E-DRUG: Potential harm of NSAIDs and oseltamivir in 2009A/H1N1 epidemic
----------------------------------------------------------------------
Dear　E-Druggers
Potential harm of NSAIDs and oseltamivir in 2009A/H1N1 epidemic.
Harmful effects of both non-steroidal anti-inflammatory drugs (NSAIDs) and Tamiflu (oseltamivir) are rarely discussed in the official comments by WHO, CDC or other governmental organizations on the management of
2009A/H1N1 influenza.
And threats of "the possible second wave of pandemic after Autumn"
are frequently referred to, which I do not believe to happen unless NSAIDs are so extensively used as in the past pandemic.
No pandemic has occurred, since the three major pandemics (1918, 1957,
1968) and the relatively mild pandemic (1977). The periods after these pandemics coincided with the periods when salicylates were suspected of and then proven as the cause of Rye's syndrome, and their use was restricted in the treatment of viral infections, especially in children.
I found NSAIDs such as aspirin (Bufferin 325mg), ibuprofen (Brufen 400/600mg tab), diclofenac (Voltaren or Artrenac tabs/suppositories) and mefenamic acid (Ponstan 500mg) are available as OTC in many countries including Latin American countries and the North American countries as well.
A previously healthy woman aged 35 years at 32 weeks' gestation with fever (38.7 degree C) received a parenteral non-steroidal
anti- inflammatory medication and acetaminophen at a local emergency department before she was diagnosed with 2009A/H1N1 influenza. She has fortunately recovered.
However, I am very anxious about the patients who have died from
2009A/H1N1 influenza, as it is not known if they had been treated with NSAIDs or not. Also, I cannot understand why the harmful effects of NSAIDs have neither been argued nor investigated, even though virulence of the influenza virus causing a pandemic has extensively been discussed.
It is urgently needed to carry out a series of carefully planned case -control studies to assess the risks of NSAIDs including ibuprofen, aspirin, diclofenac and even metamizole when used as antipyretics in patients with influenza.
I wrote a rapid response to an article
http://www.bmj.com/cgi/content/full/338/may12_3/b1962
on BMJ.
Potential harm of oseltamivir and NSAIDs should be discussed, before the threa t of a 2009A/H1N1 influenza-caused pandemic is feared.
It's on the web now.
http://www.bmj.com/cgi/eletters/338/may12_3/b1962#214206
Please look at it and respond it,if possible.
regards
HAMA, Rokuro
HAMA, Rokuro MD Chairperson　"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 <URL> http://npojip.org/ Deputy Editor:The Informed Prescriber