Author: Li Suhua, General Hospital of the Southern Theater
The State Food and Drug Administration issued a document on November 16 that 7 drugs that can be used for colds and fevers, such as pediatric amine granules, ammonia non-coffee tablets, compound aminopyrine theophylline tablets, aminophenol coffee capsules, ammoniacarmin tablets, pediatric compound aspirin tablets, and ammonia non-coffeeamine tablets, have been cancelled, and their main ingredients contain aminopyrine or phenacetine.
What exactly is wrong with aminopyrine and fernacetin?
After the marketing of aminopyrine in Europe in 1897, it was found that the drug could cause severe leukopenia, which led to various serious infections and could be fatal, and in 1938, the United States removed it from the legal drug list.
Fenarcetin has also been a widely used antipyretic analgesic, because it increases the risk of kidney disease in users and causes hundreds of people to die of chronic renal failure, some patients can die of kidney failure even if they stop phenacetin for up to 8 years, in 1982, the US FDA announced that it would stop using drugs containing phenacetin in prescriptions.
In China, drugs containing the above two ingredients such as aminophenol coffee tablets, compound aminopyrine theophylline tablets and so on.
Although China in 1982 has eliminated aminopyrine unilateral preparations, but there are still many aminopyrine compound preparations in use, from the State Food and Drug Administration issued by the aminopyrine containing product specifications, can be queried including metamizole tablets, compound aminopyrine injection, pain tablets and other drugs, a total of more than 2,000 specifications. The above drugs are only domestic drugs, and none of them are imported.
At present, the pediatric antipyretic analgesic drugs available for use are relatively safe: acetaminophen, ibuprofen, and the above two types of drugs have a variety of dosage forms and specifications to choose from.
For formulations such as aminopyrine that have caused many severe ADR and ADE in many children, the state has now launched a post-marketing evaluation.
Common cold vs influenza
1. Common cold
Causes: There are hundreds of viruses that cause the common cold, of which rhinoviruses are the most common (30% to 50%), followed by coronavirus (10% to 15%), respiratory syncytial virus (5%), parainfluenza virus (5%), adenovirus (<5%) and enteroviruses (<5%).
Symptoms: Nasopharyngeal symptoms such as low-grade fever and runny nose, nasal congestion, sneezing, and sore throat are the mainstay.
2. Influenza (abbreviation: influenza)
Causes: There are two main types of influenza-causing viruses – type A (also known as "stream A") and type B (also known as "stream B").
Symptoms: Mainly symptoms of systemic muscle pain and high fever, a small number of patients have serious complications such as viral myocarditis, pneumonia, encephalitis and so on.
Colds and flu are caused by viruses, while antibacterial drugs are only effective against bacteria and ineffective against viruses.
At present, there is no specific antiviral drug for the treatment of colds, so for the common cold, the clinical treatment is mainly symptomatic treatment and relief of cold symptoms, and patients are instructed to strengthen rest as much as possible, appropriately replenish water, maintain indoor air circulation, and avoid secondary bacterial infections. For various cold symptoms, the commonly used cold medicine ingredients are as follows:
Antipyretic analgesics
Acetaminophen, ibuprofen, diclofenac
It is mainly aimed at symptoms such as fever, sore throat and general soreness in patients with common colds.
■Acetaminophen is the safest antipyretic drug for pregnant women (FDA recommends Class B drugs).
■ Ibuprofen is the most commonly used antipyretic analgesic drug in children, but it is contraindicated in pregnant women.
■ Diclofenac is not recommended during pregnancy. Patients with liver and kidney function impairment should use with caution, and the elderly should use with caution.
Nasal decongestants
Pseudoephedrine, ephedrine
Can make the swollen nasal mucosa vasoconstriction, in order to reduce nasal congestion, relieve nasal congestion, runny nose, sneezing and other symptoms, decongestant continuous use should not exceed 7 days. Pseudoephedrine is the most commonly used oral nasal decongestant in pediatrics.
Antihistamines
Chlorpheniramine, diphenhydramine, loratadine, cetirizine
Inhibits the dilation of small blood vessels by blocking the histamine receptor (H1), reduces vascular permeability, and helps eliminate or alleviate symptoms such as sneezing and runny nose.
■ The first generation of antihistamines (such as chlorpheniramine, diphenhydramine) has different degrees of central inhibition, manifested as sedative, drowsy effect, and has a certain degree of anticholinergic effect, which helps to reduce secretions and reduce cough symptoms;
■ The second generation of antihistamines (loratadine, cetirizine) does not have a central sedative effect, nor does it have an anticholine effect, so it cannot suppress cough and is not recommended for use in cold treatment.
Antitussive drugs
Dextromethorphan, nacotin, codeine
It is mainly divided into central and peripheral antitussive drugs, the former directly inhibits the cough center of the brain, and the latter inhibits the receptors, afferent nerves, efferent nerves or effectors in the cough reflex arc and plays an antitussive effect.
When patients have sputum, try not to use antitussive drugs to avoid affecting the coughing up of sputum. Cough suppressants may be used under the guidance of a physician and pharmacist in patients with severe dry cough or chest pain.
1. Right methafen
Non-dependent central antitussive, without analgesic and hypnotic effects. A variety of over-the-counter compound antitussive drugs contain this product, mainly for dry cough. The FDA recommends Class C drugs, which are contraindicated in women less than 3 months of pregnancy, those with a history of psychiatric illness, and lactating women. Taking monoamine oxidase preparations is contraindicated within 2 weeks of discontinuation.
2. Nakotin
Peripheral antitussives, can relieve bronchial smooth muscle spasm, inhibit cough caused by pulmonary traction reflex, no analgesia and sedative effect, do not inhibit breathing, no dependence, suitable for irritating dry cough.
3. Codeine
Central antitussives, which are addictive, can be used for severe dry coughs and irritating coughs caused by various causes. In large doses, there is significant inhibition of the respiratory center, and central excitatory symptoms such as irritability can occur. It can be excreted through the placental barrier and self-milking, so it is contraindicated in pregnant, lactating women and children. Elderly people and patients with hepatic and renal insufficiency should use with caution.
Expectorants
Guaiac glycerol ether, ambroxol, acetylcysteine, carboxystam/erdostam, myrtle oil
Expectorants are drugs that thinn sputum, reduce viscosity and make it easy to cough up, or can accelerate the movement of cilia of the respiratory mucosa and improve the transport function of sputum. According to its pharmacological mechanism of action, it is divided into mucus secretion promoting drugs and mucus dissolving drugs.
1. Guaiac glycerol ether
After oral administration, irritation of the gastric mucosa, reflexively causes increased bronchial secretion, diluting sputum. It is contraindicated in patients with pulmonary hemorrhage, acute gastroenteritis and nephritis, and is contraindicated within 3 months of pregnancy.
2. Ambroxol
Breaks the acid glycoprotein fibers in the sputum and reduces the viscosity of the sputum by inhibiting the synthesis of glycoproteins. Use with caution in women in the first trimester of pregnancy and patients with gastric ulcers.
3. Acetylcysteine
As a mucin dissolving agent, through the exchange of disulfide bonds between thiol groups and mucin in the drug structure, the mucin molecule is lysed to produce the effect of reducing sputum viscosity. It can cause choking cough and bronchospasm, so asthma patients are contraindicated, and the elderly with respiratory insufficiency should be used with caution.
4. Carboxylastam/Erdosteine
All are mucolytic agents with a mechanism of action similar to acetylcysteine, the former is contraindicated in patients with bleeding tendencies to peptic ulcers and pregnant women, and the latter is contraindicated in children under 15 years of age and severe hepatic and renal insufficiency. Care should be taken to avoid concomitant use with central antitussive drugs.
5. Myrtle oil
By promoting solubility, regulating secretion and actively promoting drainage, mucus is easily discharged. Adverse reactions are rare and oral safety is high. Existing experience shows that there is no danger in the standardized use of pregnant women, but because it is lipophilic and can enter the milk, and there is no data on the use of lactating women, it is recommended to use with caution.
Anti-infective drugs
The common cold is mostly caused by rhinovirus infection, which is a self-limiting disease, and there is currently no specific antiviral drug for the common cold, so there is no need to use antiviral drugs. In order to avoid drug resistance and control drug abuse, those who have no basis for bacterial infection should not use antibacterial drugs for the purpose of prevention. Antimicrobial therapy should be added when a concomitant bacterial infection is identified, such as elevated total number of white blood cells, neutrophil number, and/or C-reactive protein in peripheral blood picture, accompanied by symptoms such as pus or yellow pus, hearing loss, ear pain, etc., and pneumonia, sinusitis, or otitis media.
Compound preparations
Most of the cold medicines currently on the market are compound preparations that contain two or more of the above types of drugs or other drugs. Although there are many kinds of drugs for the treatment of colds, the names are different, but the composition of the formula is the same or similar, the effects of the drugs are similar, so the compound anti-cold drugs should only choose one of them, such as taking more than two drugs at the same time, which can lead to repeated medication, over-medication, and increase the incidence of adverse reactions to the above drugs.
Review expert: Ji Bo, General Hospital of the Southern Theater
The above is the original work of the volunteers of the "Drug Safety Cooperation Alliance", if you reprint, please indicate the author and source!
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