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1.
Minerva Anestesiol ; 88(6): 448-456, 2022 06.
Article in English | MEDLINE | ID: covidwho-1789846

ABSTRACT

BACKGROUND: Postoperative pain relief remains a key problem after surgery. Multimodal pain therapy has proven beneficial in alleviating pain to a certain extent. However, when combining non-opioids, the focus has been on NSAIDs and paracetamol, but effects of combined use are only moderate. Metamizole could be a potent adjunct, due to its preclusion in several countries, data on its combined use are sparse, despite its common use in many countries. The aim of this study was to examine whether the combination of metamizole and ibuprofen is superior in relieving postoperative pain to either drug alone. METHODS: For this randomized, placebo-controlled, cross-over study, 35 patients undergoing bilateral lower third molar extraction were randomized. Each patient received three applications of 1000 mg metamizole + 400 mg ibuprofen for surgery on one side and either 1000 mg metamizole + placebo or 400 mg ibuprofen + placebo on the other side. Pain ratings, rescue-medication (tramadol), and sleep were assessed for 18 hours. RESULTS: The combined treatment of metamizole and ibuprofen showed lower mean pain scores over 12 hours than ibuprofen (2.4±1.3 vs 3.8±1.6; P=0.005). Further, combined treatment showed lower mean pain scores over 6 hours than ibuprofen (2.0±1.2 vs. 3.1±1.6; P=0.022) or metamizole alone (2.0±1.2 vs. 3.3±1.7; P=0.015). Consumption of rescue medication was lowest in the combination-group (25% vs. 46%-metamizole; 50%-ibuprofen). The trial was stopped prematurely as the COVID-pandemic halted elective surgeries. CONCLUSIONS: Combined use enables superior pain control compared to ibuprofen after molar extraction and tends to be superior to metamizole alone. The premature study-termination may overestimate this effect.


Subject(s)
COVID-19 , Ibuprofen , Analgesics/therapeutic use , Cross-Over Studies , Dipyrone/therapeutic use , Double-Blind Method , Humans , Ibuprofen/therapeutic use , Pain, Postoperative/drug therapy
2.
BMC Pediatr ; 22(1): 195, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-1785147

ABSTRACT

BACKGROUND: Literature on factors influencing medication adherence within paediatric clinical trials is sparse. The Paracetamol and Ibuprofen in the Primary Prevention of Asthma in Tamariki (PIPPA Tamariki) trial is an open-label, randomised controlled trial aiming to determine whether paracetamol treatment, compared with ibuprofen treatment, as required for fever and pain in the first year of life, increases the risk of asthma at age six years. To inform strategies for reducing trial medication crossovers, understanding factors influencing the observed ibuprofen-to-paracetamol crossovers (non-protocol adherence) is vital. The aim of this study was to investigate the factors influencing the decision-making process when administering or prescribing ibuprofen to infants that may contribute to the crossover events in the PIPPA Tamariki trial. METHODS: Constructivist grounded theory methods were employed. We conducted semi-structured interviews of caregivers of enrolled PIPPA Tamariki infants and healthcare professionals in various healthcare settings. Increasing theoretical sensitivity of the interviewers led to theoretical sampling of participants who could expand on the teams' early constructed codes. Transcribed interviews were coded and analysed using the constant comparative method of concurrent data collection and analysis. RESULTS: Between September and December 2020, 20 participants (12 caregivers; 8 healthcare professionals) were interviewed. We constructed a grounded theory of prioritising infant welfare that represents a basic social process when caregivers and healthcare professionals medicate feverish infants. This process comprises three categories: historical, trusting relationships and being discerning; and is modified by one condition: being conflicted. Participants bring with them historical ideas. Trusting relationships with researchers, treating clinicians and family play a central role in enabling participants to challenge historical ideas and be discerning. Trial medication crossovers occur when participants become conflicted, and they revert to historical practices that feel familiar and safer. CONCLUSIONS: We identified factors and a basic social process influencing ibuprofen use in infants and trial medication crossover events, which can inform strategies for promoting adherence in the PIPPA Tamariki trial. Future studies should explore the role of trusting relationships between researchers and treating clinicians when conducting research.


Subject(s)
Asthma , Ibuprofen , Acetaminophen/therapeutic use , Asthma/drug therapy , Fever/drug therapy , Grounded Theory , Humans , Ibuprofen/therapeutic use , Infant , Infant Welfare
3.
Drug Discov Ther ; 15(5): 278-280, 2021 Nov 21.
Article in English | MEDLINE | ID: covidwho-1542929

ABSTRACT

To help stop the coronavirus disease 2019 (COVID-19) pandemic, vaccines are currently the most critical tool. However, the COVID-19 mRNA vaccines frequently cause systemic side effects shortly after the injection, such as fever, headache and generalized fatigue. In our survey, after receiving the second dose of the COVID-19 vaccine, 80% developed fever, 62% headache and 69% generalized fatigue. Among people who required antipyretics, the average durations of fever and headache were significantly shorter in those who took non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, loxoprofen and ibuprofen, than those who took acetaminophen. In our patch-clamp studies, NSAIDs effectively suppressed the delayed rectifier K+-channel (Kv1.3) currents in T-lymphocytes and thus exerted immunosuppressive effects. Because of this pharmacological property, the use of NSAIDs should be more effective in reducing the vaccine-induced systemic side effects that are caused primarily by the enhanced cellular immunity.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 Vaccines/adverse effects , Immunosuppressive Agents/therapeutic use , Acetaminophen/therapeutic use , Adolescent , Aspirin/therapeutic use , Fatigue/drug therapy , Fatigue/etiology , Fever/drug therapy , Fever/etiology , Headache/drug therapy , Headache/etiology , Humans , Ibuprofen/therapeutic use , Patch-Clamp Techniques , Phenylpropionates/therapeutic use , Young Adult
7.
Orv Hetil ; 161(50): 2104-2106, 2020 12 13.
Article in Hungarian | MEDLINE | ID: covidwho-973207

ABSTRACT

Összefoglaló. A koronavírus-fertozés 2019 végén indult útjára, lassan a Föld teljes lakosságát eléro pandémiaként. Egy olyan kórokozóról van szó, amely ilyen nagy számú megbetegedést még nem okozott, ezért annak természetes lefolyásáról, a szövodmények kialakulásáról és a kezelési lehetoségekrol még keveset tudunk. Ennek következtében a kezdetben megjelent információk nagyon felületesek voltak, a következtetések nemritkán tévútra vezették mind az orvosokat, mind a betegeket. Az adatok gyarapodásával azonban egyre több kérdésre kapunk választ. Erre a folyamatra az egyik legreprezentánsabb példa az ibuprofén története, amely kezdetben tiltott, késobb turt terápiás szer volt, de ma már támogatott kezelési lehetoség a koronavírus-fertozésben. Orv Hetil. 2020; 161(50): 2104-2106. Summary. The coronavirus infection started in late 2019, as a pandemic slowly reaching the entire population of the earth. This pathogen has not yet caused such a large number of diseases, so little is known about its natural course, the development of complications, and treatment options. As a result, the information initially published was very superficial, and the conclusions often misled both physicians and patients. As the data grows, however, we get more and more questions answered. One of the most representative examples of this process is the history of ibuprofen, which was initially banned, thereafter tolerated, and is now a supported treatment option for coronavirus infection. Orv Hetil. 2020; 161(50): 2104-2106.


Subject(s)
Coronavirus Infections/drug therapy , Ibuprofen/adverse effects , Pneumonia, Viral/drug therapy , Humans , Ibuprofen/therapeutic use
8.
J Headache Pain ; 21(1): 38, 2020 Apr 25.
Article in English | MEDLINE | ID: covidwho-1021356

ABSTRACT

The world is currently dominated by the Corona Virus Disease 2019 (COVID-19) pandemic. Besides the obvious concerns about limitation of virus spread and providing the best possible care to infected patients, a concomitant concern has now arisen in view of a putative link between the use of certain drugs, such as Renin-Angiotensin System (RAS) inhibitors and ibuprofen, and an increased risk for COVID-19 infection. We here discuss this concern in relation to headache treatment and conclude that, based on current evidence, there is no reason to abandon treatment of headache patients with RAS inhibitors or ibuprofen.


Subject(s)
Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Coronavirus Infections/pathology , Headache/drug therapy , Ibuprofen/adverse effects , Pneumonia, Viral/pathology , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus , COVID-19 , Humans , Ibuprofen/therapeutic use , Pandemics , Peptidyl-Dipeptidase A/metabolism , Renin-Angiotensin System , Risk Factors , SARS-CoV-2 , Up-Regulation/drug effects
9.
Neurologia (Engl Ed) ; 35(9): 628-632, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-747866

ABSTRACT

INTRODUCTION: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. MATERIAL AND METHODS: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. RESULTS: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. CONCLUSIONS: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.


Subject(s)
Analgesics/adverse effects , Coronavirus Infections/complications , Headache/drug therapy , Neuralgia/drug therapy , Pneumonia, Viral/complications , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Analgesics/pharmacology , Analgesics/therapeutic use , Angiotensin-Converting Enzyme 2 , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Antihypertensive Agents/adverse effects , Antihypertensive Agents/therapeutic use , Antiviral Agents/pharmacology , Benzimidazoles/adverse effects , Benzimidazoles/therapeutic use , Betacoronavirus , Biphenyl Compounds , COVID-19 , Calcitonin Gene-Related Peptide Receptor Antagonists/adverse effects , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Carbamazepine/adverse effects , Carbamazepine/therapeutic use , Coronavirus Infections/drug therapy , Disease Susceptibility/chemically induced , Drug Interactions , Enzyme Induction/drug effects , Headache/complications , Headache/prevention & control , Humans , Ibuprofen/adverse effects , Ibuprofen/pharmacology , Ibuprofen/therapeutic use , Lisinopril/adverse effects , Lisinopril/therapeutic use , Neuralgia/complications , Pandemics , Peptidyl-Dipeptidase A/biosynthesis , Peptidyl-Dipeptidase A/genetics , Receptors, Virus/biosynthesis , Receptors, Virus/genetics , Risk Factors , SARS-CoV-2 , Tetrazoles/adverse effects , Tetrazoles/therapeutic use
10.
Br J Clin Pharmacol ; 87(3): 776-784, 2021 03.
Article in English | MEDLINE | ID: covidwho-717284

ABSTRACT

AIMS: In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections. METHODS: We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications. RESULTS: In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies. CONCLUSION: In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19/drug therapy , Ibuprofen/therapeutic use , COVID-19/complications , COVID-19/mortality , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Humans , Randomized Controlled Trials as Topic
11.
Inflammopharmacology ; 28(5): 1141-1152, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-716334

ABSTRACT

The coronavirus disease 19 (COVID-19) pandemic is currently the most acute healthcare challenge in the world. Despite growing knowledge of the nature of Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2), treatment options are still poorly defined. The safety of non-steroidal anti-inflammatory drugs (NSAIDs), specifically ibuprofen, has been openly questioned without any supporting evidence or clarity over dose, duration, or temporality of administration. This has been further conflicted by the initiation of studies to assess the efficacy of ibuprofen in improving outcomes in severe COVID-19 patients. To clarify the scientific reality, a literature search was conducted alongside considerations of the pharmacological properties of ibuprofen in order to construct this narrative review. The literature suggests that double-blind, placebo-controlled study results must be reported and carefully analysed for safety and efficacy in patients with COVID-19 before any recommendations can be made regarding the use of ibuprofen in such patients. Limited studies have suggested: (i) no direct interactions between ibuprofen and SARS-CoV-2 and (ii) there is no evidence to suggest ibuprofen affects the regulation of angiotensin-converting-enzyme 2 (ACE2), the receptor for COVID-19, in human studies. Furthermore, in vitro studies suggest ibuprofen may facilitate cleavage of ACE2 from the membrane, preventing membrane-dependent viral entry into the cell, the clinical significance of which is uncertain. Additionally, in vitro evidence suggests that inhibition of the transcription factor nuclear factor-κB (NF-kB) by ibuprofen may have a role in reducing excess inflammation or cytokine release in COVID-19 patients. Finally, there is no evidence that ibuprofen will aggravate or increase the chance of infection of COVID-19.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Coronavirus Infections/drug therapy , Ibuprofen/therapeutic use , Pneumonia, Viral/drug therapy , Angiotensin-Converting Enzyme 2 , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , COVID-19 , Coronavirus Infections/complications , Humans , Ibuprofen/adverse effects , Inflammation/etiology , Inflammation/prevention & control , NF-kappa B/drug effects , Pandemics , Peptidyl-Dipeptidase A/drug effects , Pneumonia, Viral/complications
12.
Brachytherapy ; 20(1): 284-289, 2021.
Article in English | MEDLINE | ID: covidwho-695371

ABSTRACT

PURPOSE: The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer, the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of locally advanced cervical cancer in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based intracavitary brachytherapy (ICBT). METHODS AND MATERIALS: This technical report will highlight our experience with the use of paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment. RESULTS: 18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCBs and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D2cc for rectum and bladder were 64.8 (58.6-70.2) Gy and 84.1 (70.9-89.4) Gy, respectively. Median (IQR) CTV high-risk D90 was 88.0 (85.6-89.8) Gy. CONCLUSIONS: In a multidisciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.


Subject(s)
Ambulatory Surgical Procedures/methods , Analgesics/therapeutic use , Anesthesia, Local/methods , Anesthesia, Obstetrical/methods , Brachytherapy/methods , Pain, Procedural/prevention & control , Uterine Cervical Neoplasms/radiotherapy , Anti-Anxiety Agents/therapeutic use , Antiemetics/therapeutic use , COVID-19 , Female , Gabapentin/therapeutic use , Humans , Hydromorphone/therapeutic use , Ibuprofen/therapeutic use , Lorazepam/therapeutic use , Organs at Risk , Pain, Procedural/drug therapy , Pandemics , Promethazine/therapeutic use , Radiotherapy Dosage , Rectum , SARS-CoV-2 , Urinary Bladder , Uterine Cervical Neoplasms/pathology
14.
Clin Microbiol Infect ; 26(9): 1259.e5-1259.e7, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-597470

ABSTRACT

OBJECTIVE: It was recently suggested that ibuprofen might increase the risk for severe and fatal coronavirus disease 2019 (COVID-19) and should therefore be avoided in this patient population. We aimed to evaluate whether ibuprofen use in individuals with COVID-19 was associated with more severe disease, compared with individuals using paracetamol or no antipyretics. METHODS: In a retrospective cohort study of patients with COVID-19 from Shamir Medical Centre, Israel, we monitored any use of ibuprofen from a week before diagnosis of COVID-19 throughout the disease. Primary outcomes were mortality and the need for respiratory support, including oxygen administration and mechanical ventilation. RESULTS: The study included 403 confirmed cases of COVID-19, with a median age of 45 years. Of the entire cohort, 44 patients (11%) needed respiratory support and 12 (3%) died. One hundred and seventy-nine (44%) patients had fever, with 32% using paracetamol and 22% using ibuprofen, for symptom-relief. In the ibuprofen group, 3 (3.4%) patients died, whereas in the non-ibuprofen group, 9 (2.8%) patients died (p 0.95). Nine (10.3%) patients from the ibuprofen group needed respiratory support, compared with 35 (11%) from the non-ibuprofen group (p 1). When compared with exclusive paracetamol users, no differences were observed in mortality rates or the need for respiratory support among patients using ibuprofen. CONCLUSIONS: In this cohort of COVID-19 patients, ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol or no antipyretic.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Fever/drug therapy , Ibuprofen/therapeutic use , Acetaminophen/adverse effects , Acetaminophen/therapeutic use , Adult , Antipyretics/adverse effects , Antipyretics/therapeutic use , Female , Fever/virology , Humans , Ibuprofen/adverse effects , Israel , Male , Middle Aged , Retrospective Studies
15.
Med Hypotheses ; 144: 109880, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-361316

ABSTRACT

Fever has been reported as a common symptom occurring in COVID-19 illness. Over the counter antipyretics such as ibuprofen and acetaminophen are often taken by individuals to reduce the discomfort of fever. Recently, the safety of ibuprofen in COVID-19 patients has been questioned due to anecdotal reports of worsening symptoms in previously healthy young adults. Studies show that ibuprofen demonstrates superior efficacy in fever reduction compared to acetaminophen. As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness.


Subject(s)
Antipyretics/adverse effects , Antipyretics/therapeutic use , COVID-19/drug therapy , Fever/drug therapy , Ibuprofen/adverse effects , Ibuprofen/therapeutic use , Acetaminophen/therapeutic use , Fever/physiopathology , Humans , Models, Theoretical , Patient Safety , Treatment Outcome
16.
Am J Ther ; 27(4): e400-e402, 2020.
Article in English | MEDLINE | ID: covidwho-194451

ABSTRACT

Ibuprofen is an over-the-counter medication that is used widely for the treatment of pain and fever during COVID-19 pandemic. A concern was raised regarding the safety of ibuprofen use because of its role in increasing ACE2 levels within the Renin-Angiotensin-Aldosterone system. ACE2 is the coreceptor for the entry of SARS-CoV-2 into cells, and so, a potential increased risk of contracting COVID-19 disease and/or worsening of COVID-19 infection was feared with ibuprofen use. However, available data from limited studies show administration of recombinant ACE2 improves lung damage caused by respiratory viruses, suggesting ibuprofen use may be beneficial in COVID-19 disease. At this time, there is no supporting evidence to discourage the use of ibuprofen.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Coronavirus Infections/complications , Ibuprofen/adverse effects , Pneumonia, Viral/complications , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Animals , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/drug therapy , Evidence-Based Medicine , Humans , Ibuprofen/therapeutic use , Lung/drug effects , Pandemics , Peptidyl-Dipeptidase A/biosynthesis , Pneumonia, Viral/drug therapy , Receptors, Virus/drug effects , Renin-Angiotensin System/drug effects , SARS-CoV-2
17.
Drug Ther Bull ; 58(5): 69, 2020 May.
Article in English | MEDLINE | ID: covidwho-27917

ABSTRACT

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal , Betacoronavirus , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 , Europe , Humans , Ibuprofen/adverse effects , Ibuprofen/therapeutic use , International Agencies , Pandemics , SARS-CoV-2
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