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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