Paracetamol and Fever

A recent letter to the New Zealand Medical Journal has raised concern that Paracetamol should not be used for fever in influenza.  The advice given is contradictory, stating that it is fine to use the drug for pain or headache which are most often associated with the fever but not for the fever itself.  According to the letter, some animal studies have shown evidence of harm coming from paracetamol.  The authors feel that this, coupled with the lack of evidence of benefit other than for symptoms measn that paracetamol should not be used for fever alone.

There is good reason to wonder whether treating the fever is a good idea as it does have a biological basis in helping to fight disease, but to date no human studies have shown evidence of harm from doing so.  A quality review of paracetamol and other antipyretics in 2006 concluded that there was no evidence of harm or of illness extension due to the use of paracetamol but it is worth noting that the absence of evidence is not the same as evidence of absence of harm.
If harm does occur, it is probably rare, though as stated,  there have been no human studies.
We respectfully suggest that animal evidence is not wisely extrapolated to humans, especially where it is not in concordance with general observation.  Animal studies do not take into account the differences in treatment given to human patients who do not progress as well as expected during their illness and so poorer outcomes are to be expected.

It remains our advice that if you feel unwell as a result of fever, paracetamol is a sensible and reasonable treatment to use.  If this advice changes, we will of course post it here first.

We should like to remind parents that it is unwise to give ASPIRIN to children under 18 and dangerous to use it for children under 12.  There is a rareand often fatal neurological disorder called Reye's Syndrome which can be triggered by givin aspirin to young children (ibuprofen and paracetamol are safe)

 

Dabigatran (Pradaxa)

Recent media articles have focussed on the newly introduced anticoagulant Dabigatran.  There have been reports of deaths of patients using the drug and concern has been raised that the medication is very new and that it has no antidote.  All this is true.

The evidence for the safety of Dabigatran is very robust - a large trial in which over 18,000 people were randomised to receive either warfarin or dabigatran showed that the risk of bleeding on dabigatran was no higher than for warfarin and that the risk of stroke was lower.

In New Zealand, we are often among the last in the developed world to be offered new drugs.  This is for many reasons, including funding, safety concerns and the fact that we are a relatively small market.  This time, Pharmac has been convinced that dabigatran is worth funding.  This is not due to the cost of blood tests - dabigatran is much more expensive than warfarin and blood tests.  Any savings will come from the expected reduction in strokes, which is the whole point of taking the medication.

The antidote question is most often misunderstood.  Though warfarin may be reversed following overdosage by using vitamin K, this is not quick and often takes 48 hours or more to work.  Dabigatran wears off a lot faster than warfarin and simply stopping the drug should be as effective as giving vitamin K (in theory - there is little experience) Whichever drug you are taking, if you are bleeding then fresh frozen plasma is an effective means of replenishing lost clotting factors.

At Sumner Health Centre we monitor the use of many dangerous medications all the time and are confident that we have excellent systems in place to ensure your safety, whichever medication you choose.

Healthcare Advice Online

Why not check out our After Hours Care section - it's full of hints and tips to help you deal with common family emergencies when the surgery is closed. If you would like more information about a subject, please let us know and we will do our best to add it to the site.

Sumner Health Centre Top Rated by Patients

Thank you very much to all who completed the pilot patient satisfaction survey for Pegasus Health last year. Over 98% of patients rated our service as very good or excellent. We received a number of very pleasant comments and some great suggestions, which we are busy incorporating into our practice. If you have a comment, suggestion, or even a complaint, please let us know - you may call the surgery or email us (see the Contact Us section of this website)

Vitamin C benefit in cancer?

A recent study published by Kuiper et al (Cancer Res; 70(14) July 15, 2010) has generated a lot of interest as it links low levels of vitamin C in endometrial (womb) cancer cells with more aggressive tumours.  It was a very well conducted study and is unusual for a medical paper in that it is also a good read.  Sadly, this study does not show that vitamin C supplementation helps or prevents cancer.  Rather, it shows that in some tumours, lower levels of vitamin C in the tumour cells are associated with more aggressive tumours.  This was only in the tumours, and vitamin C levels were not measured in the patients so we do not know whether patients who had higher levels of vitamin C intake had milder cancers.
To date, there is evidence that intravenous vitamin C can produce concentrations in the body that inhibit the growth of some rat tumours in the lab, but no evidence at all that this helps humans; nor is there any logical reason to believe that any inhibitory effect would last long enough to make any difference.  Oral vitamin C has been proven to be ineffective in treating tumours.  It does not work for colds either.

Paracetamol and Asthma?

There has been a fair bit of interest over the last two years in a possible link between the use of paracetamol in young children and the later development of asthma or allergies.  It is important to note that as yet no such link has been demonstrated.  Several studies have shown that children who receive paracetamol are more likely to get asthma but there are many more plausible explanations for this than the medication.  A recent observational study in Christchurch studied 505 children under 18 months of whom 90% had received paracetamol.  This study showed that the children who did not have paracetamol were three times less likely to report allergies and half as likely to have asthma.  This is such a dramatic change that it is extremely unlikely that paracetamol alone is responisble for the findings.  Paracetamol has been tested in much larger scale trials in children and has not been found to be associated with a significant increase in allergy or illness (though these findings were not actively sought, it is almost inconceivable that a doubling of wheeze symptoms would not be noticed)  The very small number who had not received paracetamol also makes the study valueless in terms of comparison.

For the time being, we feel that there is insufficient evidence to change our current advice that paracetamol is safe to use in children.  This is also the opinion of Medsafe, who monitor medication in New Zealand.  Don't feel too bad if you prefer not to use paracetamol though - your child is unlikely to come to harm from not having it either.

Hopefully a larger scale trial will be arranged soon to put the matter to rest.

 

 

The Calcium Question

Calcium supplements - should I take them or not?  is one of the most frequently asked questions in general practice this year. Initial concern was raised by a study which showed an increase in the risk of cardiac disease in patients taking calcium supplements.  This was followed by two pooled data studies which have tended to confirm the intial suspicions.  All these studies suffer from critical flaws and are of generally poor quality but despite this it remains concerning that they have consistently reported similar risks.
At present the evidence would suggest that on the balance of probabilities, calcium supplements may not be a good idea for most patients, though the matter is by no means settled 'beyond reasonable doubt'.
It is thought that the high peak levels of calcium obtained when using supplements (and particularly soluble supplements) are the cause of the problem.  This may also explain why high levels of calcium in food do not seem to have the same effect.

If you are currently taking calcium supplements, we recommend you make an appointment to discuss them with your doctor.  It remains Sumner Health Centre policy to prescribe calcium supplements where the benefits outweigh the risks, usually to people who have a daily food calcium intake less than 1000mg per day.

Subsidised Mole Removal

Did you know that you can ask your GP to refer you to Sumner Health Centre for top quality minor surgery? Our usual price for most mole removal is $160 but you may qualify for a subsidy of up to $125 depending on your circumstances. Remember, to qualify, you MUST be referred by your own GP.

What a Drip!

Sumner Health Centre now offers Aclasta (Zoledronate) infusions for our enrolled patients.  Aclasta is given once per year and is used as an alternative to Fosamax for osteoporosis.  Infusions take about 30 minutes and cost $100.  If you think Aclasta would suit you, please make an appointment.

Who's On When?

Now it's easy to find out when your favourite doctor or nurse is available.  Use this link to our calendar showing the usual availability of staff.  Please note that this calendar is indicative only.

SHC Indicative Roster Link