How to choose acetaminophen or other NSAIDs when patient has a cold and fever?😷😷😷

Common cold symptoms are mainly nasal congestion, runny nose, sneezing, coughing and so on. It may also have a sore throat, muscle pain or fever. Clinical treatment is generally aimed at the symptoms and to relieve its symptoms. The following will introduce the dosage and precautions of commonly used antipyretic analgesics.

1. Acetaminophen.

It is an aniline compound. It inhibits prostaglandin synthesis and release in the central nervous system. It is a selective cyclooxygenase-2 (COX-2) inhibitor, which has antipyretic and analgesic effects. Because it selectively inhibits COX-2, it has no significant gastrointestinal irritation. Its oral absorption is rapid and complete. Its metabolic pathway occurs mainly in the liver. It is combined with glucuronic acid in the liver and excreted in the urine.

Dosage and contraindications:

When having pain or fever, children over 12 years and adults take 500mg each time. If the pain or fever does not go away, take another tablet 4-6 hours later. Do not take more than 4 times a day. 

Patients allergic to acetaminophen are contraindicated. To prevent overdose, it should not be taken with other medicines that also contain acetaminophen.

Adverse effects:

When acetaminophen is taken correctly, side effects such as liver and kidney toxicity are less likely to occur. It is also a very safe antipyretic and analgesic drug for pregnant women. The FDA's pregnancy drug classification is Class B.

2. Diclofenac.

Diclofenac is a fenamic acid compound. It is a strong NSAID. It changes the release and uptake of fatty acids. It causes the concentration of free arachidonic acid in leukocytes reducing. 

Dosage and contraindications:

Its recommended dose is 25 mg 1 to 2 times a day after meals.

It is not suitable for children under the age of 16 or breastfeeding women. Pregnant women are forbidden to use it. It should not be used in patients with a history of allergy to aspirin, diclofenac or other NSAIDs, peptic ulcers, urticaria, asthma or other allergies.

Adverse effects:

Gastrointestinal reactions such as epigastric discomfort, gastric bleeding, gastric perforation, etc. are common adverse reactions of diclofenac. It should be used with caution in the elderly or patients with liver and kidney dysfunction. Diclofenac can penetrate the placenta, so it is forbidden for pregnant women.

3. Aspirin.

Aspirin is a salicylic acid compound. Under its action, the hypothalamus thermoregulatory center causes peripheral blood vessels to dilate, increase blood flow to the skin, and sweat. This will increase the body's heat dissipation to achieve antipyretic effect. It also inhibits the synthesis of prostaglandins and other substances that make pain sensitive to external stimuli. It is a peripheral analgesic drug.

Dosage and contraindications:

The recommended dose of aspirin is 50 to 150 mg daily in 1 to 2 divided doses.

Aspirin is contraindicated in patients with aspirin allergy, asthma, hemophilia, thrombocytopenia, peptic ulcer with bleeding symptoms, or other active bleeding. Aspirin is not recommended for use in children, pregnant and breastfeeding women unless directed by a doctor.

Adverse effects:

Since aspirin also inhibits COX-1 and reduces prostaglandin synthesis, it can induce or exacerbate the risk of gastrointestinal ulcers and bleeding. Allergic reactions such as angioedema, asthma, and urticaria also occur in patients with  idiosyncrasy. Use aspirin for flu or chickenpox in children. It may cause Reye's syndrome. It can cause severe encephalopathy and liver damage. Therefore, it is not used to treat colds in children.

4. Indomethacin.

Indomethacin is an indole derivative. It has a strong inhibitory ability on COX, but it is not selective and it inhibits COX-1 and COX-2.

Dosage and contraindications:

Indomethacin is 6.25 to 12.5 mg each time for antipyretic. It should not be taken more than 3 times a day.

Indomethacin is contraindicated in patients allergic to indomethacin, urticaria after taking other NSAIDs or aspirin, asthma or other allergies, undergoing coronary artery bypass grafting, pregnant and lactating women. It is also not suitable for children under the age of 14.

Adverse effects:

Its most common adverse reactions are central nervous system reactions. In addition, gastrointestinal reactions, asthma, skin and mucous membrane allergies also occur. Its incidence of adverse reactions is high. If treatment with indomethacin is required, the lowest dose that can achieve efficacy should be used under the guidance of a doctor.

Medication guidelines for special populations.

Children: The WHO recommended antipyretics for children worldwide are acetaminophen and ibuprofen. In addition, it is not recommended to use the two in combination or alternately for antipyretic in children. Routine use of acetaminophen to prevent fever in children before and after vaccination is also not recommended.

Pregnant: On the basis of physical cooling, water supplementation and corresponding treatment, acetaminophen can be used to reduce fever. Other antipyretics should be avoided.

Patients with gastrointestinal ulcers or a history of gastrointestinal bleeding: For them, acetaminophen is relatively safe. Aspirin and NSAIDs are not recommended. They can irritate the gastrointestinal mucosa and have the risk of gastrointestinal bleeding.

Patients with cardiovascular and cerebrovascular disease: Most of them will need to take aspirin as a preventive medicine. Therefore, it is not recommended to use NSAIDs and is recommended to use acetaminophen.

Elderlies: Be aware of the medications they are taking to avoid interactions. In the absence of clear contraindications, normal doses may be considered.

During the antipyretic period, all patients should be adequately hydrated to avoid the risk of shock. Generally, the symptoms will disappear or improve after 1 week of treatment, otherwise you should seek medical attention in time.