--Select--

Internal Medicine

Is Paracetamol A Cure To All Kind of

Fevers?
Is Paracetamol A Cure To All Kind of Oct 12, 2017
Fevers?

girl taking medicine, disease session viral fever

Question: What is fever?

Answer: Fever is the body’s way of heat-killing
germs. Just like we try to kill germs by boiling
or burning, the body increases the body
temperature in an attempt to kill the infecting
germs. The more severe an infection, the
higher is the fever. Also, for those germs that
are heat resistant, the body has to increase its
temperature much higher. Viruses are very
heat resistant which is why viral infections
often results in very high temperatures, and is
not easily controlled with normal fever
medication like paracetamol.For
example, dengue fever symptoms do not
abate completely with paracetamol.
Question: Why do we try to
control fever?
Answer: Our body can function most effectively
within a narrow range of temperature called the
“Optimum Temperature”. Outside this
temperature range the biochemical processes of
our body cannot function properly. Therefore we
need to control the temperature. Also children
between 6 months and 6 years may be prone to
developing seizures with temperature
particularly if they have a family history of it, so
we may want to reduce that risk. But most
importantly, it is to make the child feel better, eat
and drink better and help parents cope with
their child’s illness. We must remember that
controlling fever with fever medicines does not
treat the actual cause of the fever which is the
infection.
Questions: Is there any
downside of actively
controlling fever?
Answer: By actively controlling fever, we are
actually suppressing body’s own mechanism of
fighting the infecting germs. Recent evidences
that have surfaced over the past few years are
quite surprising. Recent researches have shown
that the higher the temperature in severe
bacterial infections, the better is the survival.
Treatment with paracetamol has shown to
increase the duration of illness in diseases
like chicken pox and malaria, and the period of
infectivity for normal cold. It is very common to
prescribe paracetamol after vaccines for children.
But researches show that giving paracetamol
reduces the effectiveness of vaccines. In the
wake of these research findings, a massive HEAT
Study was conducted on patients admitted in
intensive care with serious infections, which
showed that if we do not control moderately
high temperatures and instead restrict the
paracetamol use only to very high temperature,
more patients will survive. This has given rise to
the concept of “Permissive Hyperthermia”
where, for children, we administer paracetamol
only when the temperature goes above 104F
rather than the usual practice of using
paracetamol for temperature more than 101F.
But the biggest danger that we need to be
worried about is that paracetamol that all of us
think is a harmless medication, is actually the
most common medication that causes serious
damage to the liver that needs liver transplant,
a facility not widely available in India.
Question: What is the danger
of getting Liver Failure from
paracetamol use during
fever?
Answer: We do see this often. Paracetamol is
generally safe when used strictly according to its
recommended dosage. But problem arises
because we often do not realise that we are
inadvertently exceeding the recommended
dose. Recommended dose for paracetamol is
60mg for each 1 kilogram body weight for an
entire 24 hours. And it is given usually at 6 hourly
gaps i.e. a total of 4 doses a day. Thus a 10kg baby
should have a total of 600mg in a day, usually
given as 150mg every 6 hours. Very often,
particularly with viral infection, where
temperature does not fully get controlled with
paracetamol, temperature either does not come
down to normal, or does not stay down for full 6
hours. At these times there is often a tendency to
repeat the dose before schedule, or giving
another formulation that may also contain
paracetamol in it as a combination with some
other medication. We think it is a different
medication but very few of us actually read the
composition to find out if it contains
paracetamol or not. Thus unknowingly we
overdose our children with paracetamol and
then find that the child has become jaundiced
and once we take him to the hospital we find he
has got Liver Failure which is potentially a life
threatening condition.
Question: What are the
medications that contain
paracetamol in combination
with some other medication?
Answer: There are many such medications. The
Most common ones of which are: Ibuprofen +
Paracetamol and Diclofenac + Paracetamol –
mostly used for pain and swelling, and
sometimes unwisely used for fever as well, owing
to the preconception that any medication that
relieves pain and swelling (inflammation) also
helps with fever Decongestants (often used for
cough and cold) contain an antiallergic and a
decongestant as a fixed dose combination with
paracetamol. Many times we prescribe just plain
Ibuprofen, but the medicine shops may
inadvertently dispense Ibuprofen’s fixed dose
combination with paracetamol, for often the
name is similar, with just a “Plus” written next to
it. The problem arises for Ibuprofen “Plus” that
contains Ibuprofen which is meant to be
administered every 8 hourly is combined with
paracetamol which is meant to be administered
every 6 hourly. Thus if we use this as a substitute
for paracetamol and give it 6 hourly, we are
giving an overdose of ibuprofen which may
cause damage to kidneys, and if we use it 8
hourly, we are not giving adequate dose of
paracetamol.
Question: Fixed dose
combination medications can
be very confusing!
Answer: Indeed. That is why we hardly ever use
fixed dose combinations in Developed Countries.
Question: So what to do if
fever is not controlled with
Paracetamol?
Answer: First we need to decide how important
it is to control the temperature. Often a little bit
of a temperature may be acceptable. If
temperature returns within 6 hours of a
paracetamol dose, and we need to control it, we
need to give a dose of Ibuprofen to alternate
with paracetamol. Ibuprofen is to be given every
8 hours and paracetamol is to be given every 6
hours. Caution should be exercised while using
Ibuprofen in dengue prone areas particularly the
Dengue seasons, and your doctor should be
consulted before starting Ibuprofen for your
feverish child. But most importantly if you are
prescribed Ibuprofen, you need to make sure
that you are not given one of those “Plus”
formulations that contain paracetamol in it.
Question: So is it important
to check the composition of
the tablet or Syrup?
Answer: Absolutely. It is very important to make
sure that the composition of your Ibuprofen
formulation does not mention paracetamol. If
you are unsure, just ask your pharmacist to
check the composition for you.

Related Blogs View all

Internal Medicine Internal M

Enjoy A Healthy Monsoon Zoono

Dr. J. M. S. Kalra Jan 23, 2024 admin

Keep track of your

appointments, get
updates & more!

Feel Free to ask us

Ask your question

About Us

Patient Care and Services

Statutory Compliances

Clinical Outcomes

Tower A, Unitech Business Park,

Block - F, South City 1, Sector - 41,
Gurgaon, Haryana - 122001

STAY IN TOUCH

Contact Us Privacy Policy Terms & Conditions

Gifting Policy Online payment & refund policy Tele-consult
Contact

© 2022 Fortis Healthcare. All Rights Reserved.

Request a Callback Book Appointment Get Health Checkup