Aspirin

Paracetamol

Indications

Contra-indications

Cautions

Side-effects

Drug interactions

See BNF appendix 1 for a comprehensive list of interacting drugs

The usual adult dose of paracetamol is 500-1000mg every 4-6 hours, to a maximum of 4g daily. As the dose is age and weight related for children, nurses should refer to the Nurse Prescribers' Formulary (NPF) for prescribing information. Higher doses of analgesics may be prescribed when children are discharged from hospital, but should not be continued for more than two to three days.

What are they used for?

Aspirin and paracetamol are used to treat various musculo-skeletal aches, pains, headaches and minor injuries, as well as pyrexia (see table 1). Aspirin (and other NSAIDs) may also be useful in treating bone pain in palliative care.

In addition, aspirin is used in low doses to reduce platelet aggregation and prevent the recurrence of cerebrovascular or cardiovascular disease. However, nurses should not prescribe aspirin for these conditions.

Paracetamol is the simple analgesic of choice in most cases, especially in pregnancy and for children under the age of twelve years. It is also used to treat discomfort caused by minor acute infections, surgical procedures and vaccinations.³

Prescribing analgesics in children

Health visitors have most contact with children in the community. However, the move to earlier discharge after surgery means some aspects of pain management in children have shifted from hospital to district nurses. It is, therefore, important that all community nurses are aware of the special attention required when prescribing for children.

Drug absorption, metabolism, distribution and excretion are very different in children, especially younger children, compared with adults.⁴ Drug distribution depends on many factors, including total body fat and water, maturity of physio-logical barriers, blood flow and the concentration of plasma proteins. These factors can alter significantly as a child grows, thus affecting drug distribution.⁴ It is, therefore, vital that the appropriate dose is given.

When prescribing medicines for children, sugar free preparations should be used whenever possible. This is because sugar containing products cause demineralisation of tooth enamel, which expedites tooth decay.⁵

Management of pyrexia

The treatment of pyrexia is a controversial subject, with arguments for and against treatment. Treatment is usually given to provide comfort and to avoid febrile convulsions in infants. Although many doctors advocate this practice, there is a lack of evidence to support the use of antipyretics to prevent febrile seizures.⁶ In addition, a literature review concluded that routine antipyretic therapy for fever is generally unnecessary and can suppress signs of ongoing infection.⁷ While fevers of less than 41^oC are considered relatively harmless and may be very important diagnostically, many of the beneficial effects of fever diminish at 42^oC.⁶

A double-blind randomised controlled trial compared a therapeutic dose of paracetamol with placebo in 225 children with fever of presumed viral origin.⁸ Children with a history of febrile or afebrile convulsions were excluded from the trial, as were children with fever of 41^oC or over. No significant difference was found in the mean duration of fever between the groups. In the treated group, parents rated their children as having an improvement in activity (38% with paracetamol; 11% with placebo) and alertness (33% vs 12%), but no significant differences were noted in mood, comfort, appetite or fluid intake.

Before an antipyretic is given, prescribersshould assess each individual case and consider the relative risks (such as possible delayed diagnosis), and benefits (such as patient comfort) of the treatment. It is also important to ensure that the environment is conducive