IMA issues guidelines on the use of painkillers

Indian Medical Association (IMA) Thursday asked people to desist from using common painkillers like Aspirin and Paracetamol for pain and fever management saying they could cause more harm than good if taken without medical supervision.

PTI| Last Updated: Mar 12, 2015, 23:31 PM IST

New Delhi: Indian Medical Association (IMA) Thursday asked people to desist from using common painkillers like Aspirin and Paracetamol for pain and fever management saying they could cause more harm than good if taken without medical supervision.

The IMA today issued guidelines on the safety and efficacy of non-steroidal, anti-inflammatory drugs (NSAIDs) or painkillers in an attempt to clear misconceptions.

It also opposed the Government's move to allow AYUSH doctors to prescribe over the counter (OTC) painkillers like aspirin and paracetamol.

NSAIDs suppress pain by inhibiting the enzyme cyclo -oxygenase and reducing synthesis of prostaglandins, which promote the inflammatory process.

Since a few years, NSAIDs have been under constant scrutiny and criticism due to their alleged negative effects on the liver, kidney and heart.

"The Indian Medical Association is of the view that it is not right to classify certain NSAIDs safe and others as unsafe for they all have different functions and if used for the right duration, they can be extremely effective in providing pain relief.

"It is, however, important to raise awareness among the public that they must not self-medicate themselves for the underlying condition as it can cause more harm than good," said Dr A Marthanda Pillai, National President of IMA.

Pillai said it was a common perception that OTC drugs like paracetamol or aspirin can be taken for pain relief without consulting a doctor.

"Paracetamol has little anti-inflammatory activity and should be used more to manage fever than pain relief. It also is the number one suicidal agent in the west and the USFDA recommends that not more than 325mg of the drug should be used in any combination tablet," he said.

"Similarly aspirin, if self administered in children can precipitate liver failure, a condition called Reye's syndrome. IMA believes that both Paracetamol and Aspirin should be used under medical supervision," said Dr KK Aggarwal, Secretary General of IMA.

"The same may not be in the public interest as they have little knowledge about when not to use these drugs," said Aggarwal.

According to Dr Ramesh Hotchandani, Nephrologist, Moolchand Hospital, "Pain is a condition that affects almost everybody at some point of time in his or her life. In India itself, 76 per cent of professionals who are regular computer users suffer from muscular pain, 15-20 per cent from acute pain and 25-30 per cent from chronic pain at least once in their lifetime.

"This makes effective and safe pain management an extremely important topic of debate around the globe today. Painkillers, however, should be used judiciously as even one tablet can precipitate kidney failure in susceptible individuals," he said.

According to IMA guidelines on NSAIDs, aspirin should not be administered to children as it can cause fatal liver failure. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.

"Paracetamol should not be taken without medical consultation. It is number one suicidal agent in the West. As per USFDA, combination products that contain paracetamol should not contain paracetamol salt dose more than 325 mg in each tablet or capsule.

"Drug Controller General of India approved Nimesulide on January 13, 1995 for painful and inflammatory conditions as well as fever and it can be safely prescribed to people above the age of 12 years for up to 15 days," said IMA in a statement.

"In general, painkillers are safe drugs when used in patients who are not at high risk for gastrointestinal, renal, or cardiovascular reactions. All heart patients should consult their doctor before taking a painkiller especially if they are on low dose aspirin.

"Even one tablet of pain killer in susceptible kidney patients can precipitate kidney failure," the guidelines say.