There is some debate over the appropriate use of such medications, since fever is part of the body'simmune response to infection.[3][4] A study published by theRoyal Society claims that fever suppression causes at least 1% moreinfluenza deaths in the United States, or 700 extra deaths per year.[5]
Bathing or sponging with lukewarm or cool water can effectively reduce body temperature in those withheat illness, but not usually in those with fever.[6] The use of alcohol baths is not an appropriate cooling method, because there have been reported adverse events associated with systemic absorption of alcohol.[7]
The list of medications with antipyretic effects includes many common drugs that also have analgesic and anti-inflammatory activity, several of which are commonly soldover-the-counter (OTC).
NSAIDs (non-steroidal anti-inflammatory drugs), a broad class of medications that in addition to their defining effect of reducing inflammation, also tend to be potent analgesics and antipyretics. The majority work by inhibiting the activity of thecyclooxygenase (COX) family of enzymes in the body.
Phenazone-like drugs (pyrazolones), many of which have been largely phased out of used owing to safety concerns in most countries (includingmetamizole (the "Mexican aspirin"), banned in over 30 countries for causingagranulocytosis), but remain available in some locations or for specific purposes such as for treatingotitis media in the form ofear drops.
Paracetamol (acetaminophen) class antipyretics, which have negligible anti-inflammatory activity. Apart from paracetamol itself, the medications in this class are mainly previously marketed drugs which were withdrawn owing to safety concerns, one example of this beingphenacetin.
A few other medications have antipyretic effects of varying strength. While these medications tend to have too weak fever reducing effects or too many adverse effects to use primarily as antipyretics, their antipyretic effect may occasionally be useful. For example, there are theoretical reasons to believe,[10] as well as slight evidence from one human trial,[11] thatα2-adrenergic agonists, and particularlyclonidine (a common drug used to treathigh blood pressure,ADHD,spasticity and several other conditions), may have antipyretic effects, which if verified could potentially be useful in patients withseptic shock oracute respiratory distress syndrome.[12]
The U.S.Food and Drug Administration (FDA) notes that improper dosing is one of the biggest problems in givingacetaminophen (paracetamol) to children.[13] The effectiveness of acetaminophen alone as an antipyretic in children is uncertain, with some evidence showing it is no better than physical methods.[14] Therapies involving alternating doses of acetaminophen andibuprofen have shown greater antipyretic effect than either drug alone.[15] One meta-analysis indicated that ibuprofen is more effective than acetaminophen in children at similar doses when both are given alone.[16]
Due to concerns aboutReye syndrome, it is recommended that aspirin andcombination products that contain aspirin not be given to children or teenagers during episodes of fever-causing illnesses.[17][18]
Traditional use ofvascular plants with antipyretic properties is a common worldwide feature of manyethnobotanical cultures. In ethnobotany, a plant with naturally occurring antipyretic properties is commonly referred to as afebrifuge.[19]
^abcCryer B, Feldman M (May 1998). "Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs".Am J Med.104 (5):413–21.doi:10.1016/s0002-9343(98)00091-6.PMID9626023.
^Mokhtari M, Sistanizad M, Farasatinasab M (January 2017). "Antipyretic Effect of Clonidine in Intensive Care Unit Patients: A Nested Observational Study".J Clin Pharmacol.57 (1):48–51.doi:10.1002/jcph.776.PMID27264198.S2CID3741978.
^Kauffman, Ralph; Sawyer, L.A.; Scheinbaum, M.L. (1992). "Antipyretic Efficacy of Ibuprofen vs Acetaminophen".American Journal of Diseases of Children.146 (5):622–625.doi:10.1001/archpedi.1992.02160170102024.PMID1621668.
^Schultes, Richard Evans; Raffauf, Robert F. (1994). "De Plantis Toxicariis e Mundo Novo Tropicale Commentationes XXXIX Febrifuges of northwest Amazonia".Harvard Papers in Botany.1 (5):52–68.ISSN1043-4534.JSTOR41761491.
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