Flu – avoid the aspirin

I wouldn't usually visit a doctor for flu treatment I'd just suffer at home
with the cold remedies and/or over-the-counter fever reducing drugs. I guess a
lot of people will be doing that in the near future, but make sure you are using
the right drugs….

Letters in BMJ today provide some useful reminders about using drugs to bring
down fever in flu. They  are about non steroidal antiinflammatory drugs – these
drugs include include aspirin, ibuprofen, diclofenac and mefenamic acid and are
often the over-the-counter choice to reduce fevers. Until I read this I thought
one could use them on flu.  But no….

The first
letter from Rokuro Hama
of the Japanese Institute of Pharmacovigilance
reminds us there is evidence that NSAIDS can aggravate severe cases of
flu.  Its also well known that salicylates (active ingredient in aspirin)
have been linked to Reye's syndrome in children with flu. Diclofenac and
mefenamic acid are also linked to enceophalopathy in children with flu (see Miziguchi
et al 2007
). Hama says some case control studies of fever reducing drugs in
flu are urgently needed. I can't help but agree!

The second
letter  from Tsunetoshi Shimazu
of Shimazu Clinic in Kyoto, Japan notes
that aspirin was used by patients in the 1918 flu epidemic to reduce fever. But,
he says, a study in 1921 suggests mortality in those who used aspirin was 5-30%
and in those who didn't it was 1%. Can we believe this – the author of that study
was a homeopath- did he have an unbiased view? Then again what doses did people
take? It is suggested that the dosing was higher than we would use today.

Looking at my flu remedy of choice it doesn't contain NSAIDs but paracetamol
(acetaminophen). That cheers me but you have to watch your intake of
paracetamol – its easy to overdose and get liver damage.

Information about treating mild flu:

WHO

CDC

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