The drug specialized in pain relief is paracetamol. Its beneficial effects are felt 30-60 minutes after administration. The analgesic effect lasts about 4-5 hours on a balanced, optimal for the body level. We owe painkilling to inhibiting the production of prostaglandin synthesis in the central nervous system (CNS) by blocking the enzyme-synthesizing pain - arachidonic acid cyclooxygenase. The drug also reduces the sensitivity of the pain receptors to the action of inflammation mediators such as: serotonin and kinins, which increases the pain threshold. The drug has analgesic and antipyretic effect, without an anti-inflammatory component. The addition of codeine and caffeine to the preparation with paracetamol enhances its analgesic effect and improves the patient's well-being.
General therapeutic indications of paracetamol
♦ Fever
♦ Painful menstruation
♦ Neuralgia
♦ Myofascial, bony and other pain.
♦ Pains of various origins of low or moderate severity, migraine pain, toothache, etc.
Safe for children
For reasons of efficiency and safety, paracetamol is the basic medicine for fighting pain for young children. It is almost unpolluted by young children - so it does not pose a threat to their kidneys and liver to the same extent as for adolescents and adults. Generally, however, it is not allowed to exceed the daily dose of 4 grams, because paracetamol metabolites are toxic and threaten the liver and kidneys. The failure of these organs is a contraindication to taking paracetamol.
Safe for the stomach
Paracetamol is safe for ulcers and those who are treated with anticoagulants. It does not damage the gastric mucosa, it does not inhibit platelet aggregation and coagulation system.
An adverse reaction
Side effects are rare. These include cutaneous allergic reactions (urticaria, erythema, rash, pruritus, dermatitis, purpura pigmentosa); gastrointestinal disorders: nausea, vomiting, diarrhea. However, when used in high doses or long-term, it may impair the function of the liver or kidneys!
How fast does it work?
After oral administration, it is well absorbed from the gastrointestinal tract, reaching a maximum concentration in the blood after about 30-60 min. The maximum effect occurs after about 1 hour and lasts for 4-6 h. Paracetamol is metabolised in the liver. Metabolites are inactive and excreted in the form of glucuronides and sulphates in the urine.
Precommendations for the use of paracetamol
Do not give paracetamol to infants under 3 years of age. In addition, contraindication is hypersensitivity to paracetamol, severe hepatic failure, viral hepatitis, severe renal failure, alcoholism. When kidney failure occurs, paracetamol is in the blood and joining with proteins becomes toxic and damages the kidneys and liver. It must not be administered in the case of gallbladder and blood diseases. A very rare but important contraindication is the innate deficiency of blood cell enzymes - G-6-PD and methemoglobin reductase.
Interactions with other drugs
Increases the effect of central analgesics. It is forbidden to use with drugs that inhibit the breakdown of paracetamol in the liver - such as rifampicin, carbamazepine, phenobarbital, glutethimide, phenytoin, etc. - because the risk of liver damage increases. Do not combine with drugs from the group of non-steroidal anti-inflammatory drugs, because the risk of kidney damage increases. Used: with MAO inhibitors it can cause excitability and high fever. Increases the toxicity of chloramphenicol.A number of drugs such as cimetidine, metyrapone, probenecid, antipyrin, salicylamide, isoniazid, ranitidine, propranolol - significantly prolongs the duration of paracetamol in the body, which may cause overdose. The toxic effect of the drug is increased under the influence of alcohol.
Be careful!
The maximum daily dose of paracetamol for an adult should not exceed 4g in short-term treatment, and 2.5g in chronic therapy. Toxic effects of paracetamol may appear already at twice the daily maximum dose - therefore, it should be thoroughly checked using various complex analgesics - whether they also contain paracetamol and in what amount. Especially if you are suffering from liver or kidney failure. Paracetamol should be used with caution in pregnancy and breast-feeding, as well as in starved patients with bronchial asthma allergic to acetylsalicylic acid. It is not allowed to combine paracetamol with isoniazid, rifampicin and barbiturates. It exhibits serious interactions with most antiviral drugs.
Support for pain management
To support painkillers, in addition:
- sedatives,
- betamimetics, direct sprays and calcium channel blockers.
- less frequently used alternative treatments for headaches and other types of pain include acupuncture, acupressure, hypnosis and psychotherapy.
ed. Edward Ozga Michalski, MA
internal medicine consultation med. Ewa Pakuła internist
neurological consultation med. Tomasz Rosochowicz
Literature
1. "Menstrual pain and ways to fight it"; Dr Marek Marcyniak, gynecologist-obstetrician; II Chair and Clinic of Gynecology and Obstetrics at the Medical Academy in Warsaw, publ. Internet http://www.mediweb.pl/womens.
2. 30 years after the discovery of John Vane: what we know about the mechanisms of action of non-steroidal anti-inflammatory drugs
3. Drugs used in rheumatology and cardiovascular system - PhD. Biol., Lek. med. Ryszard Międzybrodzki1, med. Jerzy Świerkot, prof. dr hab. ed. Jacek Szechiński - Institute of Immunology and Experimental Therapy of the Polish Academy of Sciences in Wrocław; REUMATOLOGY - Trapia - MARCH 2005
4. "Oncology" - a textbook for students and physicians edited by Radzisław Kordek, Jacek Jassema, Maciej Krzakowski and Arkadiusz Jeziorski, Medical Press, Gdańsk, 2003
5. Encyclopedia of Practical Medicine ONLINE, PHARMINDEX
