What is the difference between acetaminophen and ibuprofen?👀👀👀

Acetaminophen and ibuprofen are very commonly used antipyretic and
analgesic drugs in clinical practice. However, their chemical structure, intensity of action and adverse reactions will differ. Will there be any difference in clinical use?

Difference in effectiveness of acetaminophen and ibuprofen.

The analgesic and antipyretic effect of ibuprofen is slightly stronger than that of acetaminophen, and its duration is also longer (ibuprofen <183 minutes, acetaminophen <134 minutes). However, ibuprofen takes a slightly slower onset of action. Patients will experience a more significant decrease in body temperature within 30 minutes of taking acetaminophen than ibuprofen. Both of them can be used to treat headaches, migraines, toothaches, muscle pain, dysmenorrhea (ibuprofen is more effective), and osteoarthritis (ibuprofen is more effective). However, acute attacks of gout and rheumatoid arthritis can only be treated with ibuprofen. Neither of them can be used to treat abdominal pain. In terms of effectiveness alone, ibuprofen is superior to acetaminophen.

Comparison of the safety of acetaminophen and ibuprofen.

Acetaminophen: Excessive doses of acetaminophen can cause life-threatening liver failure. Patients who are dehydrated or malnourished also have an increased risk of liver damage. It is less damaging to the gastrointestinal tract. It is contraindicated in patients with viral hepatitis and favismia. It should be used with caution in patients with renal insufficiency, active peptic ulcer, or aspirin allergy. Acetaminophen may also be used during pregnancy and in patients with severe heart failure.

Ibuprofen: It can cause irreversible damage to the kidneys. Overdose or use while dehydrated may increase a patient's risk of kidney damage. It also increases the risk of myocardial infarction and cerebral infarction. Although it can also cause gastrointestinal bleeding, ulceration, and perforation, the risk is lower than other NSAIDs. Ibuprofen is contraindicated in patients with renal insufficiency, active peptic ulcer, severe heart failure, pregnancy, and aspirin allergy. However, it can be used in patients with viral hepatitis and favismia.

Precautions when using acetaminophen and ibuprofen.

Acetaminophen: It can be used in children older than 3 months and can be taken before meals. The maximum daily dose for children is 15 mg/kg and for adults it is 2 g/day, once every 4 to 6 hours, and should not be taken more than 4 times a day. Alcohol and other hepatotoxic drugs can worsen liver damage when combined with acetaminophen. Acetaminophen is occasionally used concomitantly with coumarin anticoagulants without significant effects.

Ibuprofen: It can be used in children older than 6 months, with or after meals. The maximum daily dose for children is 10mg/kg and for adults it is 1.2g/day, once every 6 to 8 hours, and should not be taken more than 4 times a day. When ibuprofen is combined with alcohol, it can aggravate gastrointestinal damage. When used together with antihypertensive drugs, it will also reduce the antihypertensive effect. It may also reduce the effectiveness of low-dose aspirin in preventing cardiovascular disease and stroke. Other nephrotoxic drugs may worsen kidney damage when used with ibuprofen. When anticoagulant drugs such as heparin and dicoumarol are used together with it, it will prolong the prothrombin time and increase the risk of bleeding.

Conclusion.

For children, the elderly over 60 years old, and patients with multiple underlying diseases (except those with liver dysfunction), it is recommended to use acetaminophen first.

For patients who require long-term medication and those with arthritis, it is recommended to give priority to ibuprofen (because acetaminophen has no anti-inflammatory effect).

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What is methotrexate?😵😵😵

Methotrexate is a drug that can be used to treat both cancer and non-cancer. It prevents cell division and the production of new cells. It can be used to prevent rejection in patients following bone marrow or stem cell transplants. It is also used to treat psoriasis and rheumatoid arthritis.

What are the indications and doses of methotrexate?

Methotrexate is a metabolic inhibitor of folic acid analogues. Dihydrofolate reductase will be inhibited by it and interfere with DNA synthesis, cell repair and replication. It is generally more sensitive to actively proliferating tissues such as malignant cells, bone marrow, fetal cells, oral cavity cells, intestinal mucosal cells, and bladder cells. It is mainly suitable for the treatment of hematological malignancies, solid tumors, psoriasis and various arthritis.

Treatment of adult hematological malignancies:

• Various acute leukemias (especially acute lymphoblastic leukemia), non-Hodgkin lymphoma, malignant lymphoma and mycosis fungoides, multiple myelopathy.
• Intrathecal methotrexate can be used to prevent and treat neural invasion of meningeal leukemias and malignant lymphomas.
• Methotrexate is used in combination with other chemotherapy drugs for the palliative treatment of acute leukemias, especially acute lymphoblastic leukemia. It is also used to treat Burkitt's lymphoma, coronal lymphosarcoma and mycosis fungoides.
• High-dose methotrexate is used to treat non-Hodgkin's disease subtypes but must be combined with rescue therapy with leucovorin.
• Oral administration: Adults take 1 to 2 days a week, once a day, 5 to 10 mg each time. The safe dosage for a course of treatment is 50 to 100 mg. Its maintenance dose for acute lymphoblastic leukemia is 15 to 20 mg/m² once a week.

Treatment of various solid tumors in adults including head and neck cancer, lung cancer, various soft tissue sarcomas, breast cancer, ovarian cancer, cervical cancer, malignant mole, chorioepithelial cancer, and testicular cancer. Commonly used oral tablet dosages are as follows:

• Adults take it orally 1 to 2 days a week, once a day, 5 to 10 mg each time. The safe dose for a course of treatment is 50 to 100 mg.

For the treatment of rheumatoid arthritis in adults. Common dosages are as follows:

• Rheumatoid Arthritis: 7.5 to 15 mg orally once weekly, with the highest dose being 25 mg once weekly. The dose of methotrexate should be reduced when used in combination with other immunosuppressants.
• Psoriatic Arthritis: 15 to 20 mg orally once weekly.
• Peripheral arthritis in ankylosing spondylitis: 7.5 to 10 mg orally once weekly.

Methotrexate is also used to treat severe, refractory and disabling psoriasis in adults who are unresponsive to conventional treatments. Commonly used injectable dosage forms.

What is the pharmacological mechanism of methotrexate?

Its main mechanism of action is to competitively inhibit folate reductase. Folic acid is reduced to tetrahydrofolate by folate reductase during DNA synthesis and cell replication. Folate reductase is inhibited by methotrexate, which interferes with cell replication. Methotrexate is a cell cycle-specific drug and acts primarily on cells during the DNA synthesis phase. 

Tissues and cells with active proliferation such as bladder cells, bone marrow, embryonic cells, intestinal mucosal cells, malignant tumor cells, oral cells, and skin epithelial cells are generally more sensitive to the effects of methotrexate. In addition, most normal tissues proliferate more slowly than malignant tumor tissues, so methotrexate will preferentially weaken the growth of malignant tumors. The skin epithelial cells of patients with psoriasis also have a greater ability to proliferate than normal skin cells, so methotrexate can also be used to control the progression of psoriasis. 

One of the important coenzymes in the synthesis of pyrimidine deoxynucleotides and purine nucleotides in the human body is tetrahydrofolate. Methotrexate is a folate reductase inhibitor. It inhibits dihydrofolate reductase and prevents dihydrofolate from being reduced to active tetrahydrofolate. This blocks the transfer of carbon groups during the biosynthesis of pyrimidine deoxynucleotides and purine nucleotides. DNA biosynthesis will be inhibited. In addition, although methotrexate also inhibits thymus nucleotide synthase, its inhibitory effect on protein and RNA synthesis is weak. It mainly acts in the S phase of the cell cycle. It is a cell cycle specific drug. It also delays cells in the G1/S phase, but the effect is weaker.

What are the common side effects of methotrexate?

Blood and Lymphatic System: Myelosuppression, pancytopenia, agranulocytosis, granulocytopenia, anemia, leukopenia, aplastic anemia, neutropenia, thrombocytopenia, lymphopenia.

Cardiovascular system: palpitations, tachycardia, increased blood pressure.

Gastrointestinal system: nausea, vomiting, oral ulcers, abdominal pain, diarrhea, oral mucositis, oropharyngeal pain, abdominal distension, acid reflux, gastrointestinal bleeding, lip ulcers, indigestion, blood in the stool, flatulence, dry mouth, oral bleeding, Belching, tongue ulcers, dysphagia, bleeding gums, peptic ulcers, melena, anal ulcers, and tongue pain.

Hepatobiliary system: abnormal liver function, liver cell damage, liver damage, hepatitis, jaundice, liver failure.

Immune system: Hypersensitivity reactions, anaphylactoid reactions, graft-versus-host disease.

Infections: infectious pneumonia, cytomegalovirus infection, fungal infection, herpes virus infection, sepsis, herpes zoster, Epstein-Barr virus infection.

Kidney and urinary system: renal damage, hematuria, hemorrhagic cystitis.

Nervous system: dizziness, headache, hypoesthesia, tremor.

Respiratory system: cough, dyspnea, pneumonia, pharyngitis, interstitial lung disease, pulmonary fibrosis, respiratory failure.

Skin and subcutaneous tissue: rash, pruritus, alopecia, erythema, skin ulcers, ecchymosis, erythema multiforme, maculopapular rash, vesicular rash, papules, erythematous eruption, urticaria, peeling, dermatitis, pruritic rash, purpura, Petechiae, exfoliative dermatitis, skin erosions.

Systemic reactions: fatigue, fever, mucosal ulcers, chest tightness, pain, chills, mucosal erosion, chills, facial edema, high fever, peripheral edema.

Others: loss of appetite, appetite disorder, joint pain, irregular menstruation, blurred vision, visual impairment, flushing, tinnitus.

Adverse effects of methotrexate can be prevented by using low-dose folic acid, but it should be used 24 hours after the patient takes the drug. It is recommended that patients supplement 5mg of folic acid every week to reduce gastrointestinal adverse reactions and liver function damage. Leucovorin and levofolinic acid are antidotes for methotrexate overdose. Patients with methotrexate overdose should be given an antidote as soon as possible and should undergo hydration and alkalinization of the urine.

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What should patients pay attention to when taking aspirin for a long time?📝📝📝

Aspirin is a classic and commonly used antithrombotic drug. In clinical, its application is very extensive. It can be used to prevent and treat cerebral thrombosis, cardiopulmonary infarction, angina pectoris, ischemic heart disease, etc. It plays an important role in the prevention of primary and secondary cardiovascular disease. Therefore, aspirin needs to be taken by many patients for a long time. The best results for these patients can only be achieved by taking aspirin correctly. The following will tell about the correct way to take aspirin.

When is it better to take aspirin?

Is it better for patients to take aspirin in the morning, noon, or evening? Some experts pointed out that there is controversy about the time of taking aspirin in the current research. Studies have shown that platelet activity increases in the morning. Therefore, from six o'clock to twelve o'clock in the morning is the high incidence time of cardiovascular events, so patients are advised to take aspirin in the morning. However, other studies have suggested that patients take aspirin at night to lower their blood pressure better, so they are advised to take it at night. In fact, the mechanism of action of aspirin is that the peak blood levels of the drug are not reached until several hours after taking the drug. Its antiplatelet effect can also last for several days after repeated administration. Therefore, whether aspirin is taken in the morning or in the evening, its antiplatelet effect persists after repeated doses. Therefore, it is generally more important to recommend that patients take aspirin regularly for a long time.

Different dosage forms of aspirin have different doses.

Different dosage forms of aspirin have different effects when taken before or after meals. If a patient is taking aspirin as a regular tablet, this dosage form causes it to be broken down in the stomach. Therefore, this form of aspirin should be taken after meals to reduce its damage to the gastric mucosa. If a patient is taking aspirin as an enteric-coated tablet, it will only dissolve in alkaline intestinal fluids and not in acidic gastric fluids. Taking this form of aspirin after meals can delay its absorption. Moreover, the alkaline content of food may cause the enteric-coated tablet to dissolve in the stomach and cause damage to the gastric mucosa. Therefore, it recommends that enteric-coated tablets should be taken 30 to 60 minutes before meals.

Patients should avoid missing to take aspirin.

Missed doses occasionally occur in patients taking long-term medication. What are the effects of missing an aspirin? Although the activity of existing platelets can be effectively inhibited by a single low-dose aspirin, the human body generates 10-15% of platelets every day. Therefore, patients need to take regular daily aspirin to keep these new platelets suppressed. If the patient occasionally misses an aspirin, it has little effect on the antithrombotic effect. However, frequent missed doses increase the risk of blood clots. It is recommended to take the medicine at a fixed time each day to avoid missed doses. If the patient misses a dose and is close to the next dose, there is no need to make up the dose and do not double the dose to avoid increasing adverse reactions. If the patient misses a dose and it is long before the next dose, make up the dose immediately.

Do not drink alcohol while taking aspirin.

First, the activity of an alcohol metabolizing enzyme (alcohol dehydrogenase) is inhibited by aspirin. It slows the metabolism of alcohol and causes more alcohol to accumulate in the body. Alcohol intoxication can become more likely. In addition, alcohol also increases the risk of gastric mucosa and liver damage. Therefore, alcohol should be avoided while taking aspirin. If the patient must drink alcohol, the patient should separate the medication time and alcohol consumption to reduce the interaction between the two.

Who is more likely to experience gastrointestinal adverse reactions when taking aspirin?

The patient's medication compliance is often affected by the adverse reactions of the medication. If a patient develops stomach pain after taking aspirin, it is easy for them to stop taking the drug. Digestive tract adverse reactions are more likely to occur in patients with a history of smoking and drinking, taking high-dose aspirin, taking anticoagulants at the same time, age > 65 years, or previous history of gastrointestinal diseases. These patients may need to take stomach-protecting drugs to reduce the occurrence of gastrointestinal adverse reactions.

Patients who develop aspirin resistance should be reassessed and adjusted their medication.

Aspirin resistance refers to the inability of patients to prevent blood clots after taking aspirin. When this occurs, the patient needs to be reassessed and assessed for factors that affect the efficacy of aspirin. Such as blood pressure, blood sugar, blood lipids are not effectively controlled. Does the patient take medication regularly? Are there any interactions between other drugs (such as NSAIDs) and aspirin? If the patient does not have the above factors, consider increasing the aspirin dose or switching to other antiplatelet drugs.

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Drink enough water when taking these drugs.💧💧💧

In general, almost all medicines are taken with water. However, the amount of drinking water is various when taking different medicines. There are some medicines require drinking a lot of water. Most of medicines taken by the human body are eliminated by the kidneys. Drinking plenty of water when taking medicines can reduce the burden on the kidneys, excrete toxins and enhance metabolism of medicines. The following types of drugs should be noted to drink a lot of water when taking:

1. Antipyretic and analgesic

When you have a cold and you are taking antipyretic and analgesics, you should drink more water. Your urine output should not be less than 1.5 liters per day. You should pay more attention when you have a high fever or in summer. First of all, since these drugs can irritate the stomach at high concentrations, this irritation can be reduced by drinking more water. In addition, drinking water during a cold helps the body to urinate a lot to metabolize toxins in the body. Finally, antipyretic drugs have the effect of reducing fever and sweating occurs during the process of reducing fever. When sweat evaporates, it can take away a large amount of body temperature and water, thereby returning body temperature to normal. It is necessary to properly supplement water. If you drink too little water, it is not conducive to sweating and reducing fever. It will also cause collapse because the body's water is not replenished in time.

2. Antibacterial drugs

Aminoglycoside antibiotics: such as amikacin, gentamicin, etc. Aminoglycoside antibiotics are highly toxic to the kidneys. The higher the concentration, the greater damage to the renal tubules. Therefore, it is advisable to drink more water to dilute and accelerate the excretion of the drug.

Sulfonamide antibacterial drugs: Sulfonamide drugs and their metabolites are mainly excreted through the kidneys. Sometimes they precipitate out from the urine and form crystals, causing low back pain, proteinuria and hematuria. In severe cases, the crystals can block the urinary tract and obstruct urine excretion. Drinking a lot of water can increase urine output and reduce the concentration of drugs in the urine. It can also combine with some drugs that can alkalize urine at the same time, such as sodium bicarbonate, to avoid precipitation of crystals and damage the kidneys.

Quinolone antibacterial drugs: such as levofloxacin, ciprofloxacin, etc., are mainly excreted through the kidneys. Crystal urine may occur when large doses of fluoroquinolones are used or the urine pH is above 7. In order to avoid the occurrence of crystal urine, you should drink more water and maintain a 24-hour urine output above 1200ml.

3. Antiviral drugs

Antiviral drugs such as acyclovir and famciclovir can cause crystalline renal failure. Therefore, it is advisable to drink more water during the medication period, especially the elderly. Due to the decline of physiological renal function, the dosage should be reduced. Combined use with zidovudine can cause nephrotoxicity. It manifests as fatigue, deep lethargy. It also competitively inhibit the secretion of organic acids with probenecid, which can slow down the excretion of this class of drugs. It will accumulate the amount of drugs in the body.

4. Anti-gout drugs

When you are taking anti-gout drugs such as benzbromarone, allopurinol, etc., you should drink more water and ensure that the drinking amount is not less than 2 liters. It can reduce the irritation to the digestive tract. At the same time, enough water can alkalize the urine to prevent the formation of stones in the urinary tract during the excretion of uric acid.

5. Bisphosphate

Bisphosphonates such as alendronate sodium, clodronate disodium, etc. In the treatment of hypercalcemia, bisphosphonates can cause electrolyte disturbance and water loss. Therefore, you should pay attention to supplement body fluids and make the daily urine output reaching more than 2000ml. Bisphosphonates are also very irritating to the gastrointestinal tract. Drinking plenty of water when taking it can help reduce the irritation of bisphosphonates to the gastrointestinal tract. In addition, it is not advisable to lie down immediately after taking the medicine and keep the upper body upright for at least 30 minutes (Ibandronate should keep the upper body upright for 60 minutes).

👉In addition to drinking plenty of water when taking these drugs, you should also drink enough water at ordinary times.

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