Recently, my friend circle has been flooded with discussions among moms about a fever reducing drug that has been phased out overseas for nearly 40 years - Anaconda. It's amazing and infuriating that someone is still using it for our children! Due to its ability to cause serious side effects such as blood system damage such as neutropenia and anemia, Anaxacin has long been phased out of history abroad. However, there are still people in our country who continue to use it, and the reasons behind this are inevitably regrettable. In reality, the drugs that should be phased out but are still in use are not just the "typical" example of metamaterial. At present, in clinical practice, except for ibuprofen and acetaminophen, other antipyretic drugs have long disappeared. These drugs are being phased out not because of poor efficacy, but because of their significant side effects, many of which are even more harmful than Anaxacin.
1、 Why are these antipyretics being phased out abroad? After the continuous release of evidence-based medicine data, drugs with high side effects are gradually replaced by more effective and safer drugs. Aspirin, nimesulide, aminopyrine, metamizole, and phenacetin, which were once widely used for fever reduction, were eliminated in this way.
(1) Aspirin and Reye's Syndrome: In terms of the entire history of medication, aspirin, originally extracted from willow bark, can be considered a century old good medicine. It not only has analgesic, antipyretic, and anti-inflammatory effects, but also plays an important role in preventing platelet aggregation and preventing cardiovascular and cerebrovascular diseases. At present, it still has its place in certain diseases. But in terms of pain relief and fever reduction, with the emergence of the rising star "ibuprofen", aspirin has been taken down. Due to the lack of selectivity in its mechanism of action, aspirin may cause severe gastrointestinal ulcers, gastric bleeding, and tinnitus. If children use it during viral infections such as chickenpox and influenza, it also increases the risk of developing Reye Syndrome. Reye's syndrome is a rare but very dangerous disease that is more common in children under the age of 15. It can cause functional damage to multiple organs such as the brain and liver, and is difficult to treat with a high mortality rate. Therefore, the American Academy of Pediatrics, the Centers for Disease Control and Prevention, the Public Health Agency, and the FDA all recommend that aspirin and aspirin containing drugs should not be used to reduce fever in patients under the age of 19. It is gratifying that the number of patients with Reye's syndrome has greatly decreased since the medical community issued a warning to children to stop using aspirin to reduce fever.
(2) Nimesulide and liver damage: Like aspirin, Nimesulide also exerts antipyretic, analgesic, and anti-inflammatory effects through a similar mechanism. Once loved by doctors for its excellent antipyretic effect. This drug was launched in China in 1997 and was initially approved for the treatment of fever caused by upper respiratory tract infections, postoperative trauma pain, chronic arthritis, and other conditions. At that time, due to limited data, there was no emphasis on the applicable patient age when it was launched. With the widespread use of this drug, the China Food and Drug Administration (CFDA) has received an increasing number of adverse reaction reports from various regions. The adverse reaction reports mainly focus on severe liver damage, mainly seen in children. So CFDA issued a document in 2011, mandating drug manufacturers to emphasize in the instruction manual "Children's Medication" that it is prohibited for children under 12 years old to use it. And downgrade Nimesulide to a second-line anti-inflammatory and analgesic medication, which means that even adult patients can only consider its use if at least one other nonsteroidal anti-inflammatory drug fails.
(3) Aminopyrine and neutropenia/deficiency: Pain relievers were already developed in the 19th century, with Hirschst's "Antipyrine" pioneering in 1883. Later, due to its ability to cause nausea, liver damage, and decreased/deficient granulocytes, antipyrine was eventually eliminated. Aminopyrine is developed on the basis of antipyretic and analgesic effects, but the side effects of reducing granulocytes have not been effectively avoided. Granulocytes are an important safeguard for protecting the human body from pathogenic bacteria. If the protective effect brought by granulocytes is artificially compromised, the patient is in a very dangerous situation. At this time, a small pathogen may cause great harm to the person, and even lead to serious infection and death of the patient. So, in 1938, aminopyrine was removed from the US drug catalog. The current US Pharmacopeia, European Pharmacopeia, and Japanese Pharmacopoeia JP16 cannot find this drug.
(4) Analytica and Granulocyte Deficiency: From the "Family Photo" of the antipyretic drug, it can be seen that Analytica is developed on the basis of aminopyrine. In theory, this advanced development of the drug generally enhances its efficacy and reduces adverse reactions. However, Anabaptin still has a significant side effect of causing granulocyte deficiency (1.1%), which occurs approximately once in every 100 people. Advanced drug Anabapple is not good enough. In 1977, the US FDA withdrew all formulations of metamaterial based on drug safety considerations, and several EU member states such as Japan, Australia, and Iran followed suit. The National Adverse Drug Reaction Monitoring Center has provided a case of death: a 12-year-old girl at the age of a flower paid the price of her life for acute aplastic anemia caused by metamaterial. And her initial illness was only a self limiting disease called 'acute upper respiratory tract infection'.
(5) Finacetin and kidney damage and cancer: Finacetin, invented in 1887, was mainly used as a painkiller at the time. At that time, female workers in Swiss watch companies stared at delicate clocks every day and couldn't help but suffer from headaches, so they almost consumed phenacetin like food every day. As a result, many people experience various health problems after taking medication. After more than half a century of observation and confirmation, doctors have found that long-term use of phenacetin can damage the kidneys and even induce cancer. Other possible adverse reactions include cyanosis and hemolytic anemia. Finally, in 1986, almost all developed countries included phenacetin in their banned drug list.
Throughout the research history of antipyretics, it is not only a glorious development history, but also a bloody history of survival of the fittest. The modern pharmaceutical industry is constantly eliminating old drugs and developing safer and more effective new drugs, which is using scientific and technological means to strive for improving people's quality of life and medical standards. However, I am also deeply saddened to see that these efforts in the pharmaceutical industry have not been fully effective. Some of the drugs on the "family portrait" list that should have been eliminated are still being produced openly, while others have changed their vests and continue to be used. If you really need to choose, I hope everyone will choose to refuse to use such drugs from now on!
2、 What are safe and effective antipyretics?
Refusing to use unsafe antipyretics, what medication should be used? Currently, the safe and effective drugs recognized by the World Health Organization, the US Food and Drug Administration, and the medical community for reducing fever in children are ibuprofen and acetaminophen. Under normal usage and dosage, both are safe. Among them, acetaminophen, marketed as "Tylenol", can be used for babies over 3 months old; The product name of ibuprofen is "Meilin", which can be used for babies over 6 months old. The specific usage and dosage should be scientifically used according to the baby's weight and other conditions. If parents are unsure, please consult a pediatrician and pharmacist.