NSAID's??

iVillage Member
Registered: 12-13-2007
NSAID's??
10
Sat, 10-11-2008 - 6:36pm

I read this board all the time. Am normally a lurker though. I have seen quite a few times now mentioning not to use NSAID's. I have a 6 month old DD and we are not vaccinating and I am just curious where I can get information about NSAID's and why a person should/should not be using them for disease/immunization side effects/fever.

TIA

Nicky

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*Thanks Keisha for the beautiful Siggy!*


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iVillage Member
Registered: 07-17-2005
Sun, 10-12-2008 - 12:47am

http://www.garynull.com/documents/Vaccines/ChickenPoxWhy.htm

When you google, type-in "fever, skin rash and NSAID's". From what I understand, it is the combination of bringing a fever down using NSAID's WHILE the patient has a rash. If I'm wrong, maybe Tash will correct me :)

The link above probably came from her, I like it best because it's easy to understand but I do have more. I'm not at my PC but I have many articles bookmarked - I'll look and see what else I got when I get time.

iVillage Member
Registered: 12-13-2007
Sun, 10-12-2008 - 5:30pm

Thank you for the link. Very informative.

It seems that we should have more belief in a person's immune system then we do.

I am thankful that I decided to delay vacc until I could make a decision which has ended up being a non-vacc decision. Last night though it occurred to me that DD received the Vit K shot when she was born. The nurse told me she had to have it because she was pre-mature. I had told them I didn't want her getting any shots. Period. Last night I looked up the Vit K shot and now I'm pretty upset about the whole situation. It just makes me firmer in my beliefs. They lied to me, and that makes me pretty angry. My ped ran me through the ringer at DD's 6 mo appt on Thursday. Telling me I was not rational. I stood my ground though. I asked him three times if he had ever read the package inserts for the vaccines...he didn't say he had not read them...but the blank stare was enough to tell me he had not. He told me that he had never once seen a side effect or reaction from a vaccine in 18 years. I asked him, if a child came in to his office a week after vaccinations with seizures, would he suspect the vaccine?? He said he would not and had no reason to and that the child was probably pre-disposed to having them for no reason at all. I told him that it made sense then that he thought he had never seen an adverse reaction. I asked him if I were to get DD vaccinated and she did have an adverse reaction would he feel responsible, or even look into it. His reply was that no he would not because "he did the right thing by vaccinating". I was pretty shocked.

So while I'm angry about the Vit K shot and now wondering how much damage that could have already done to DD, I am happy I stood my ground with my ped. Information such as the link you provided on NSAID's is the type of information I will never get from my pediatrician and that makes me pretty angry.

Sorry for the tangent.

Thanks again for the info.

Nicky

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*Thanks Keisha for the beautiful Siggy!*


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iVillage Member
Registered: 07-17-2005
Sun, 10-12-2008 - 11:19pm

Nicky - Congratulations on your new baby!

I wanted to tell you that my vaccinated son came down with a really bad case of chicken pox. I gave him NSAID's and am now convinced it was why he had the pox so bad...it was SEVERE and lasted an unusually long time. My daughter, OTOH, got a very mild case, I knew to bring her fever down with a bath - if she had one, but she didn't. It was over very quickly, two weeks later you couldn't tell she ever had the chicken pox. I continue to dwell on these two cases!

There was a time when I thought that maybe parents are not given this information because it was thought that they are not capable of making the correct decisions for their child. I mean, let's face it, some parents are simply not. Intelligent and attentive parents are though! So why doesn't the AAP advertise common sense safety measures like the one above instead of running the vaccine ads? Because they need us to all be equally ignorant so their one-size-fits-all theories can be tested? I don't like conspiracy theories but I don't like what I've learned about all these vaccines either!

Welcome to the board! I pop in and out frequently, I hope you will too!

iVillage Member
Registered: 07-17-2005
Sun, 10-12-2008 - 11:46pm

"the type of information I will never get from my pediatrician and that makes me pretty angry."

It's the system, the government needs to get out! The system decides what the pediatrician is told to tell you and it takes an act of congress to get updated procedures published. After that then there's the whole training process. Your doctor - he nutted-up, if you ask me, lol!

"Sorry for the tangent."

Don't apologize for that, sometimes it's a good thing!




Edited 10/12/2008 11:48 pm ET by crunchymomto2
iVillage Member
Registered: 12-14-2005
Tue, 10-14-2008 - 10:17am

"information I will never get from my pediatrician and that makes me pretty angry."

Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given.

---

We don't have these in Canada but I am curious, if you are in the states - did your Doctor review the VIS with you prior to vaccination? It's required by federal law.

I note Hep B:

"Any unusual conditions, such as a serious allergic reaction, high fever or unusual behavior. Serious allergic reactions are extremely rare with any vaccine. If one were to occur, it would most likely be within a few minutes to a few hours after the shot. Signs can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. If a high fever or seizure were to occur, it would usually be within a week after the shot." http://www.cdc.gov/vaccines/Pubs/vis/vis-text-files.htm#hepb

"If a high fever or seizure were to occur, it would usually be within a week after the shot." - There is my DD's adverse event.






iVillage Member
Registered: 12-14-2000
Tue, 10-14-2008 - 10:42am

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I'm always surprised at how many people don't even know what these are (VIS.)

 

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iVillage Member
Registered: 12-14-2005
Tue, 10-14-2008 - 10:53am

"Instead of just handing the parent the VIS, they should really make sure the parent understands what the VIS is and what it's saying."

ITA, I also think if Doctors/Nurses did this more often, it might assist in taking away some of the "conspiracy" people seem to think about around vaccines - that is, information is being purposely kept away from parents.

It would also result in hopefully more accurate adverse event reporting - if you know what the common side-effects are and the rare ones, if you have read about them and have been told how to report them - perhaps VAERS data would become more accurate.






iVillage Member
Registered: 07-17-2005
Sat, 10-18-2008 - 12:55pm

"ITA, I also think if Doctors/Nurses did this more often, it might assist in taking away some of the "conspiracy" people seem to think about around vaccines - that is, information is being purposely kept away from parents."

I totally agree and I think there's a serious lack of educating the parent/patient going on. There's not a big trust in the American people being smart enough to interpret what the doctor tells them.

Here are some links about NSAID's that I saved:

http://www.whale.to/m/ibupro.html

http://www.righthealth.com/Health/History_Of_Ibuprofen/-od-definition_medmaster_a682159-s

Check out the side effects:

What SIDE EFFECTS can this medicine cause?

Ibuprofen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

* constipation
* diarrhea
* gas or bloating
* dizziness
* nervousness
* ringing in the ears

Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more ibuprofen until you speak to your doctor.

* unexplained weight gain
* fever
* blisters
* rash
* itching
* hives
* swelling of the eyes, face, throat, arms, hands, feet, ankles, or lower legs
* difficulty breathing or swallowing
* hoarseness
* excessive tiredness
* pain in the upper right part of the stomach
* upset stomach
* loss of appetite
* yellowing of the skin or eyes
* flu-like symptoms
* pale skin
* fast heartbeat
* cloudy, discolored, or bloody urine
* back pain
* difficult or painful urination
* blurred vision, changes in color vision, or other vision problems
* red or painful eyes
* stiff neck
* headache
* confusion
* aggression

Ibuprofen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online or by phone .

___________________________________________________________________________________

I cannot help but wonder how many doctors actually fill out the paperwork in this regard?
The paperwork insanity is ignored due to BS politics creating a full-time job of just filling out paperwork. Doctors do not have time, there's simply too much paperwork! Even if our government decided TODAY that they would create an adverse-reaction-reporting agency for drugs and vaccines --- it would be ten years AT LEAST to cut through the red tape and begin to implement. Just thinking about it makes me crazy!!!

iVillage Member
Registered: 07-17-2005
Sat, 10-18-2008 - 1:28pm
iVillage Member
Registered: 07-17-2005
Sat, 10-18-2008 - 2:52pm

I'm wondering how "uncomon" it would be if proper reporting happened? And what if doctors KNEW of the possibility? THEN would deaths be diagnosed as related to the NSAID's?

_______________________________________________________________________________________

Severe poisoning and death following poisoning with ibuprofen is extremely uncommon. Most cases are either asymptomatic or experience mild gastrointestinal symptoms only. In the case presented here the patient presented after ingestion of up to 105 g sustained-release ibuprofen with a reduced Glasgow Coma Scale, a severe metabolic acidosis and significant haemodynamic compromise. Despite meticulous supportive care initially in the Emergency Department and subsequently in the intensive care unit, attempted correction of her metabolic acidosis and the use of multidose activated charcoal to reduce further ibuprofen absorption from the gastrointestinal tract, the patient did not survive. This is the first reported case of fatality following ingestion of sustained-release ibuprofen and the first fatality following isolated ibuprofen toxicity.

Ibuprofen is a NSAID commonly used as an analgesic, as an anti-pyretic agent and as an anti-inflammatory agent. The predominant pharmacological effect of ibuprofen, similar to other NSAIDs, is to inhibit the activity of cyclooxygenase (both COX-1 and COX-2), leading to an inhibition of prostaglandin synthesis. Following a therapeutic dose of 400 mg, the serum ibuprofen concentration is approximately 28 mg/l (range 17–36 mg/l). Clinical features of toxicity of ibuprofen and other NSAIDs are predictable and occur due to an inhibition of cyclooxygenase activity.

The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists have published a position statement on the use of multidose activated charcoal. This position statement, however concentrated on the evidence base for the increased elimination of drugs undergoing enterohepatic/enteric circulation, rather than reducing the absorption of sustained-release or modified-release preparations.

In the case reported here a sustained-release preparation of ibuprofen was ingested, and therefore multidose activated charcoal was recommended to try and reduce further absorption of ibuprofen. The post mortem gastric content ibuprofen concentration was 116 mg/l, suggesting a significant amount of ibuprofen had still not been absorbed more than five hours post-presentation to the Emergency Department. Another patient who was found dead who had recently been prescribed an 800 mg preparation of ibuprofen, presumed to be a sustained-release preparation, had a post mortem total ibuprofen concentration of 131 mg in the gastric contents. Both our case and the other presumed sustained-release case would support the use of multidose activated charcoal in the management of patients who have ingested a sustained-release preparation of ibuprofen in any subsequent cases.

The toxicity of ibuprofen following self-poisoning has been reported in five large case series. Between 80% and 90% of the patients in these case series were either asymptomatic or had mild gastrointestinal symptoms, such as nausea, vomiting and diarrhoea, following ibuprofen intoxication. Several case series have demonstrated that, in patients with a history of ingestion of less than approximately 100 mg/kg ibuprofen, symptoms did not occur and that symptoms of ibuprofen toxicity following ingestion of a standard release preparation usually occur within four hours of ingestion.

Severe toxicity is uncommon following ibuprofen self-poisoning, and in general less than 10% of patients develop 'life-threatening' symptoms such as coma, seizures, respiratory arrest, hypotension or anuric renal failure. Life-threatening features of ibuprofen toxicity have been shown only to occur in patients who have ingested greater than 400 mg/kg ibuprofen. Histories in patients presenting with an overdose have been shown to be unreliable, however, so to try and predict those patients who are at risk of severe ibuprofen-induced toxicity, a nomogram based on the time since ingestion and the serum ibuprofen concentration, similar to that used for paracetamol (acetaminophen), has been developed. Subsequent studies have shown conflicting results as to whether this nomogram is accurate or inaccurate at predicting those at risk of severe toxicity. Since ibuprofen concentrations are not routinely available in most emergency departments or hospitals, there are concerns about the accuracy of the nomogram, the toxic effects of ibuprofen are predictable and (unlike paracetamol poisoning) there is no effective antidote, we would not recommend use of the ibuprofen nomogram in routine clinical practice.

Management of patients presenting following deliberate self-poisoning with ibuprofen consists of gut decontamination with activated charcoal, if they present within one hour of a potentially toxic overdose, and generalised supportive care. As already discussed, multidose activated charcoal may be appropriate in patients who have ingested a potentially toxic amount of a sustained-release preparation. Other more severe features of ibuprofen toxicity should be managed appropriately. Ibuprofen-induced seizures that are nonself-limiting should initially be managed with intravenous diazepam (0.1–0.2 mg/kg). Significant metabolic acidosis (pH < 7.0) that does not respond to adequate intravenous fluid resuscitation, and maintenance of the blood pressure, with intropic support if appropriate, should be corrected with intravenous 50–100 ml boluses of 8.4% sodium bicarbonate. For resistant metabolic acidosis that is not responding, then haemofiltration with a nonlactate bicarbonate buffer may be beneficial. Although ibuprofen has a relatively low volume of distribution (0.1 l/kg), its high protein binding to albumin (99%) limits removal by extracorporeal treatments such as haemodialysis or haemofiltration.

Previous studies have demonstrated no accumulation of ibuprofen in patients with renal impairment and, in functionally anephric patients undergoing renal replacement therapy with haemodialysis, no accumulation of ibuprofen was seen and there was no detectable ibuprofen in the dialysate, indicating that the ibuprofen was eliminated through metabolism. This provides further support that extracorporeal treatments will probably not be beneficial in increasing the clearance of ibuprofen in overdose, and there have been no previous reported cases of their attempted use in patients with ibuprofen toxicity. There have been no published studies on the routine prophylactic use of H2 histamine receptor antagonists or proton pump inhibitors in trying to reduce the risk of ibuprofen or other NSAID-related gastrointestinal toxicity. Our current practice in patients with significant epigastric pain/tenderness after ibuprofen poisoning is to treat them with 1 week of a proton pump inhibitor such as lansoprazole 30 mg once daily.

There have been nine reported cases of fatality following ibuprofen self-poisoning in the literature to date, although other factors probably contributed to death in eight of these cases. The co-ingestion of other drugs at the time of the overdose, such as aspirin, paracetamol, theophylline and cyclobenzaprine, contributed to death in four cases. Aspiration pneumonia that developed as a complication of ibuprofen-induced apnoeic episodes and septic shock, thought to be unrelated to ibuprofen toxicity, contributed to two deaths. Refusal of treatment of ibuprofen-induced oliguric renal failure and sepsis, felt by the authors to be survivable, significantly contributed to one death. The circumstances surrounding one death are unclear as the patient was found dead near their home. There are limited details of and no confirmatory ibuprofen concentrations for the final death, which has been reported in abstract form only.

Ibuprofen concentrations have been measured in four of the previous fatalities. One of the previously reported fatalities had an ante mortem ibuprofen concentration of 72 mg/l; although few details of the case were given, the authors concluded that the cause of death was septic shock and respiratory failure unrelated to the ibuprofen intoxication. Peripheral blood post mortem ibuprofen concentrations of 81 mg/l, 130 mg/l and 348 mg/l have been reported in a 48-year-old male, a 19-year-old male and a 26-year-old male, respectively.

Additionally, post mortem ibuprofen concentrations of 942 mg/kg and 238 mg/kg were reported in liver extract in two cases. In the case reported here, the post mortem ibuprofen concentrations were 518 mg/l in peripheral blood and 74 mg/kg in liver extract. The main differences between our reported case and the other two cases with previous reported post mortem ibuprofen concentrations is that our case had higher peripheral blood and lower liver extract concentrations. Since the exact timing of ingestion was not known in our case and was not reported in the other two cases, the differences in peripheral blood and liver extract ibuprofen concentrations may be due to differences in distribution and metabolism. It is therefore probable, given the post mortem ibuprofen concentrations in our reported case, that our patient died sooner after ingestion than the other two reported cases, as peripheral blood concentrations had not had sufficient time to fall and the liver had not started to metabolise as much ibuprofen. The other unknown factor in all of these cases is the impact of impaired haemodynamics, renal dysfunction and metabolic acidosis on ibuprofen kinetics.

http://www.medscape.com/viewarticle/525169_4