Analgesic Nephropathy: Removal of Phenacetin from Proprietary Analgesics

Murray, Robin M.

doi:10.1136/bmj.4.5833.131

Cited by 38 publications

(6 citation statements)

References 10 publications

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“…Renal function usually deteriorates in patients with continued abuse (Table 6). This is also true for the few known cases with further abuse with only aspirin [82, 203,208] or salicylamide [156,216]. Renal function deteriorates in only 18% of the patients who discontinue analgesic abuse (Table 6).…”

Section: Follow-up Studiesmentioning

confidence: 72%

Analgesic-associated nephropathy

Schwarz

1987

Klin Wochenschr

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Although the question of whether or not analgesic abuse leads to a certain type of nephropathy has been investigated since 1953, no conclusive answer has been forthcoming. Epidemiologic investigations on the correlation between analgesic abuse and renal function as well as experimental animal studies have given contradictory results concerning the possibility of analgesic-associated kidney damage. However, studies on the correlation between analgesic abuse and papillary necrosis have demonstrated that this lesion coincides in 69% of the cases with an analgesic history. Follow-up studies of patients with analgesic nephropathy have shown that renal function deteriorates in 60% of the patients with continued abuse and that it stabilizes in 80% of the patients after cessation of abuse. Studies on the legislative restriction of phenacetin/acetaminophen, carried out mostly in Scandinavian countries since 1965, show a 50%-90% decline in signs of analgesic nephropathy (papillary necrosis) following a reduction in the sale of these drugs. The prevalence of analgesic abuse may be underestimated, since up to 80% of the abusers tend to deny their analgesic intake. Obviously, only a small percentage of analgesic abusers (approximately 1%) finally develop nephropathy. Even though the results of epidemiologic and experimental studies are contradictory, the results of investigations on papillary necrosis and on legislative prevention as well as of patient follow-ups tend to indicate a correlation between analgesic abuse and a well-defined type of nephropathy.

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Section: Follow-up Studiesmentioning

confidence: 72%

Analgesic-associated nephropathy

Schwarz

1987

Klin Wochenschr

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“…The causal relationship between pyrazolones and preceding 12 agranulocytosis has been demonstrated by could have rechallenge (Madison & Squier, 1934) and by or negatively transfusion studies (Moeschlin & Wagner (1952 (Murray, 1972;Kasanen, 1973;Krishnaswamy & Nanra, 1976). A recent study n use before based on all cases of agranulocytosis admitted to hospitals in the Stockholm region has revealed no change in the incidence of that condition following the ban on dipyrone use in 1973.…”

Section: Agranulocytosis Induced By Pyrazolones 'D As a Drugmentioning

confidence: 99%

“…Regular use was define taken at least once a week during the weeks. In addition, factors that influenced aspirin use either positively were excluded from the control group (Table 2) revealed a statistically significar (Madison & Squier, 1934) and by or negatively transfusion studies (Moeschlin & Wagner (1952 (Murray, 1972;Kasanen, 1973;Krishnaswamy & Nanra, 1976). A recent study n use before based on all cases of agranulocytosis admitted to hospitals in the Stockholm region has revealed no Huguley (1964) has also chosen data from three additional reports describing 103 (Simon & Metz, 1936), 18 (Spear, 1962) and six patients (Cardon, Comess, Noble & Pomaranc, 1958) treated with aminopyrine, none of whom developed agranulocytosis.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological evaluation of rare side‐effects of mild analgesics.

Levy¹

1980

Brit J Clinical Pharma

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1 Major adverse reactions to mild analgesics, unless these drugs are abused or taken in high doses, are believed to be rare. 2 However, because of the massive and universal use of these drugs, quantitative measurement of the risk involved is imperative. At present, contradictory regulatory decisions about the use of mild analgesics are based on circumstantial evidence. 3 It is only by the conduct of epidemiological studies that data leading to decisions based on scientifically sound judgments may be obtained.

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“…Unfortunately the doses involved have often been recorded in terms of the phenacetin content and this has varied from a cumulated dose of 1 or 2 kilogrammes to over 15 kilogrammes or more (Rubenstein, Abraham, Stables, and Levin, 1968). Most patients with analgesicnephropathy have taken, in terms of phenacetin, a dose of at least 1 g per day for three years or more with a total dose of over 3 kg (Buchanan, 1961;Murray, 1972).…”

Section: The Pathological Diagnosis Of Analgesic Nephropathymentioning

confidence: 99%