Dipyrone and acetaminophen: correct dosing by parents?

Alves, João Guilherme Bezerra; Neto, Fortunato José Cardoso; Almeida, Camila Dornelas Câmara Marques de; Almeida, Natalia Dornelas Câmara

doi:10.1590/s1516-31802007000100011

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…G-CSF was given to patients with agranulocytosis who did not recover spontaneously within few days as well as to those with more severe blood dyscrasia and infections. A case of bone marrow recovery after treatment with steroids has been reported in the pediatric literature (17). All of our patients recovered fully.…”

Section: Resultssupporting

confidence: 55%

Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children

Akyay¹,

Deveci²

2015

J Turgut Ozal Med Cent

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Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyretic agent in several countries. In spite of its availability and common usage, it has serious and potentially fatal adverse effects like agranulocytosis and aplastic anemia. Objectives of this study are to evaluate incidence, severity, and clinical significance of metamizole related neutropenia and agranulocytosis, and to study recovery duration of neutropenia and agranulocytosis in children exposed to metamizole. Material and Methods: Thirteen cases of neutropenia and/or agranulocytosis secondary to metamizole usage have been evaluated retrospectively. Duration and cumulative doses of metamizole, degree of neutropenia, recovery from neutropenia, and other complications related to neutropenia were evaluated. Results: Overall, thirteen granulocytopenic patients were recorded for 12 months after metamizol usage. Mean metamizole exposure duration was 4,64 (2-7) days; mean daily total metamizole dose was 40 (15,6-78) mg/kg; mean metamizole cumulative dose was 219,4 (58,8-468) mg/kg; mean neutropenia duration was 9,4 (1-30) days; and mean absolute neutrophil count was 690 (30-1300)/mm 3 . Four patients who used ≥ 30 mg/kg daily doses of metamizole for 4-7 days (≥ 217 mg/kg cumulative dose) had agranulocytosis. All of the patients recovered fully after metamizol cessasion. The shortest recorded recovery duration from granulocytopenia was 2 days while the longest recorded recovery duration was 30 days. Conclusion: Physicians should be aware of the toxic effects of metamizole and should not prefer metamizole as a first line antipyretic agent. Neutropenia and agranulocytosis risks should be kept in mind in the application of metamizole particularly over long periods of time and in large doses in children. Metamizol İlişkili Granulositopeni ve Agranülositoz: 13 Çocuğun DeğerlendirilmesiÖzet Amaç: Metamizol sodyum (Novalgin ® ) birçok ülkede yaygın olarak kullanılan etkili bir analjezik ve antipiretik ilaçtır. Yaygın kullanımına ve kolay elde edilebilirliğine rağmen agranülositoz ve aplastik anemi gibi ağır ve ölümcül olabilecek yan etkileri olabilir. Çalışmamızın amacı metamizol kullanan çocuklarda metamizol ilişkili nötropeni ve agranülositoz sıklığını, ağırlığını, klinik önemini ve nötropeni ve agranülositozdan çıkma sürelerini değerlendirmektir. Gereç ve Yöntemler: Metamizolle ilişkili 13 nötropeni ve agranülositoz vakası metamizol kullanım süresi, kümülatif dozu, nötropeniden çıkma süresi ve nötropeni ile ilişkili diğer komplikasyonlar açısından retrospektif olarak değerlendirildi. Bulgular: Metamizol kullanımı sonrası granülositopeni veya agranülositoz gelişen toplam 13 hasta tespit edildi. Ortanca metamizol kullanım süresi 4.64 (2-7) gün, ortanca günlük doz 40 (15.6-78) mg/kg, ortanca metamizol kümülatif dozu 219.4 (58.8-468) mg/kg, ortanca nötropeni süresi 9.4 (1-30) gün, ortanca mutlak nötrofil sayısı 690 (30-1300)/mm 3 olarak tespit edildi. 4-7 gün 30 mg/kg/gün'den (≥ 217 mg/kg kümülatif doz) fazla metamizol kullanan dör...

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Section: Resultssupporting

confidence: 55%

Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children

Akyay¹,

Deveci²

2015

J Turgut Ozal Med Cent

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“…Wrong dosing of paediatric liquid medications is exceedingly common, with a considerable proportion of caregivers (10–90%) measuring the doses incorrectly . Generally, the use of calibrated oral syringes caused fewer errors as compared with other devices including dosing cups, household spoons and droppers .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…12 Wrong dosing of paediatric liquid medications is exceedingly common, with a considerable proportion of caregivers (10-90%) measuring the doses incorrectly. [13][14][15][16][17][18] Generally, the use of calibrated oral syringes caused fewer errors as compared with other devices including dosing cups, household spoons and droppers. [14][15][16][17]19,20 However, Yin et al 16 found that approximately 25% of the caregivers in a New York public hospital measured liquid medications with deviations of greater than 40% from prescribed doses, despite the measuring devices used.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Using pictograms to assist caregivers in liquid medication administration: a systematic review

et al. 2015

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SUMMARYWhat is known and objective: It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. Methods: MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. Results and discussion: Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. What is new and conclusion: The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings. WHAT IS KNOWN AND OBJECTIVELiquids are often the preferred form of oral medication delivery for young children and infants. These formulations are usually combined with pleasant-tasting excipients and easier to swallow.

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“…In children, recommended doses are 15-20 mg/kg, per dosis. Oral formulation of metamizole in doses of 500 mg/ml, as infant drops, is availible in Brazil [19]. In Germany, it is present on the market as infant 696 Volume 5 • Number 3 • December 2018 • HOPH drops (500 mg/ml), for children aged up to 3 months and who weigh more than 5 kg, as well as in tablets form for children older than 10 years [20].…”

Section: Metamizole Use During Pregnancy and In Pediatric Populationmentioning

confidence: 99%

Metamizole: Current status of the safety and efficacy

Miljković¹,

Rančić²,

Simić³

et al. 2018

Hosp Pharm Int Multi J

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Metamizole is a nonsteroidal anti-infl ammatory drug, with analgesic, antipyretic, spasmolytic, and weak anti-infl ammatory properties. The analgesic eff ect of metamizole seems to be based on the inhibition of cyclooxygenase enzyme activity and stimulation of cannabinoid receptors. Its use is still controversial, mainly due to agranulocytosis, metamizole-induced serious adverse reaction. While in many countries it is withdrawn from the market, in some countries metamizole is available as a medication prescribed for strictly defi ned indications, while in the others like Mexico, Brazil and China it can be obtained as an Over-The-Counter drug. The most common adverse eff ects of metamizole are the skin and subcutaneous tissue disorders. Metamizole appears to be of similar effi cacy to analgesics which are frequently used in the treatment of moderate to severe postoperative pain.

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Dipyrone and acetaminophen: correct dosing by parents?

Cited by 9 publications

References 11 publications

Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children

Metamizole Related Granulocytopenia and Agranulocytosis: An Analysis of 13 Children

Using pictograms to assist caregivers in liquid medication administration: a systematic review

Metamizole: Current status of the safety and efficacy

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