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DRUGS FOR PAIN and FEVER: ( Analgesic/Antipyretics)

Aspirin
Indication:
- Prophylaxis of thromboemobolic disorders in preventing myocardial infarction and
transient ischemic attacks.

- Provides quick relief of headache, rheumatism, muscular pains, toothache, neuralgia,


periodic pains

- Reduces fever and discomforts in colds and flu.

Dosing Information:
(TAKEN WITH FOOD)
=ADULT=
- 100mg tab (Prophylaxis of thromboembolic disorders) 1 tab daily
- 300mg tab (Pain) 1 to 2 tabs. Repeat after 3 to 4 hours, as needed.
=CHILDREN=
- (>5y/o) 1 tablet
- (3 to 5 y/o) 1/2 tablet
***Repeat if necessary BUT is not taken >3 times daily.

Contraindications:
- History of salicylate-induced asthma.
- Active peptic ulcers
- Hemorrhagic diathesis
- severe renal or cardiac failure
- Combination with methotrexate at doses of > or = 15mg/week

Special Precautions:
- Renal disorders
- G6PD deficiency
- Patients with flu, chicken pox, or hemorrhagic fever, GI ulceration or asthma
- Pregnant women close to delivery.

Side effects/ Adverse Reactions:


- Gastric hemorrhage
- Hypersensitivity
- Thrombocytopenia
Drug Interactions:
- Methotrexate
- Anticoagulants
- Thrombolytics and other anti platelets
- Uricosuric drugs
- Digoxin
- Antidiabetics
- Diuretics
- systemic glucocorticoids EXCEPT Hydrocortisone
- ACE inhibitors
- Valproic acid
- Alcohol

Brand Names in the Philippines:


Bayer

Paracetamol
Indication:
- Mild to moderate pain and fever.

Dosing Information:
(MAY BE TAKEN WITH OR WITHOUT FOOD)
=Oral=
ADULT
0.5-1g taken every 4 to 6 hours.
MAX: 4g/day
CHILDREN
Given every 4 to 6 hours, if necessary.
MAX DOSE: 4 doses in 24 hours.
3 to <6 months: 60mg
6 months to 2 years: 120mg
2 to <4 y/o: 180mg
4 to <6 y/o: 240mg or 250mg
8 to 10 y/o: 360mg or 375mg
10 to <12 y/o: 480mg or 500mg
12 to 16 y/o: 480 or 750mg
=Rectal Suppository=
ADULT
0.5-1g given every 4 to 6 hours.
MAX: 4g/day
CHILDREN
Given every 4 to 6 hours, if necessary.
3 months to <1 y/o: 60mg to 125mg
1 to <5y/o: 125mg to 250mg
5 to 12y/o: 250mg to 500mg
=Intravenous=
ADULT
33-50kg: 15mg/kg as a single dose, every 4 hours
MAX: 60mg/kg/day up to 3g/day
>50kg: 1g as a single dose, at least every 4 hours
MAX: 4g/day.
CHILDREN
<10kg: 7.5mg/kg as a single dose, at least every 4 hours
MAX: 30mg/kg/daily
10-33kg: 15mg/kg as a single dose, every 4 hours.
MAX: 60mg/kg up to 2g/day
>33-50kg: 15mg/kg as a single dose at least every 4 hours
MAX: 60mg/kg up to 3g/day
**Administer by infusion over 15 minutes.

Contraindications:
N/A

Special Precautions:
- Patient with chronic alcoholism, known G6PD deficiency, severe hypovolemia, chronic
malnutrition.
- Renal and hepatic impairment.
- Pregnancy and lactation

Side effects/Adverse Reactions:


- Thrombocytopenia
- Leucopenia
- Pancytopenia
- Neutropenia
- Agranulocytosis
- Pain and burning sensation at injection site
- RARE: Hypotension and Tachycardia

Drug interactions:
- May reduce serum levels with anticonvulsants (ex. phenytoin, barbiturates,
carbamazepine).
- May enhance anticoagulant effect of warfarin and other coumarins with prolonged use.
- Accelerated absorption with metoclopramide and domperidone.
- May increase serum levels with probenecid.
- May increase serum levels of chloramphenicol.
- May reduce absorption with colestyramine within 1 hour of administration.
- May cause severe hypothermia with phenothiazine.

Brand Names Available in the Philippines:


Biogesic, Tempra, Calpol, Aeknil

Ibuprofen
Indication:
- Management of mild to moderate pain and inflammation in conditions (ex.
dysmenorrhea, headache including migraine, post-op and dental pain, musculoskeletal
and joint disorders (ex. ankylosing spondylitis, osteoarthritis and rheumatoid arthritis
including juvenile idiopathic arthritis, peri-articular disorders (ex. bursitis and
tenosynovitis and soft tissue disorders (ex. sprains and strains).

- Reduction of fever.

Dosing information:
(TAKEN WITH FOOD)
=Softgel=
ADULT
- 200 to 400mg every 4 to 6 hours.
MAX: 1200mg/day.

Contraindications:
- Hypersensitivity to aspirin or to other NSAIDs.
- Concurrent or previous history of GI ulcer or bleeding.
- Last trimester of pregnancy.
Special Precautions:
- Do not take >10days for pain OR >3 days for fever OR when severe allergic reaction
including skin reddening, rash or blisters develops.
- Discontinue use if pain or fever persists or gets worse, painful area is red or swollen,
bloody vomit or stool.
- Asthma
- Heart or kidney disease
- Liver cirrhosis
- Hypertension
- Concomitant use with other NSAIDs (ex. aspirin, acetaminophen).
- May increase risk of heart attack or stroke on long-term use.
- Pregnancy and lactation.
- Children <12 y/o.
- Elderly.

Side effects/ Adverse Reactions:


- Abdominal pain
- Diarrhea
- Nausea with or without vomiting
- GI bleeding
- Ulceration

Drug interactions:
- Other NSAIDs
- Anticoagulants
- Increased risk of GI bleeding with SSRIs.
- Increased plasma concentration of lithium.

Brand Names available in the Philippines:


Advil

Naproxen
Indication:
- Musculoskeletal and joint disorders (ex. anklosing spondylitis, osteoarthritis,
rheumatoid arthritis including juvenile idiopathic arthritis.
- Dysmenorrhea
- Headache including migraine
- Post-op pain
- Soft tissue disorders
- Acute gout
- Reduce fever

Dosing Information:
(TAKEN WITH FOOD)
=Rheumatic disorders=
550mg to 1100mg daily as single or in 2 divided doses
=Acute gout=
Initially 550mg followed by 275mg every 6 to 8 hours.
MAX: 1375mg/day after the 1st day.
=Juvenile idiopathic arthritis=
CHILDREN
>5 y/o: 11mg/kg body weight daily in 2 divided doses

Contraindication:
- Hypersensitivity to naproxen, ASA or any other NSAIDs.
- Stroke (CVA)
- Heart attack (MI)
- CABG
- Uncontrolled hypertension
- CHF (NYHA II-IV).
- Active peptic ulceration
- Pregnancy

Special Precautions:
- Patients with cardiac, liver, and renal diseases/impairment
- Infection, asthma, allergic and hemorrhagic disorders
- History of peptic ulceration
- Monitor for development of blood, kidney, or eye disorders.
- May interfere with thyroid function test
- Elderly.

Side effects/Adverse Reactions:


- GI discomfort
- Nausea
- Diarrhea
- Headache
- Vertigo
- Dizziness
- Nervousness
- Tinnitus
- Depression
- Drowsiness
- Insomnia
- Anemia
- Thrombocytopenia
- Neutropenia
- Eosinophilia
- Agranulocytosis
- Nephrotoxicity
- Hematuria

Drug Interactions:
- Enhanced effects of oral anticoagulants, phenytoin and sulfonylurea anti diabetics.
- Increased plasma concentration of lithium, methotrexate and cardiac glycosides.
- Increased risk of nephrotoxicity (w/ ACE inhibitors, cyclosporin, tacrolimus, or diuretics)
- Hyperkalemia (with K-sparing diuretics)
- GI bleeding/ulceration (w/ corticosteroid or possibly, alcohol, bisphosphonates or
pentoxifylline)
- Hemotoxity (w/ zidovudine).
- Reduced effects of antihypertensives (ex. Beta blockers).
- Risk of convulsion with quinolones.
- Enhanced effect by moclobemide.
- Other NSAIDs including aspirin.
- Increased plasma concentration with probenecid.

Brand Name available in the Philippines:


Pharex

Ketoprofen
Indication:
- For Rheumatic disorders, pain and inflammation, pain and inflammation associated
with musculoskeletal and joint disorders, pain following orthopedic surgery, rectal
rheumatic disorders, and topical pain relief. Fever reducer.

Dosing Information:
(TAKEN WITH FOOD)
=IM=
Pain and inflammation associated with musculoskeletal and joint disorders, pain
following orthopedic surgery:
ADULT
50-100mg by deep injection into the gluteal muscle every 4 hours.
MAX: 200mg in 24 hours for up to 3 days.
=Oral=
Rheumatic disorders:
ADULT
100-200mg/day in 2 to 4 divided doses.
MAX: 300mg/day in divided doses. As modified-release formulation: Administer dose
once daily.
ELDERLY
>75 y/o: Reduce initial dose.
=Topical/Cutaneous=
Local Pain relief:
ADULT
As 2.5% gel: Apply onto affected areas 2-4 times daily for up to 10 days.
As 30mg plaster: Apply 1 plaster twice daily.

Contraindications:
- For all routes: Hypersensitivity to aspirin or other NSAIDs or those suffering from
asthma, angioedema, urticaria, or rhinitis.
- Active GI disease (ex. bleeding or ulcer)
- Severe heart failure and renal insufficiency
- Treatment of preoperative pain in the setting CABG surgery.
- Patients with history of proctitis or haemorrhoids

Special Precautions:
- History of GI disease (ex. bleeding or ulcer).
- Hypertensive patients
- Renal or hepatic impairment
- Pregnancy and lactation
- Elderly.

Side effects/ Adverse Reactions:


- Hypertension
- GI symptoms (ex. dyspepsia, discomfort, nausea, diarrhoea)
- Pain and tissue damage at injection site (IM)
- Cardiovascular toxicity (chest pain, dyspnea, weakness, slurred speech)
- May mask the usual signs and symptoms of infection.
- NSAID-induced liver dysfunction
- Anaphylactoid reaction (ex. difficulty breathing, swelling of the face or throat)
- Photosensitivity reactions (topical)
- Potentially fatal: Anaphylaxis, exfoliative dermatitis, Steven-Johnson syndrome, toxic
epidermal necrolysis

Drug interactions:
- Increases plasma concentrations of lithium and methotrexate.
- Reduces effects of antihypertensives (ex. ACE inhibitors, angiotensin II receptor
antagonists).
- Increased risk of GI bleeding with warfarin.
- Decreased protein binding of ketoprofen and increased risk for serious GI events with
aspirin and other NSAIDs.
- Increased risk of developing renal failure with diuretics.
- Increased risk of GI bleeding and ulceration with corticosteroids.
- Increased plasma levels with probenecid.
- Salicylate reduces conjugation and renal elimination of ketoprofen.

Brand Name available in the Philippines:


Fastum Gel (topical)

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