Good evening, I found an interesting report on the Novalgina, although it has nothing to do with computers, I think many parents will be interested, is long but worth it.
mass use in Argentina and the Third World, drug was banned in the U.S. and in Europe 25 years ago would be associated with the country enfermedad.Aunque no studies of drug surveillance, experts say racial mixing English-araucana makes us stronger.
The metamizol sodium-best known under the trade name of dipyrone, is the drug most widely used mass use in Chile and generally in all third world countries. The reason is simple and concrete: it is by far the cheaper, which is coupled with three actions in one-analgesic, anti-inflammatory and antipyretic, and is sold without prescription. So much so that one can buy a plaster on the corner store or even in the micro to the point of forgetting that this is a remedy and not a mint.
However, not everything is hunky-dory. In 1977 the FDA withdrew the products with sodium metamizol U.S. market and export ban on 27 June of that year. The decision was made after reports of several cases of agranulocytosis, white góbulos severe loss due to damage in the bone marrow, caused by its use, sometimes with fatal results.
is because the FDA found that the granulocytosis can not be prevented effectively, as damage can occur within hours of drug administration, concluding that the risks outweighed the benefits.
Soon joined European countries totaling up to now some 21 nations have banned its use, mostly whites. Denmark did in 1979, Germany in 1987, Italy in 1979. Is restricted or prohibited in Israel, Belgium, Malaysia, Bahrain, Greece, Ireland and Sweden.
In Mexico not approved for pediatric use in Venezuela has prohibited its use and sale and Peru both labeling warns of the danger of agranulocytosis and should be used with a prescription.
According to the World Health Organization (WHO) about the 70, ten years after its entry into the market, this drug was associated as well as other pirozolonas with serious and sometimes fatal reactions which caused her withdrawal.
And while the WHO report acknowledges that the issue has been discussed, "the result of a large international study published in 1986, confirmed the existence of a causal relationship granulocytosis but not with aplastic anemia. "
In Germany Dr. Peter Schnhfer, who came to Chile a few months ago to give a talk on the subject, confirmed that his country one 20 000 patients taking the drug suffered granulocytosis.
NEUTROPENIA
Carlos Merino, specialist in the department of hematology Gustavo Fricke Hospital, explains that dipyrone is a painkiller because of its low cost is the most used in all underdeveloped countries. "Unfortunately from the viewpoint of hematology is capable of producing a condition called neutropenia, which is the reduction of a type of white blood cells called neutrophils whose function is to defend against viral infections.
The decrease of neutrophils may reach such a degree of severity to produce what is called agranulocytosis, which is when the neutrophil count is less than 500 per cubic millimeter of blood (normal is that is over 1,500 per square millimeter) and the main danger is that increases susceptibility to contracting infections can be life threatening. "Among the drugs that are able to more easily cause neutropenia is dipyrone, which in developed countries is classified in dangerous drugs," he explains.
Now there are two mechanisms that produce depression of the white series. "The first is direct toxicity of neutrophil precursors in the bone marrow, which is the way it affects the antibiotic chloramphenicol, and the second is induction of antibodies against neutrophils that is the way involving dipyrone. This product binds to the membrane of neutrophils, a union that would alter some protein and induce the formation of antibodies against white blood cell, "he stresses.
Murphy insists that despite the country the drug is in widespread use, are few cases and so it is very probable that there is any racial susceptibility or genetic type that has not been determined. "What we do is shown is which is a toxic drug for the bone marrow and can cause neutropenia. And when in doubt it is better refrain, "he says.
In fact, he adds, there is a type of patients who should not because the substance administrárseles reaches higher levels in blood and in those with chronic liver damage and elderly patients where drug elimination is delayed.
"for the special one is aware privileges as an alternative analgesic, but I repeat, the cases of agranulocytosis in Chile are rare and apparently is a very large susceptibility between whites and us. Now I prefer to look for alternatives, especially in patients who have a bone disease where if a drug can increase the problem, you better find another, "he concludes.
ORIGINS CHEMICAL
From the point of view of chemical structure metadizol sodium is a drug that corresponds to the group of pyrazolones among which is the dipyrone, phenylbutazone The oxyphenbutazone and other anti-inflammatory analgesic, said Dr. Roberto García Ortiz, a nephrologist, an internist and clinical pharmacologist, who teaches the chair of clinical pharmacology at the School of Medicine, University of Valparaiso.
Within dipyrone drug classification created in the 60's, is a nonsteroidal analgesic aintiinflamatorio, ie part of those drugs that are able to control inflammation, pain and temperature actions shared with a number of other drug groups as oxicam, salicylates, anthranilic acid derivatives, etc.
Anti-inflammatory medications are the most prescribed drugs in the world. Prescribed tons and tons and are also drugs widely used for certain age groups, for example, over 60 years. Moreover, it is estimated that one third of the world's population over 60 years at some point used an anti-inflammatory.
"Within this group is dipyrone, which effectively is questioned in some countries, especially in the Anglo-Saxons by the fact that it is capable of producing a type of adverse reaction called aplastic anemia, irreversible damage to bone marrow and the patient dies then unless a bone marrow transplant. "
Garcia explains that the effect produced by pyrazolones, not only dipyrone, depends not on the dose, but in what is called hypersensitivity. "This drug is able to produce this reaction in certain population groups, Anglo-Saxon, and is therefore banned in countries where we have seen that the risk of pirozolónicos it may cause damage to the bone is high and serious."
Pharmacologist emphasizes that a drug adverse reaction is serious when it is very common and a high percentage of the population makes the adverse reaction, or when isolated, rare but very serious and people die.
"According to statistics in the Anglo-Saxon one for every 100 or 200 thousand people may have an adverse reaction. In Chile there are no statistics, but there the perception that there is the same impact as it otherwise would have because a lot of aplastic anemia who has not taken any dipyrone Once in your life? We have not seen major problems because it seems to mix English Araucanian is apparently more resistant from the viewpoint of the pharmacological effects of pirozolónicos. O is for setting up these things that happen to whites not happen to us, "he says.
Garcia explains that there are other reactions resulting from pirozolones related to the bone, but not the type hypersensitivity are idiosyncratic. "It is likely that any person taking metamizol sodium will lower the amount of white blood cells because there is a slight depression of the bone, but suspended the drug and recovered to normal levels. Ie cytotoxic dose-dependent, very often, but not serious. The other effect of idiosyncratic hypersensitivity is rare, especially in our country, but serious. In common law countries is less rare, and why it is very serious. Effects or drug reactions are produced by different mechanisms. "
Self-Medication
"The solution is a prescription"
pharmacist says one of every ten hospital beds is used to treat patients complicated by drug use.
pharmacologist Roberto Garcia acknowledges that the main problem with the use and abuse of dipyrone, as well as other drugs, is that in Chile actually abused all those that can be bought without a prescription.
"People can not self-medicate. If you are using a non-prescription pain reliever should be restricted some that are potentially lethal, as might be the dipyrone . And in Chile has not been done because the incidence is very low or no marrow dyscrasias aplasias see serious, although transient depression we " sentence.
For this professional prescribing a medication must be made by a physician who can evaluate the risks versus benefits. "I tell my students that every remedy is both medicine and poison. What use will depend? Of how and how medicine is poison. So I find extremely serious advertising that is done to drugs , which leads to self-medication. If you have a cough, take A, if you have stomach pain, take B, and if it is cold, take C night and day. This is serious because it is providing the public with information that is not complete. All drugs produce a risk and people can not use them indiscriminately, "he stresses.
NEW CULTURE
This problem arises when people have the notion that aspirin and dipyrone are not drugs. "The remedies are double-edged sword and that has to prescribe a physician alone can decide, within the wide range of anti-inflammatory that is, what is the need that person. Now there is another group of drugs over the counter, but that does not mean they are without risk. There must be a culture that what is taking is not safe. "
And that self-medication has a cost." If a person take a painkiller, anyone can make a gastrointestinal hemorrhage. Then comes the post, you do an endoscopy, I put blood, indicate medications to treat ulcer ... Self-medication is a cost to the person who is ill and for the system. And the cost of adverse drug reactions is not a minor issue: it is estimated that U.S. the cost is treating adverse drug reactions corresponds to a fifth of its annual health budget. So if we could control the adverse reactions could save money. If I stop people self-medicate, do I keep it simple and do not spend money that can be occupied for other purposes. "
And costs have been measured. According to drug surveillance studies have been conducted in developed countries has shown that one in ten hospital beds are dedicated to serving as a complication of medication. "Self-medication has social and economic implications. How can avoid this expense? Not self-medicate, following instructions, taking the right doses and during the time prescribed" review.
Garcia argues that the problem has its genesis in a person who takes the drug because it is available, because nobody controls it, because I bought at the micro and took it because television told him it was good. "That's not right. There must be a control and this is called a prescription.'ll Have to have a smaller number of drugs that can be bought without a prescription, but a limited group, labeled with the risks and which must exist a culture of people how to use them. "
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