BACKGROUND: Prostaglandin inhibitors have been successfully used to inhibit some types of postoperative pain and reduce opioids requirements in others. Antiprostaglandin activity may be ineffective unless the preparations are given at the appropriate time before surgery. This study aimed to determine if the intrarectal administration of acetaminophen immediately before surgery would markedly reduce pain in the postoperative period. METHODS: The children were divided to two groups. Each group was consisted of 15 children. The children in control group were administered intramuscularly glycopyrrolate(0.004 mg/kg) 20 minute. The children in experimental group were administered glycopyrrolate(0.004 mg/kg) intramuscularly and were administered acetaminophen(250 mg) rectally 20 minute before the children were taken to the operating theatre. RESULTS: In the recovery room, the children who had recived acetaminophen were signifcantlly quieter (p<0.01), agitated less(p<0.01) and cried less(p<0.01) painless(p<0.01) than those nonadministered group. There were no obvious differnces between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postopertive complications become evident. CONCLUSIONS: The preoperative rectal administration of acetaminophen for pain relief after tonsillectomy is safe and effective.
Acetaminophen* ; Administration, Rectal ; Analgesics, Opioid ; Child* ; Dihydroergotamine ; Hemorrhage ; Humans ; Pain, Postoperative* ; Postoperative Period ; Prostaglandin Antagonists ; Recovery Room ; Tonsillectomy*

OBJECTIVES: The hepatotoxicity of acetaminophen is not a result of the parent compound but is mediated by its reactive metabolite N-acetyl-p-benzoquinone imine. Cytochrome P4502E1 (CYP2E1) is the principal enzyme of this biotransformation, which accounts for approximately 52% of the bioactivation in human microsomes. Recently, chlormethiazole a sedative drug, is reported to be an efficient inhibitor of CYP2E1 activity in human beings. In this study we wished to evaluate whether chlormethiazole, an inhibitor of CYP2E1, could prevent acetaminophen-induced liver injury in mice. METHODS: Acetaminophen, at doses ranging from 200 to 600 mg/kg, was injected into the peritoneum of female C57BL/6 inbred mice fasted for four hours. Chlormethiazole (60 mg/kg) or 5% dextrose water was given 30 min before or 2 h after acetaminophen. Serum aminotransferase activities, histologic index score, survival rate and hepatic malondialdehyde levels were compared. RESULTS: Pretreatment with chlormethiazole 30 min before 400 mg/kg of acetaminophen completely inhibited acetaminophen-induced liver injury (median 118.5 U/L, range 75 to 142 vs. 14,070 U/L, range 5980 to 27,680 for AST; 49 U/L, range 41 to 64 vs. 15,330 U/L, range 13,920 to 15,940 for ALT). In mice receiving chlormethiazole 2 h after acetaminophen, the mean AST and ALT levels were also less elevated, reaching only 20% of the value of acetaminophen-only group. These protective effects were confirmed histologically. Whereas more than 50% of mice died at 500 mg/kg of acetaminophen, all the mice pretreated with chlormethiazole survived at the same dose. CONCLUSION: Chlormethiazole effectively reduces acetaminophen-induced liver injury in mice. Further studies are needed to assess its role in humans.
Acetaminophen/toxicity* ; Acetaminophen/metabolism ; Acetaminophen/antagonists & inhibitors ; Analgesics, Non-Narcotic/toxicity* ; Analgesics, Non-Narcotic/metabolism ; Analgesics, Non-Narcotic/antagonists & inhibitors ; Animal ; Chlormethiazole/pharmacology* ; Cytochrome P-450 CYP2E1/antagonists & inhibitors ; Enzyme Inhibitors/pharmacology ; Female ; Human ; Liver/metabolism ; Liver/injuries* ; Liver/drug effects* ; Mice ; Mice, Inbred C57BL ; Sedatives, Nonbarbiturate/pharmacology* ; Support, Non-U.S. Gov't

A 59-year-old female patient with rheumatoid arthritis showed hypokalemic metabolic alkalosis, normotensive hyperreninemic hyperaldosteronism and high urinary prostaglandin level. She was thought to have Bartter's syndrome. But, her kidney biopsy specimen showed chronic interstitial nephritis. She have used acetaminophen containing analgesics for recent three years. So we thought her disease was caused by drug. But, in this case, clinical manifestations are correspond with Bartter's syndrome and we have witnessed a successful respond to kalium replacement, angiotensin converting enzyme inhibitor, prostaglandin inhibitor and spironolactone administration.
Acetaminophen ; Alkalosis ; Analgesics ; Arthritis, Rheumatoid* ; Bartter Syndrome ; Biopsy ; Female ; Glycogen Storage Disease Type VI ; Humans ; Hyperaldosteronism ; Kidney ; Middle Aged ; Nephritis, Interstitial* ; Peptidyl-Dipeptidase A ; Prostaglandin Antagonists ; Spironolactone

Fixed drug eruption is an uncommon adverse drug reaction caused by delayed cell-mediated hypersensitivity. Levocetirizine is an active (R)-enatiomer of cetirizine and there have been a few reports of fixed drug eruption related to these antihistamines. We experienced a case of levocetirizine-induced fixed drug eruption and cross-reaction with other piperazine derivatives confirmed by patch test. A 73-year-old female patient presented with recurrent generalized itching, cutaneous bullae formation, rash and multiple pigmentation at fixed sites after taking drugs for common cold. She took bepotastine besilate (Talion®) and levocetirizine (Xyzal®) as antihistamine. She took acetaminophen, pseudoephedrine 60 mg / triprolidine 2.5 mg (Actifed®), dihydrocodeinebitartrate 5 mg / di-methylephedrine hydrochloride 17.5 mg / chlorpheniramine maleate 1.5 mg / guaifenesin 50 mg (Codening®) and aluminium hydroxide 200 mg / magnesium carbonate 120 mg (Antad®) at the same time. Patch test was done with suspected drugs and the result was positive with levocetirizine. We additionally performed patch test for other antihistamines such as cetirizine, hydroxyzine, fexofenadine and loratadine. Piperazine derivatives (cetirizine and hydroxyzine) were positive, but piperidine derivatives (fexofenadine and loratadine) were negative to patch test. There was no adverse drug reaction when she was challenged with fexofenadine. We report a case of levocetirizine-induced fixed drug eruption confirmed by patch test. Cross-reactions were only observed in the piperazine derivatives and piperidine antihistamine was tolerant to the patient.
Acetaminophen ; Aged ; Carbon ; Cetirizine ; Chlorpheniramine ; Common Cold ; Drug Eruptions ; Drug-Related Side Effects and Adverse Reactions ; Exanthema ; Female ; Guaifenesin ; Histamine Antagonists ; Humans ; Hydroxyzine ; Hypersensitivity ; Loratadine ; Magnesium ; Patch Tests ; Pigmentation ; Pruritus ; Pseudoephedrine ; Triprolidine

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.
Acetaminophen ; Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Antitussive Agents ; Ascorbic Acid ; Child ; Codeine ; Common Cold* ; Complementary Therapies ; Cough ; Drug Therapy* ; Expectorants ; Garlic ; Geranium ; Histamine Antagonists ; Honey ; Humans ; Larynx ; Nasal Decongestants ; Nonprescription Drugs ; Nose ; Pharynx ; Probiotics ; Respiratory System ; Respiratory Tract Infections ; Zinc