[e-farmacos] Uso de diclofenac como antitermico en ninhos? (cont.)

["Maldonado, Juan Carlos" <jcmr72@yahoo.es>]

Buenas tardes,

En PUBMED/MEDLINE pueden encontrarse una pocas referencias al respecto, incluyendo dos ensayos clinicos bastante especificos en el tema: contra
placebo y nimesulida (pero de 1981 y 1985!!!). Al final se adjuntan sus resumentes.

Pero utilizar ASA y AINEs en ninhos no solo conlleva riesgo de Sd. Reye y las conocidas RAM gastrointestinales. Tambien aumentan el riesgo de
broncoespasmo al permitir una mayor conversion del AA (por la ruta de la LOX) hacia leucotrienos. Ni hablar de la nimesulida y su hepatotoxicidad.

Por lo tanto, incluso si hubieran estudios actuales, vale la pena correr la probabilidad de riesgo asociado? 

El paracetamol ha sido (y sigue siendo) el tratamiento de eleccion (por eficacia y seguridad principalmente) para la fiebre y dolor comun en ninhos. Quizas, para fiebre no controlada, el ibuprofeno sea la siguiente mejor alternativa.

Saludos,

Dr. Juan Carlos Maldonado R.
Unidad de Farmacologia
Centro de Biomedicina
Universidad Central del Ecuador

The use of diclofenac sodium (Voltaren) suppositories as an antipyretic in children with fever due to acute infections: a double-blind, between-patient, placebo-controlled study.
Polman HA, Huijbers WA, Augusteijn R.
J Int Med Res 1981;9:343-8.

In a placebo-controlled double-blind, between-patient trial the antipyretic effect of diclofenac sodium (voltaren) was studied in forty-three children ranging from 2-10 years of age. All patients were hospitalized because of acute illness associated with fever (38.5 degrees C-40.4 degrees C; mean 39.3 degrees C) due to viral or bacterial infections. The trial medication
was given in the form of suppositories containing 25 mg of diclofenac sodium or as matching placebo to children aged from 2-5 years. The children aged from 6-10 years received a 50 mg diclofenac sodium suppository or placebo. Body temperature and pulse rate were measured at the time of administration and after 1/2, 1, 2, 4, and 6 hours. The results showed a
return to normal temperature values after 2 hours in all patients receiving diclofenac sodium, whereas in the placebo group only minimal changes were observed. No unwanted effects were reported.
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Antipyretic activity of nimesulide suppositories: double blind versus diclofenac and placebo. 
Reiner M, Cereghetti S, Haeusermann M, Monti T.
Int J Clin Pharmacol Ther Toxicol 1985;23:673-7.

The acute antipyretic activity of nimesulide 200 mg suppositories was tested in a double-blind trial using diclofenac 100 mg suppositories as active reference drug and placebo as blank reference. Eighty-one patients (52 males and 29 females) aged between 18 and 90 years (mean 65 +/- 16.4), with fever of various etiology entered the study. Body temperature, heart
rate and blood pressure were recorded before the drug administration and than after 30, 60, 90, 120, 240 and 360 minutes. Nimesulide proved to be as effective as diclofenac in normalizing body temperature and fever
related objective signs (heart rate and arterial pressure), significantly shortening fever duration with respect to placebo. The tolerability of both
treatments was in general good: 3 cases of nimesulide group (10%) and 4 cases of diclofenac group (17%) complained of slight and transitory side effects. No side effects were complained in the placebo group.
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Y una revision que trata algunos de los aspectos sobre la seguridad:
Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs. 2001;3(11):817-58.