[e-drug] June 08 Australian Prescriber covers pain in children

e-drug
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E-DRUG: June 08 Australian Prescriber covers pain in children
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The whole issue is worth a look and can be downloaded completely
or individual articles can be accessed at

http://www.australianprescriber.com

There are several issues of current interest covered.

Often the excitement around the launch of a new drug is
soon tempered by the emergence of problems in practice.
Mark Boyd and Sarah Pett inform us that the uptake of
enfuvirtide has been limited, and Gillian Shenfield considers
the adverse effects of 'glitazones'.

Sometimes a patient has to take a drug despite its serious
adverse effects. Cecilie Lander tells us that this is a particular
problem for pregnant women who need treatment for
epilepsy. Antiepileptic drugs are also used in bipolar disorders, but
Ajeet Singh and Michael Berk say that lithium still has an
important role.

For pain in children, paracetamol and ibuprofen are also old drugs which
remain
widely used. E-drugger, Sean Beggs reviews how they compare when
used to relieve pain in children. He provides a very useful anaylsis.

Here is a summary:
Three main analgesics are routinely used for
treating pain in children -- paracetamol, ibuprofen
and codeine. Paracetamol and ibuprofen are
equally effective when used in recommended
doses. Codeine has high inter-individual variation
in its effectiveness, particularly in children, which
significantly limits its routine use in paediatrics.
Paracetamol is associated with fewer adverse
effects than ibuprofen and so generally remains
the first-line analgesic drug in children. However,
paracetamol may not be the most appropriate
choice in all patients depending on the type of
pain being treated and the presence of comorbid
illnesses. Paracetamol has unpredictable
absorption with rectal administration so this route
is no longer recommended. The combined use of
paracetamol with non-steroidal anti-inflammatory
drugs may be of benefit for some postoperative
and musculoskeletal pain.

*Beverley Snell*

*Senior Fellow*

*Centre for International Health*

*Macfarlane Burnet Institute for Medical Research & Public Health *

*GPO Box 2284, Melbourne 3001 Australia*

*http://www.burnet.internationalhealth.edu.au***

*Telephone 613 9282 2115 / 9282 2275*

*Fax 61 3 9282 2144 or 9282 2100*

*Time zone: 10 hours ahead of GMT.*

*email <bev@burnet.edu.au>*

*Site: Alfred Medical Research & Education Precinct (AMREP),*

*85 Commercial Road, Prahran 3004*

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E-DRUG: Sudden death and other fatal reactions to Tamiflu
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Dear E-druggers,

Infection-associated encephalopathy such as Reye’s syndrome is one
of the major public health problems in many countries. Another type of
neuropsychiatric adverse reactions, including sudden deaths and
other fatal reactions observed with oseltamivir (Tamiflu) use has
been one of the major problems especially in Japan.

I have analyzed and investigated the causality link between Tamiflu
and serious neuropsychiatric adverse reactions, including sudden deaths
and accidental deaths due to abnormal behavior, since February 2005
when I first warned about this possibility.

My paper "Fatal neuropsychiatric adverse reactions to oseltamivir:
case series and overview of causal relationships" was published
in the latest issue of The International Journal of Risk & Safety
in Medicine (IJRSM20 (2008) 5-36.).

The full paper is available at Web-Kusuri-no-Check International No11
(23 June 2008)
http://npojip.org/english/no11.html

This paper adds the following three major points to earlier reports:
this is the first original paper presenting a case series of
fatal or near fatal adverse reactions to Tamiflu. It is also
the first paper overviewing the full spectrum of adverse
reactions to Tamiflu, and the first paper discussing the
causality and underlying mechanisms of the full spectrum
of reactions to Tamiflu
(from "3.13. What this paper adds to earlier reports": pp30-31).

Professor Chris J. van Boxtel wrote in his editorial(IJRSM20 (2008)1-3):
"We celebrate this anniversary with a double issue which features the
first in depth review of the safety aspects of oseltamivir.
And for making a risk-benefit analysis for this antiviral agent,
such a review is timely, given the fact that the United States and
many other countries have been stockpiling oseltamivir in the face
of the risk that avian flu will spark a pandemic. "

We hope this paper could help not only health professionals and the
public but also regulatory authorities worldwide to make rational and
safe decisions when dealing with oseltamivir.

Kusuri-no-Check

Rokuro Hama M.D.

HAMA, Rokuro MD Chair person "Kusuri-no-Check"
NPOJIP: Non-Profit Organization "Japan Institute of Pharmacovigilance"
publishing ISDB-full-membership Drug Bulletin
"Kusuri-no-Check" Check-up Your Pills to Save Your Life
TEL +81-6-6771-6345 Fax +81-6-6771-6347
New adress :#902 Ueshio 3-2-17, Tennouji-ku, Osaka, Japan 543-0002
http://npojip.org/
Deputy Editor:The Informed Prescriber