herman Avner Cohen, MD (2006)."Antipyretic treatment in young children with fever: acetaminophen, ibuprofen, or both alternating in a randomized, double-blind study".Archives of Pediatrics & Adolescent Medicine.160(2): 197–202.doi:10.1001/archpedi.160.2.197.PMID16461878.
- ^Kauffman, Ralph; Sawyer, L.A.; Scheinbaum, M.L. (1992). "Antipyretic Efficacy of Ibuprofen vs Acetaminophen".American Journal of Diseases of Children.146(5): 622–625.doi:10.1001/archpedi.1992.02160170102024.PMID1621668.
- ^CDC Study Shows Sharp Decline in Reye's Syndrome among U.S. ChildrenArchivedNovember 15, 2014, at theWayback Machine
- ^Reye's syndrome - Prevention
- ^Schultes, Richard Evans; Raffauf, Robert F. (1994). "De Plantis Toxicariis e Mundo Novo Tropicale Commentationes XXXIX Febrifuges of northwest Amazonia".Harvard Papers in Botany.1(5): 52–68.ISSN1043-4534.JSTOR41761491.
