Download Nós médicos seguimos o lema: “Deixar de aprender é omitir socorro”

O paracetamol (acetaminofeno) pode provocar lesões hepáticas e não deve ser usado por
adultos ou crianças e muito menos prescrito pelos médicos
José de Felippe Junior
09-09-2013
“Primum non nocere” aforismo médico
“Os pacientes não devem tomar paracetamol – acetaminofeno : lesão hepática”
“O paracetamol – acetaminofeno não é prescrito pelos médicos atualizados”
Todos medicamentos que levam em sua composição o paracetamol (acetaminofeno)
estão proibidos nos países que realmente cuidam da saúde do seu povo.
Existe grande exagero por parte dos médicos na prescrição de paracetamol também
conhecido como acetaminofeno (por ex.Tylenol) sozinho ou combinado com codeína (por ex.
Tylex). A mídia farmacêutica é irresponsável e os pacientes compram a droga nas farmácias
para se livrar de pequenos sintomas dolorosos ou febres inócuas e até benéficas.
O acetaminofeno que é o mesmo que paracetamol é uma droga muito perigosa
porque pode provocar insuficiência hepática às vezes mortal.
Esta droga deveria ser proibida pela nossa vigilância sanitária. E não poderia de
forma alguma ser proclamada na mídia para Dengue.
O mecanismo de toxicidade do acetaminofeno se deve a produção de estresse
oxidativo com aumento da geração de radicais livres de oxigênio. O paracetamol de tão tóxico
que é lesa tão intensamente os hepatócitos de ratos que chega a provocar carcinoma
hepatocelular .
Na Inglaterra e no País de Gales morriam 150 a 200 pessoas por ano, com o uso do
paracetamol. Estudos multicêntricos mostraram que a restrição da venda da droga nestes
países diminuiu o número de mortes e também o número de consultas em hepatologia e o
número de transplantes hepáticos.
Muito interessante é o fato dos trabalhos catalogados no PubMed (site de pesquisa
muito utilizado pelos médicos) catalogar no seu índice somente os nomes dos trabalhos sobre
os efeitos colaterais e hepatotóxicos do paracetamol, entretanto , não mostram os resumos,
que são mais contundentes e específicos sobre os malefícios da droga. Seria apenas
coincidência?
O ibuprofeno apresenta eficácia semelhante na dor de fraturas, dor de cabeça e febre
quando comparado ao paracetamol mais codeína, e não possui efeitos colaterais tão temíveis.
Nós médicos devemos nos abster de prescrever o paracetamol e muito importante
instruir os pacientes e principalmente as mães para não usar medicamento tão perigoso.
“Não vale a pena correr grandes riscos por apenas pequenos sintomas”
ou melhor ainda
“Não precisamos de drogas tóxicas”
Nós médicos seguimos o lema:
“Deixar de aprender é omitir socorro”
A seguir alguns trabalhos sobre o assunto:
Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review.
J Public Health (Oxf). 2005 Mar;27(1):12-8.
Morgan O, Majeed A.
Office for National Statistics, London SW1V 2QQ, UK. [email protected]
BACKGROUND: Paracetamol poisoning is implicated in about 150-200 poisoning deaths per
year in England and Wales. We review previous studies assessing the effectiveness of
regulations introduced in 1998 to restrict sales of paracetamol and reduce paracetamol
poisoning. METHODS: We searched the following electronic databases: MEDLINE, EMBASE,
CINHAL, HIMIC, COCH, APC, CENTRAL and DARE. English language publications between 1998
and 2003 were included. Studies were included if they took place in the United
Kingdom and assessed changes in any aspect of paracetamol poisoning following the
introduction of the 1998 regulations.
RESULTS:
Twelve studies were identified, which examined several different outcomes. Three studies
examined admissions to liver transplant units; all reported reductions. Eight studies evaluated
severity of paracetamol poisoning; three reported reductions but five did not. Five out of
six studies reported reductions in hospital admissions. One study reported reduced mortality
in England and Wales after 1 year while another found no difference in Scotland 2 years after
the regulations were introduced. Two studies observed a significant reduction in over-thecounter sales. Studies suffered from several limitations including short follow-up periods, no
case definition for paracetamol poisoning and lack of comparison groups.
CONCLUSIONS:
The limitations of these studies makes it difficult to draw firm conclusions. They do, however,
suggest that the 1998 regulations may have been associated with reduced admissions to liver
units and liver transplants, reduced hospital attendance due to paracetamol poisoning and
reduced sales of paracetamol. Further research is needed to fully evaluate the impact of the
1998 regulations. In the future, formal evaluation of the impact of similar interventions should
be na integral part of policy formation.
PMID: 15590709
Acute liver failure associated with a prolonged course of acetaminophen at recommended
dosages in paediatric age
Pediatr Med Chir. 2008 Nov-Dec;30(6):302-5
Gentili A, Latrofa ME,Giuntoli L,MelchiondaF,Pession A,Lima M,Baroncini S.
Department of Paediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi University
Hospital, Via Massarenti, 9-40138 Bologna. [email protected]
Acetaminophen is not considered as a safe analgesic and antipyretic drug in paediatric age.
The main problem in the use of acetaminophen is acute liver failure after a normal dose , an
overdose or an acute intoxication. We report a case of fulminant liver failure in a patient
treated with a prolonged course of acetaminophen at recommended dosages.
PMID: 19431953
A Randomized Clinical Trial of Ibuprofen Versus Acetaminophen With Codeine for Acute
Pediatric Arm Fracture Pain
Ann Emerg Med. 2009 Aug 18
Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK.
the Pediatric Emergency Medicine Division, Medical College of Wisconsin, Milwaukee, WI.
STUDY OBJECTIVE: We compare the treatment of pain in children with arm fractures by
ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component).
METHODS: This was a randomized, double-blind, clinical trial of children during the
first 3 days after discharge from the emergency department (ED). The primary outcome was
failure of the oral study medication, defined as use of the rescue medication. Pain medication
use, pain scores, functional outcomes, adverse effects, and satisfaction were also assessed.
RESULTS: Three hundred thirty-six children were randomized to treatment, 169 to ibuprofen
and 167 to acetaminophen with codeine; 244 patients were analyzed. Both groups used a
median of 4 doses (interquartile range 2, 6.5). The proportion of treatment failures for
ibuprofen (20.3%) was lower than for acetaminophen with codeine (31.0%), though not
statistically significant (difference=10.7%; 95% confidence interval -0.2 to 21.6). The proportion
of children who had any function (play, sleep, eating, school) affected by pain when pain was
analyzed by day after injury was significantly lower for the ibuprofen group. Significantly more
children receiving acetaminophen with codeine reported adverse effects and did not want to
use it for future fractures.
CONCLUSION:
Ibuprofen was at least as effective as acetaminophen with codeine for outpatient analgesia
for children with arm fractures.
There was no significant difference in analgesic failure or pain scores, but children receiving
ibuprofen had better functional outcomes. Children receiving ibuprofen had significantly fewer
adverse effects, and both children and parents were more satisfied with ibuprofen. Ibuprofen
is preferable to acetaminophen with codeine for outpatient treatment of children with
uncomplicated arm fractures.
PMID: 19692147
Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of
acute pain in children with extremity injuries: a randomized clinical trial
Acad Emerg Med. 2009 Aug;16(8):711-6
Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR.
Department of Pediatrics, University of California-San Diego, La Jolla, CA, USA.
[email protected]
OBJECTIVES: This study compared the analgesic effectiveness of acetaminophen-codeine with
that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that
the two medications would demonstrate equivalent reduction in pain scores in an
emergency department (ED) setting. METHODS: This was a randomized, double-blinded
equivalence trial. Pediatric ED patients 5 to 17 years of age with acute traumatic extremity
pain received acetaminophen-codeine (1 mg/kg as codeine, maximum 60 mg) or
ibuprofen (10 mg/kg, maximum 400 mg). The patients provided Color Analog Scale (CAS) pain
scores at baseline and at 20, 40, and 60 minutes after medication administration. The primary
outcome measured was the difference in changes in pain score at 40 minutes, compared to a
previously described minimal clinically significant change in pain score of 2 cm. The difference
was defined as (change in ibuprofen CAS score from baseline) - (change in acetaminophencodeine CAS score from baseline); negative values thus favor the ibuprofen group. Additional
outcomes included need for rescue medication and adverse effects. RESULTS: The 32
acetaminophencodeine and the 34 ibuprofen recipients in our convenience sample had
indistinguishable pain scores at baseline. The intergroup differences in pain score change at 20
minutes (-0.6, 95% confidence interval [CI] = -1.5 to 0.3), 40 minutes (-0.4, 95% CI = -1.4 to
0.6), and 60 minutes (0.2, 95% CI = -0.8 to 1.2) were all less than 2 cm. Adverse effects were
minimal: vomiting (one patient after acetaminophen-codeine), nausea (one patient after
ibuprofen), and pruritus (one after acetaminophen-codeine). The three patients in
each group who received rescue medications all had radiographically demonstrated fractures
or dislocations.
CONCLUSIONS:
This study found similar performance of acetaminophen-codeine and ibuprofen in analgesic
effectiveness among ED patients aged 5-17 years with acute traumatic extremity pain.
Both drugs provided measurable analgesia. Patients tolerated them well, with few treatment
failures and minimal adverse effects.
PMID: 19624576
Drug-induced hepatotoxicity or drug-induced liver injury
Clin Liver Dis. 2009 May;13(2):277-94.
Pugh AJ, Barve AJ, Falkner K, Patel M, McClain CJ.
Department of Medicine, University of Louisville School of Medicine, 550 South Jackson Street,
Louisville, KY 40292, USA.
Drug-induced hepatotoxicity is underreported and underestimated in the United States. It is an
important cause of acute liver failure. Common classes of drugs causing drug-induced
hepatotoxicity include antibiotics, lipid lowering agents, oral hypoglycemics, psychotropics,
antiretrovirals, acetaminophen, and complementary and alternative medications. Hepatotoxic
drugs often have a signature or pattern of liver injury including patterns of liver test
abnormalities, latency of symptom onset, presence or absence of immune hypersensitivity,
and the course of the reaction after drug withdrawal.
PMID: 19442919
Results of a prospective study of acute liver failure at 17 tertiary care centers in the United
States.
Ann Intern Med. 2002 Dec 17;137(12):947-54.
Summary for patients in: Ann Intern Med. 2002 Dec 17;137(12):I24.
Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO,
Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM; U.S. Acute Liver Failure Study
Group. Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD
4215, Australia.
BACKGROUND: Because acute liver failure is rare, related data have been sparse. Studies have
suggested that viral hepatitis is the most common underlying cause of this condition.
OBJECTIVE: To describe the clinical features, presumed causes, and short-term outcomes
of acute liver failure. DESIGN: Prospective cohort study. SETTING: 17 tertiary care centers
participating in the U.S. Acute Liver Failure Study Group. PATIENTS: 308 consecutive patients
with acute liver failure, admitted over a 41-month period. MEASUREMENTS: Detailed
clinical and laboratory data collected during hospitalization, including outcome 3 weeks after
study admission.
RESULTS:
73% of patients were women; median age was 38 years. Acetaminophen overdose was the
most common apparent cause of acute liver failure, accounting for 39% of cases.
Idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A
and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate
cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent of patients had liver
transplantation, and 43% survived without transplantation. Short-term transplant-free survival
varied greatly, from 68% for patients with acetaminophen-related liver failure to 25% and 17%
for those with other drug reactions and liver failure of indeterminate cause, respectively.
Coma grade at admission appeared to be associated with outcome, but age and symptom
duration did not.
CONCLUSIONS:
Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as
the most frequent apparent causes of acute liver failure.
Apparent cause and coma grade at admission were associated with outcome. Although
transplantation may improve patient survival, it was unavailable or unnecessary for most
patients.
PMID: 12484709
Associação Brasileira de Medicina Biomolecular e Nutrigenômica – ABMB
www.medicinabiomolecular.com.br
Rua Conde de Porto Alegre, 1985, Campo Belo, São Paulo – Capital. Tel: 11- 50935685
[email protected]
Abaixo-assinado Área de Atuação em Medicina Biomolecular
ABAIXO - ASSINADO
Direcionado aos órgãos competentes : CFM - Conselho Federal de Medina / CNRM Comissão Nacional de Residência Médica / AMB - Associação Médica Brasileira
A Associação Brasileira de Medicina Biomolecular (ABMB) e seus 2492 associados
estão pleiteando a condição de Área de Atuação para a Estratégia Biomolecular que
foi Regulamentada pelo CFM na Resolução 1938 de 2010, pois somente assim ela
poderá ser incluída no SUS - Sistema Único de Saúde e assim possa beneficiar a
população brasileira.
Cumpre salientar que
1º - A Estratégia Biomolecular já foi Regulamentada pelo Conselho Federal de
Medicina na Resolução 1938 de 2010, e portanto ela não é Medicina Alternativa
2º - O próximo passo para ser colocada à disposição da população em geral no
Sistema Único de Saúde é ser considerada Área de Atuação pela AMB, CNRM e
novamente CFM
3º - Este tipo de medicina não pode ficar restrito às classes econômicas mais
favorecidas
4º - Este tipo de medicina além de manter a saúde e o vigor físico consegue
diminuir drasticamente o risco de doenças graves como: infarto do miocárdio,
vários tipos de câncer, derrame cerebral, diabetes, reumatismos, alergias, etc...
Contamos com seu apoio
link para assinatura
http://www.peticaopublica.com.br/?pi=BIOMOL13