Pain relief with paracetamol and NSAIDs

Paracetamol and NSAIDS
Has antipyretic action


Inhibits enzyme cyclooxygenase No significant anti- In Rheumatoid Arthritis
Effects
that catalyses synthesis of inflammatory effect. PCM alone not enough
Mechanism of prostaglandins and thromboxane +add NSAIDs
action from arachidonic acid
mild analgesic


No effect on platelet function, or clotting factors


Orally well absorbed
not uricosuric.


Pharmacokinetics Absorption does not cause gastric irritation.



Conjugation with glucuronic acid Non
Metabolism -



Paracetamol
toxic
Paracetamol
Glutathione metabolite
(acetaminophen) P450 NABQI
About
Toxic intermediate
5%-10%
metabolite

Toxic
In an overdose, the capacity for Once glutathione
metabolites
conjugation is exceeded with a higher stores are
accumulate
amount undergoing oxidation forming an depleted
,liver
excessive amount of NABQI damage

Excretion - urine


- 4 g daily for an adult Given 4-6 hrly
Dosage Maximum daily
dose 60 mg/kg for a child. In children given
weight based doses

ØChronic alcoholics
Caution ØChronic malnutrition
ØHepatic impairment