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Ilmu Terapan => Kesehatan => Topik dimulai oleh: syx pada Maret 24, 2009, 11:46:51 PM

Judul: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Maret 24, 2009, 11:46:51 PM: Obat pereda nyeri aman dan efektif jika digunakan secara benar. Jutaan orang menggunakan obat ini setiap hari. Pemakaian tidak sesuai anjuran yang tertera pada label bisa menyebabkan akibat yang serius.
Satu hal yang perlu diperhatikan selama pemakaian obat over-the-counter (OTC) adalah label yang memuat daftar isi bahan aktif. Banyak obat OTC yang dijual untuk pemakaian berbeda namun memiliki bahan aktif yang sama. Bukan itu saja, bahan aktif dalam OTC juga bisa ditemui dalam obat resep. Misalnya, obat batuk dan flu bisa mengandung bahan aktif yang sama dengan obat sakit kepala atau obat resep untuk penghilang rasa sakit.
Pada dasarnya ada dua jenis obat OTC pereda nyeri, yaitu yang mengandung acetaminophen atau paracetamol dan yang mengandung non-steroidal anti-inflammatory drugs (NSAIDs). Obat ini digunakan untuk meredakan rasa sakit dan nyeri minor yang berkaitan dengan sakit kepala, demam, flu, artritis, sakit gigi, kram menstruasi, dan migren.
Acetaminophen adalah pereda nyeri dan penurun panas yang paling umum digunakan. Pemakaian bahan ini dalam jumlah berlebih bisa menyebabkan kerusakan hati. Resiko kerusakan hati bisa meningkat karena konsumsi alkohol selama pemakaian obat yang mengandung acetaminophen. Tanda-tanda atau gejala gangguan hati antara lain warna mata dan kulit berubah menjadi kuning, urin berwarna lebih gelap, feses berwarna lebih terang, mual, muntah dan kehilangan nafsu makan. Tanda yang terjadi bisa mirip dengan gejala flu hingga tidak diketahui selama beberapa hari karena pasien beranggapan itu adalah gejala penyakit awal yang ingin diobati. Gangguan yang lebih serius bisa berupa gangguan mental, koma, dan bahkan kematian.
NSAID juga sering digunakan sebagai pereda nyeri dan penurun panas. Contoh obat dari golongan ini antara lain aspirin, ibuprofen, naproxen sodium, dan ketoprofen. Ada beberapa faktor yang dapat meningkatkan resiko pendarahan lambung selama pemakaian obat ini, antara lain usia di atas 60 tahun, penggunaan obat pengencer darah, sebelumnya telah memiliki tukak lambung atau masalah pendarahan yang lain. Jika ada faktor resiko tersebut sebaiknya pasien memberitahukan kepada dokter sebelum pemakaian NSAID. NSAID juga bisa menyebabkan gangguan ginjal, yang faktor resikonya bisa meningkat pada pasien yang berusia di atas 60 tahun, pasien dengan tekanan darah tinggi, gangguan jantung atau sebelumnya mengidap gangguan ginjal, dan/atau pasien yang menggunakan obat diuretik.
Jadi kenali obat yang akan anda gunakan dan jangan gunakan melebihi dosis yang dianjurkan. Sebaiknya tidak menggunakan obat melebihi waktu yang ditentukan atau menggunakan beberapa produk obat yang mengandung bahan yang sama pada saat bersamaan.

Sumber:
Health Hints: Use Caution with Pain Relievers
Health Bulletin: Use Caution with Pain Relievers
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: h4ry pada Maret 25, 2009, 01:31:00 AM: klo Db ?

pa jga sama kalau disaat lagi panas dikasih obat itu , , , ;D ;D
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Maret 25, 2009, 04:09:08 AM: demam berdarah? dalam penyakit ini acetaminophen yang jadi pilihan utama. pemakaian NSAID dihindari karena resiko pendarahan lambung dan beberapa bisa mengganggu proses pembekuan darah. akibatnya NSAID bisa memperparah pendarahan yang ada pada dbd akibat penurunan trombosit.
Judul: Analgesik
Ditulis oleh: biobio pada Juli 13, 2009, 01:30:00 AM: Apa yang terjadi ketika kita mengkonsumsi analgesik (misal:asam mefenamat) dalam jumlah berlebih?
Judul: Re: Analgesik
Ditulis oleh: syx pada Juli 14, 2009, 07:22:33 AM: ini yang dimaksud adalah pemakaian obat NSAID (non steroidal antiinflammatory drugs) secara berlebih? efek samping tentu saja berkaitan dengan mekanismenya dalam menghambat pembentukan (biosintesa) prostaglandin (PG). selain itu karena kebanyakan obat golongan ini bersifat asam (asam salisilat, asam mefenamat, asam diklofenak, dll), maka lebih sering ngumpulnya pada sel yang bersifat asam, misalnya di lambung, ginjal dan jaringan yang meradang. karena itu efek sampingnya lebih banyak pada tempat ngumpulnya itu karena kadarnya yang cenderung tinggi di area situ.
secara umum efek samping cenderung terjadi pada tiga sistem organ, yaitu saluran cerna, ginjal dan hati. jadi pemakaian berlebih bisa merusak hati, terutama pada pasien lansia. apesnya lagi emang pasien lansia yang banyak pake obat ini karena udah mulai sering ngilu karena encok ato penyakit masa tua lainnya.
efek lain yang sering nongol adalah tukak lambung ato yang biasa disebut sakit maag. kadang bisa parah banget sampe pendarahan lambung yang diikuti anemia sekunder. beratnya efek samping ini tergantung obatnya. ada dua mekanisme yang bisa terjadi, yaitu efek lokal dan efek sistemik. efek lokal terjadi kalo obat kontak langsung pada permukaan mukosa lambung dalam jumlah yang tinggi, misalnya obat tidak pecah dengan cepat di lambung sehingga bentukan tablet menempel pada mukosa. efek lokal ini paling banyak ditemui kalo kita menggunakan asam salisilat. makanya sekarang sediaan asam salisilat ada dalam bentuk esternya, aspirin dan dibuat dalam sediaan tablet salut enterik, artinya obat dilepaskan di usus.
efek sistemik terjadi setelah obat diserap dan menghambat biosintesa PGE2 dan PGI2. kedua macam prostaglandin ini banyak terdapat di mukosa lambung dan berfungsi untuk menghambat sekresi asam lambung dan merangsang sekresi mukus yang bersifat sitoprotektif.
efek samping lan adalah gangguan fungsi trombosit akibat hambatan biosintesis tromboksan A2 (TXA2). efek samping ini dipake juga dalam terapi dan pencegahan tromboemboli, misalnya aspirin dalam dosis 80 mg.
Judul: Re: Analgesik
Ditulis oleh: nandaz pada Juli 14, 2009, 10:24:39 AM: Kutip
kedua macam prostaglandin ini banyak terdapat di mukosa lambung dan berfungsi untuk menghambat sekresi asam lambung dan merangsang sekresi mukus yang bersifat sitoprotektif.
...hmm, baru tau sekresi mukus juga ada dilambung(sebelumnya kupikir cuman dihidung) :)

oh ya ada yang tidak dimengerti disini istilahnya maksudnya apa?
1.
Kutip
pencegahan tromboemboli
2.
Kutip
pasien lansia
3.
Kutip
anemia sekunder
Judul: Re: Analgesik
Ditulis oleh: syx pada Juli 14, 2009, 10:52:08 PM: di lambung ada lapisan mukus untuk mencegah kontak langsung antara enzim pencerna protein dan asam lambung terhadap sel permukaan dinding lambung. tau sendiri kan akibatnya kalo enzim pencerna ini mengenai sel yang juga terdiri dari protein?

tromboemboli adalah penyumbatan pembuluh darah yang disebabkan aktifitas abnormal dari trombosit.

lansia adalah singkatan dari lanjut usia.

anemia adalah penyakit kekurangan darah, terutama sel darah merah (atau hemoglobinnya) sebagai pengangkut makanan dan oksigen. penyebabnya bisa karena ketidakmampuan membentuk sel darah merah, misalnya karena gangguan sumsum tulang pembentuk sel darah merah, kekurangan zat besi, asam folat dan vitamin B12; kehilangan darah karena pendarahan; atau karena perusakan sel darah merah dalam waktu singkat. anemia sekunder adalah yang disebabkan oleh pendarahan.
Judul: Re: Analgesik
Ditulis oleh: nandaz pada Juli 17, 2009, 10:06:17 AM: oh gitu, thanks...
Judul: Re: Analgesik
Ditulis oleh: ade_sugi pada Juli 18, 2009, 01:49:25 AM: mohon saran syx (global moderator frofesor)

bagaimana klo kt udah mengkomsumsi untuk menetralkannya?
adakah obat pengganti analgesik ?

mohon sarannya....?
Judul: Re: Analgesik
Ditulis oleh: syx pada Juli 18, 2009, 09:20:15 AM: gw bukan profesor...
pengganti analgesik? maksudnya?
obat ini cuma menghilangkan gejala aja, tidak menghilangkan penyebab. tapi gejala itu seringkali terasa mengganggu, misalnya sakit kepala, demam disertai panas tinggi, dan kadang peradangan. kalo tahan menderita ya ga usah pake obat itu. tapi untuk panas tinggi musti tetep pake biar panasnya ga kebablasan.
sementara ini yang dianggap paling aman sebagai obat analgesik antipiretik adalah parasetamol. cuma pemakaiannya jangan overdosis karena metabolitnya yang bisa menyerang hati (hepatotoxic). kalo ada bengkak, parasetamol ga mampu mengatasinya.
Judul: Re: Analgesik
Ditulis oleh: dark_nekron pada Juli 30, 2009, 11:24:30 PM: Klo gak salah..
Klo mucus d gaster n d intestinum tenue nya hilang dapat terjadi gastric ato duodenal ulcer..

@masta syx
kan seorang fever itu karena inflamasi khususnya karena infeksi. Gmn klo infeksinya d hepar? Denger2 NSAIDs adverse effect nya ngerusak hepar.
Judul: Re: Analgesik
Ditulis oleh: adinnda pada Juli 31, 2009, 02:23:22 AM: analgesik yg dianggap paling aman parasetamol, tapi dalam pemakaian jangka panjang merusak hati

@dark nekron : maksudnya demam karena inflamasi khususnya karena infeksi??? salah satu gejala inflamasi adalah panas (color)
Judul: Re: Analgesik
Ditulis oleh: syx pada Juli 31, 2009, 04:06:10 AM: ... bukan cuma jangka panjang, tapi pemakaian melebihi dosis yang dianjurkan bisa merusak hati (>4 gram sehari).
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 07, 2010, 10:05:37 PM: Recommendations for Prescribing NSAIDs in the Primary Care Setting
Laurie Barclay, MD

December 28, 2009 — A review article published in the December 15 issue of the American Family Physician offers recommendations for prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting.

"...NSAIDs are commonly used to treat inflammation, pain, and fever by decreasing prostaglandin synthesis through blockage of the cyclooxygenase (COX) enzyme," write Amanda Risser, MD, MPH, from Oregon Health and Science University in Portland, and colleagues. "The two major isoforms of COX (COX-1 and COX-2) are inhibited by nonselective NSAIDs. COX-2 is also inhibited by selective NSAIDs. All nonselective NSAIDs inhibit platelet aggregation through inhibition of COX-1 and the thromboxane A2 (TXA2) pathway."

Although NSAIDs are in widespread use, there are accompanying risks, including significant upper gastrointestinal (GI) tract bleeding (particularly in older persons), risks in those receiving anticoagulant therapy, and risks in patients with a history of upper GI tract bleeding associated with NSAID use. Dyspepsia, abdominal pain, GI discomfort, and GI bleeding may be reduced by combining the NSAID with a proton pump inhibitor (PPI) or histamine H2 blocker.

Despite the cardioprotective qualities of aspirin, other NSAIDs may have adverse cardiac effects, including worsening of congestive heart failure, increase in blood pressure, myocardial infarction, and ischemia. The risk for myocardial infarction is increased with COX-2 inhibitors, although celecoxib, which is the only COX-2 inhibitor still available in the United States, is somewhat safer regarding cardiovascular effects.

NSAIDs should not be used in patients with cirrhotic liver diseases because such patients are at greater risk of bleeding and for kidney failure. However, NSAIDs rarely cause hepatic damage, and any hepatic effects are usually reversible. NSAIDs with more potential for hepatic problems include sulindac and diclofenac.

Caution is advised when NSAIDs are prescribed in the setting of anticoagulant therapy, platelet dysfunction, or immediately before surgery.

Central nervous system adverse effects of NSAIDs may include aseptic meningitis, psychosis, and tinnitus. NSAIDs may also trigger or exacerbate asthma. In patients with asthma, especially those with nasal polyps or recurrent sinusitis, NSAIDs and aspirin should be avoided.

During the last 6 to 8 weeks of pregnancy, NSAIDs should be avoided to prevent prolonged gestation from inhibition of prostaglandin synthesis, premature closure of the ductus arteriosus, and antiplatelet activity causing maternal and fetal complications. However, most NSAIDs are likely safe in pregnancy. In breast-feeding women, ibuprofen, indomethacin, and naproxen can be safely used. Parents should be educated regarding correct NSAID dosing and storage in childproof containers to prevent accidental NSAID overdose in children.

Key Recommendations

Specific key clinical recommendations for practice, and their accompanying level of evidence rating, are as follows:

* Physicians should consider prescribing PPIs, double-dose histamine H2 blockers, or misoprostol with NSAIDs for persons who must take NSAIDs, although they have had an NSAID-associated ulcer. Celecoxib may also be used alone in these patients, but this drug should be avoided in patients at increased risk for myocardial infarction. Women who might become pregnant should not take misoprostol (level of evidence, C). Two systematic reviews describe the use of NSAIDs in this setting for the prevention of endoscopic ulcers.
* For prevention of acute renal failure, NSAIDs should be avoided whenever possible in patients with preexisting kidney disease, congestive heart failure, or cirrhosis (level of evidence, C, based on a literature review and a summary of consensus guidelines).
* For patients at risk for renal failure, and in those taking angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, physicians should consider monitoring serum creatinine levels after prescribing treatment with NSAIDs (level of evidence, C, based on a summary of consensus guidelines).
* In patients taking anticoagulants, NSAIDs and aspirin should be avoided if possible. An increase in international normalized ratio (INR) should be expected if concurrent use of NSAIDs and anticoagulants is required. These patients should have appropriate INR monitoring, dosage adjustments of warfarin, and GI prophylaxis (level of evidence, C, based on a systematic review).
* In breast-feeding women, ibuprofen, indomethacin, and naproxen can be safely used (level of evidence, C, based on a consensus guideline).

Editorial: Increased Cardiovascular Concerns

In an accompanying editorial, Gunnar H. Gislason, MD, PhD, from Copenhagen University Hospital Gentofte in Copenhagen, Denmark, describes increased concerns regarding the cardiovascular safety profile of NSAIDs, which have come to light during the last decade. Although these concerns were first recognized for COX-2 inhibitors, increased cardiovascular risk associated with nonselective NSAIDs has recently been identified.

Because there will always be groups of patients with pain conditions who must take NSAIDs, there is a need to focus on the balance between risk and benefit before NSAID therapy is started.

"This is especially important in persons with established cardiovascular disease in whom alternative pain treatment with lower cardiac risk (e.g., acetaminophen, weak opiates) should always be the first choice," Dr. Gislason writes. "In persons needing NSAID treatment, NSAIDs with the highest COX-1 selectivity (e.g., naproxen, ibuprofen, aspirin) should be preferred and used in the lowest dosages and for the shortest durations possible. For stronger analgesic effect, a combination with other types of analgesics should be considered."

As supplements to analgesic therapy, Dr. Gislason also recommends considering nonpharmacologic treatment, such as physiotherapy and physical exercise.

"Epidemiologic studies have demonstrated extensive use of prescription NSAIDs in the general population, as well as in persons with established cardiac disease," Dr. Gislason concludes. "Also, in many countries, NSAIDs are sold without a prescription, expert advice, limits on their use, or information on potential adverse effects. This indicates the need for reevaluation of current treatment strategies regarding NSAID use and the misconception that NSAIDs are harmless for everyone."

The review authors and editorialist have disclosed no relevant financial relationships.

Am Fam Physician. 2009;80:1371-1378.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Januari 07, 2010, 10:33:08 PM: Oia, mau tanya juga,
Yang parasetamol bisa merusak hati itu kan karena sifatnya yang mengganggu metabolisme Billirubin karena paresetamol itu bersaing dengan UDP-Glukoronil Transferase ya? Jadinya UDP tidak bisa mengikat Billirubin di Hati. Karena itu terjadi penimbunan billirubin di Hati sehingga hatinya menjadi rusak. Benarkah demikian?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 07, 2010, 10:47:16 PM: coba cari di topik Acetaminophen/Paracetamol.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Huriah M Putra pada Januari 08, 2010, 07:06:42 AM: Apa aspirin termasuk NSAID? Terus pernah baca katanya aspirin menghambat COX-3?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 08, 2010, 07:37:34 AM: yup, aspirin termasuk NSAID. aspirin inhibitor non selektif terhadap COX. aspirin 166 x lebih kuat menghambat COX-1 daripada COX-2. beberapa jurnal menyebutkan aspirin juga menghambat COX-3 di otak.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Januari 08, 2010, 11:51:41 AM: paracetamol juga menghambat COX-3 kan?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 14, 2010, 10:33:31 PM: Best Evidence Interview: CINODs -- The NSAID Holy Grail?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are universally used in the treatment of conditions that cause chronic pain, such as osteoarthritis (OA). However, their use is limited by their safety profiles, particularly gastrointestinal side effects and adverse effects on the cardiovascular system. Traditional NSAIDs such as ibuprofen and naproxen, which act by blocking the COX-1 and -2 enzymes, and COX-2 selective inhibitors, such as celecoxib, are associated with the destabilization of blood pressure control. This effect is particularly marked in hypertensive patients treated with blockers of the renin-angiotensin system (RAS).

Naproxcinod, a nitric oxide (NO) derivative of naproxen, is an investigational drug and the first of a class of NSAIDs known as COX-inhibiting NO donors. It is being developed by NicOx S.A. (Sophia Antipolis, France). Naproxcinod has been studied in a clinical phase 3 program in patients with OA of the knee and hip, and, on the basis of the results of these studies, it is currently under regulatory review for approval for treatment of OA in the United States. As of the date of this interview, a regulatory submission is also planned in Europe for late 2009. In preclinical studies, naproxcinod had similar anti-inflammatory and analgesic activity to naproxen but caused less gastric injury. Phase 2 and 3 trials showed that naproxcinod is an effective analgesic agent with reduced gastrointestinal toxicity compared with naproxen, and in contrast to naproxen, it reduces systemic blood pressure by 2-3 mm Hg. On the basis of these findings, naproxcinod may represent an alternative to traditional NSAIDs or COX-2 inhibitors in patients who have or are at risk for cardiovascular disease.

In the best evidence study discussed in this interview, the effects of naproxcinod on blood pressure in patients with OA were compared with those of naproxen and placebo over 13 weeks in a phase 3, randomized clinical trial carried out at the University of Connecticut, Farmington, and Northwestern University, Chicago, Illinois. The results of the trial, which were first presented at US and European rheumatology and cardiology conferences,[1,2] were published recently in the American Journal of Cardiology.[3] The trial randomly assigned a total of 916 patients with OA, with or without a history of hypertension, to treatment twice daily with either naproxcinod 750 mg, naproxcinod 375 mg, naproxen 500 mg, or placebo. Reductions in systolic blood pressure (SBP) with naproxcinod 750 mg were larger and significantly different from those with naproxen 500 mg at 2, 6, and 13 weeks (P < .05). The difference in mean change from baseline between these 2 groups was -2.9 mm Hg (P = .015). The 2 doses of naproxcinod showed reductions from baseline in diastolic blood pressure relative to naproxen (P < .04) and similar changes compared with placebo. The proportion of patients in the overall population with SBP increases > 10 mm Hg was greater with naproxen 500 mg (22%) compared with naproxcinod 750 mg (14%; P = .04), naproxcinod 375 mg (14%; P = .055), and placebo (15.6%; P = .155).

Separate analysis of a subgroup of 207 patients with hypertension treated with RAS-blocking agents alone or with diuretics showed a difference in mean change from baseline in SBP between naproxen 500 mg and naproxcinod 750 mg of -6.5 mm Hg in favor of naproxcinod (P = .011). Analysis of 73 patients being treated with antihypertensive drugs that did not include a RAS blocker did not show any statistically significant differences from baseline in SBP within or between groups.

The study authors concluded that naproxcinod is likely to destabilize the control of SBP compared with naproxen in patients with OA and behaves in a similar fashion to placebo overall as well as in patients treated with antihypertensive therapies involving blockade of the RAS. They suggested that the hypertensive burden induced by traditional NSAIDs in patients with OA and hypertension could be reduced by an NO-donating agent such as naproxcinod.

References
1. Schnitzer TJ, Kivitz A, Rankin B, et al. Comparison of naproxcinod to naproxen and placebo: results of a 13-week phase 3 pivotal trial in patients with osteoarthritis of the knee with particular focus on blood pressure effects. Ann Rheum Dis. 2008;67(suppl II):394. Abstract 0350.
2. White WB, Schnitzer T. The cyclooxygenase inhibiting nitric oxide donator naproxcinod lacks the hypertensive effects seen with naproxen in patients with osteoarthritis. Program and abstracts of the American College of Cardiology 2009 Annual Meeting; March 29-30, 2009; Orlando, Florida. Abstract 0910-4.
3. White WB, Schnitzer TJ, Fleming R, et al. Effects of the cyclooxygenase inhibiting nitric oxide donator naproxcinod versus naproxen on systemic blood pressure in patients with osteoarthritis. Am J Cardiol. 2009;104:840-845.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 25, 2010, 10:34:38 PM: saya lakukan pemisahan topik karena sebelumnya sudah melenceng dari NSAID. untuk membahas aspirin dengan indikasi antipiretik, antiradang, dan analgesik gunakan topik ini, untuk efek antitrombotik silakan di topik Antikoagulan, Antitrombotik, Trombolitik dan Hemostatik. terima kasih.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 28, 2010, 10:17:00 PM: NSAIDs May Be More Effective Than Paracetamol for Menstrual Pain

January 20, 2010 — Nonsteroidal anti-inflammatory drugs (NSAIDs) may be more effective than paracetamol for menstrual pain, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews.

"Dysmenorrhoea is a common gynaecological problem consisting of painful cramps accompanying menstruation, which in the absence of any underlying abnormality is known as primary dysmenorrhoea," write Dr. Jane Marjoribanks, Cochrane Menstrual Disorders and Subfertility Group in Auckland, New Zealand, and colleagues. "Research has shown that women with dysmenorrhoea have high levels of prostaglandins, hormones known to cause cramping abdominal pain. ...NSAIDs are drugs which act by blocking prostaglandin production."

The goal of this review was to compare the effectiveness and safety of NSAIDs used in the treatment of primary dysmenorrhea vs placebo, paracetamol, and each other. The reviewers searched the Cochrane Menstrual Disorders and Subfertility Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science to May 2009. They also searched the National Research Register, the Clinical Trials Register, abstracts of major scientific meetings, and bibliographies of identified articles.

Inclusion criteria were all randomized controlled comparisons of NSAIDs vs placebo, other NSAIDs, or paracetamol for treatment of primary dysmenorrhea. Two reviewers independently evaluated trials for methodologic quality, extracted data, and calculated odds ratios (ORs) for dichotomous outcomes and mean differences for continuous outcomes. The reviewers then combined the data using inverse variance methods.

Based on 73 randomized controlled trials meeting selection criteria, NSAIDs were significantly more effective for pain relief than placebo among women with primary dysmenorrhea (OR, 4.50; 95% confidence interval [CI], 3.85 - 5.27), but there was marked heterogeneity for this finding (I² statistic = 53%). Excluding 2 outlying studies with no or negligible placebo effect decreased heterogeneity (OR, 4.14; 95% CI, 3.52 - 4.86; I² = 40%). Compared with paracetamol, NSAIDs were also significantly more effective for pain relief (OR, 1.90; 95% CI, 1.05 - 3.44), but NSAIDs were associated with significantly more overall adverse effects than placebo (OR, 1.37; 95% CI, 1.12 - 1.66).

"Women using these drugs need to be aware of the side effects," Dr. Marjoribanks said in a news release. "It would be interesting to see whether these could be reduced, without loss of effectiveness, by combining lower doses with other drugs such as paracetamol, or with other therapies such as transcutaneous electrical nerve stimulation."

Comparison of various NSAIDs vs other NSAIDs showed limited evidence that any individual NSAID was superior for either pain relief or safety.

Limitations of this review include limited power to detect differences among NSAIDs because most individual comparisons were based on very few trials with small sample size.

"NSAIDs are an effective treatment for dysmenorrhoea, though women using them need to be aware of the significant risk of adverse effects," the review authors conclude. "There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea."

Cochrane Database Syst Rev. Published online January 20, 2010.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: r.a.n pada Januari 29, 2010, 02:13:52 PM: Mas ini NSAID yang mana yah..mas...Indometasin..aspirin..piroxicam..diklofenak...mefenamat...ato semua yang saya sebut bisa ???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 29, 2010, 09:53:51 PM: yo... begitulah.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Januari 30, 2010, 01:25:58 PM: semua NSAID kok :) kok disuruh pilih yang mana? :p
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: r.a.n pada Januari 31, 2010, 03:21:16 AM: Yah..memang...sih semua digolongkn NSAID..Namun, denger denger.. walapun sama-sama menghambat COX-2, ada yang lebih sebagai anti nyeri..ada yang onset kerjanya sebentar..ada yang memang bisa sebagai anti inflamasi..tapi secara fungsi rendah..
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Januari 31, 2010, 10:33:21 AM: Kutip dari: r.a.n pada Januari 31, 2010, 03:21:16 AM
Yah..memang...sih semua digolongkn NSAID..Namun, denger denger.. walapun sama-sama menghambat COX-2, ada yang lebih sebagai anti nyeri..ada yang onset kerjanya sebentar..ada yang memang bisa sebagai anti inflamasi..tapi secara fungsi rendah..

ga semua nya kok menghambat COX-2 Mas ran :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Januari 31, 2010, 11:21:03 AM: @ pak ran: Walaupun mekanisme kerja NSAID sebagai inhibor COX, baik yang selektif (hanya menghambat COX2) maupun non selektif (menghambat COX2 dan COX1, contoh: celexocib), adalah sama, tetapi masing2 NSAID punya potensi yang berbeda. Perbedaan potensi ini dipengaruhi banyak faktor (salah satunya adalah faktor farmakokinetika)

@ pak astrawinata: oya? ada NSAID yang ngga menghambat COX 2? contoh obatnya apa pak?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Januari 31, 2010, 11:24:09 AM: sori salah: celexocib adalah NSAID selektif, hanya menghambat COX 2

maaf... maaf,, salah ketik
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Januari 31, 2010, 11:30:02 AM: aspirin dan ketorolac spesifik terhadap COX-1. sedangkan indomethacin dan piroxicam agak condong ke COX-1, MasRian :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 31, 2010, 11:58:34 AM: NSAID mencakup berbagai macam golongan obat dng mekanisme beragam. Yg terkuat adalah golongan opioid.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: r.a.n pada Januari 31, 2010, 01:58:22 PM: Eh iyah deng..maksunya menghambat enzim COX..kalo COX-2 emang golongan..coxib-coxib. Jadi opioid..juga golongan.NSAID..bukan dia dihas spesifik yah..mekanisme kerjanya khan beda...kalo opioid..bukanya diamenghambat reseptor..kappa betta delta..gamma...begitu yah ???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Januari 31, 2010, 04:40:01 PM: Ini mekanisme NSAID dalam konteks topik: jawab #21 kan? Apa aku yang ga nyambung? :)

NSAID golongan opioid? bingung mode: on ???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 01, 2010, 04:14:06 AM: iya nih...kalo opioid kan menghambat rasa sakit di otaknya langsung???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Februari 01, 2010, 10:07:59 PM: sorry, uda bikin bingung. analgesik opioid dan NSAID beda golongan.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 02, 2010, 06:13:12 AM: akhirnya ada konfirmasi dari om momod :D
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Februari 02, 2010, 06:47:57 AM: emang rada rancu dengan istilah 'non-steroidal'. jadi buka buku lagi...
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: r.a.n pada Februari 02, 2010, 12:05:33 PM: Ditunggu hasil penelusuran kepustakaannya ... ;D
Sorry but you are not allowed to view spoiler contents.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 02, 2010, 01:20:48 PM: kepustakaan apa lagi Mas? ???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: r.a.n pada Februari 02, 2010, 01:46:46 PM: yah maksudnya ada pembagian baru lagi..ato mas syx ada info baru..sebab opioid..memang secara kerja..bisa digolongkan non-steroidal, walaupun rada maksa..tapi karena bekerja di reseptor yang berbeda...makanya diisahkan..dalam topik khusus,,,
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 02, 2010, 03:13:03 PM: mungkin opioid digolongkan dalam non-steroidal anti pain drugs...disingkat jadi NSAPID :P
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Februari 02, 2010, 09:56:26 PM: cukup sebagai analgesik opioid gitu aja. ga ada efek antiradang (antiinflamasi) dan antipiretik. paracetamol masi dapat dispensasi, meski ga punya efek antiradang tapi masi tergolong NSAID.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 03, 2010, 06:35:00 AM: maksud hati buat nyindir momod nih sebetulnya :p
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Februari 03, 2010, 07:13:22 AM: waah... berarti kurang peka nih. disindir ga nyadar. ;D
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Juni 22, 2010, 10:05:56 PM: June 14, 2010 — The first study to examine the cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals has found increased morbidity and mortality with diclofenac, rofecoxib (Vioxx, Merck), and high doses of ibuprofen [1]. Naproxen, in contrast, has a safer cardiovascular risk profile, say Dr Emil Loldrup Fosbøl and colleagues in their paper published online June 8, 2010 in Circulation: Cardiovascular Quality and Outcomes.

The increased cardiovascular morbidity and mortality seen with diclofenac, which is similar to that observed with rofecoxib--a drug that was withdrawn from the market in 2004 because of poor cardiovascular safety--is particularly concerning.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 23, 2010, 04:22:00 AM: wah ibuprofen NSAID idolaku e.. hehe

Cardiovascular risknya apa ya? dan high doses ibuprofennya yang dimaksud kira2 berapa bung?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Juni 23, 2010, 07:41:44 AM: lihat file terlampir dah... ;D
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: truf777 pada Juni 23, 2010, 09:31:13 AM: sayang ibuprofen susah cari generiknya :(
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Huriah M Putra pada Juni 24, 2010, 10:26:57 AM: Mana susah?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: truf777 pada Juni 24, 2010, 12:48:46 PM: susah :(
banyakan dijual dgn merek pr*ris
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: lidya handayani pada Juni 27, 2010, 07:17:48 AM: Kutip dari: Astrawinata G pada Januari 31, 2010, 11:30:02 AM
aspirin dan ketorolac spesifik terhadap COX-1. sedangkan indomethacin dan piroxicam agak condong ke COX-1, MasRian :)
Pak Astra... tanya dong... lha kalo aspirin n ketorolac spesifik inhibitor terhadap COX-1, lalu gmana mekanisme efek antiinflamasinya? Yg berperan dalam efek antiinflamasi kan COX-2 nya ya? Kalau COX-1 kan benernya kalo terinhibisi tu jd efeksamping NSAID? Atau gmana benernya? thxxxx :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: lidya handayani pada Juni 27, 2010, 07:22:21 AM: Kutip dari: syx pada Februari 02, 2010, 09:56:26 PM
cukup sebagai analgesik opioid gitu aja. ga ada efek antiradang (antiinflamasi) dan antipiretik. paracetamol masi dapat dispensasi, meski ga punya efek antiradang tapi masi tergolong NSAID.
Kutip dari: syx pada Februari 02, 2010, 09:56:26 PM
cukup sebagai analgesik opioid gitu aja. ga ada efek antiradang (antiinflamasi) dan antipiretik. paracetamol masi dapat dispensasi, meski ga punya efek antiradang tapi masi tergolong NSAID.
pak mod, kalo ga salah paracetamol ga dgolongkan ke dalam NSAID... karena memang dia ga punya efek antiinflamasi.... NSAID kan antiinflamasi non steroid..?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: lidya handayani pada Juni 27, 2010, 07:25:41 AM: temen2 ada yg bisa share ga? gmana kalo px DHF tp dia alergi paracetamol? sementara NSAID juga kontraindikasi pd px DHF?
Gmana juga kalo seorang alergi paracetamol n alergi thp byk jenis NSAID kena DHF? apa pilihan antipiretik yang boleh dipakai? Thxxx...
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 27, 2010, 12:42:02 PM: Kutip dari: lidya handayani pada Juni 27, 2010, 07:25:41 AM
temen2 ada yg bisa share ga? gmana kalo px DHF tp dia alergi paracetamol? sementara NSAID juga kontraindikasi pd px DHF?
Gmana juga kalo seorang alergi paracetamol n alergi thp byk jenis NSAID kena DHF? apa pilihan antipiretik yang boleh dipakai? Thxxx...

ehm.... ,itu berarti alergi sama semua antipiretik utk DHF.
Ya gmn lagi berarti ga usah dikasih antipiretik.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 27, 2010, 03:20:51 PM: Kutip dari: lidya handayani pada Juni 27, 2010, 07:17:48 AM
Kutip dari: Astrawinata G pada Januari 31, 2010, 11:30:02 AM
aspirin dan ketorolac spesifik terhadap COX-1. sedangkan indomethacin dan piroxicam agak condong ke COX-1, MasRian :)
Pak Astra... tanya dong... lha kalo aspirin n ketorolac spesifik inhibitor terhadap COX-1, lalu gmana mekanisme efek antiinflamasinya? Yg berperan dalam efek antiinflamasi kan COX-2 nya ya? Kalau COX-1 kan benernya kalo terinhibisi tu jd efeksamping NSAID? Atau gmana benernya? thxxxx :)

baik Cox-1 maupun Cox-2 memiliki efek dalam peradangan :) jadi bukan hanya Cox-2 saja...

sebenarnya penggunaan Nsaid untuk Cox-1 dan Cox-2 ini punya banyak lika liku bisnisnya :)

Kutip dari: lidya handayani pada Juni 27, 2010, 07:22:21 AM
Kutip dari: syx pada Februari 02, 2010, 09:56:26 PM
cukup sebagai analgesik opioid gitu aja. ga ada efek antiradang (antiinflamasi) dan antipiretik. paracetamol masi dapat dispensasi, meski ga punya efek antiradang tapi masi tergolong NSAID.
Kutip dari: syx pada Februari 02, 2010, 09:56:26 PM
cukup sebagai analgesik opioid gitu aja. ga ada efek antiradang (antiinflamasi) dan antipiretik. paracetamol masi dapat dispensasi, meski ga punya efek antiradang tapi masi tergolong NSAID.
pak mod, kalo ga salah paracetamol ga dgolongkan ke dalam NSAID... karena memang dia ga punya efek antiinflamasi.... NSAID kan antiinflamasi non steroid..?

penggolongan parasetamol memang banyak versi, ada yang bilang dia termasuk NSAID selektif cox-2, ada yang bilang dia golongan sendiri :)

Kutip dari: lidya handayani pada Juni 27, 2010, 07:25:41 AM
temen2 ada yg bisa share ga? gmana kalo px DHF tp dia alergi paracetamol? sementara NSAID juga kontraindikasi pd px DHF?
Gmana juga kalo seorang alergi paracetamol n alergi thp byk jenis NSAID kena DHF? apa pilihan antipiretik yang boleh dipakai? Thxxx...

mungkin bisa dipakai antalgin (methampyron), phenazone, sama kina...mereka punya aktivitas antipiretik juga :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 27, 2010, 04:20:14 PM: antalgin dan phenazone juga termasuk NSAID (klp turunan Pyrazolidine).
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: lidya handayani pada Juni 28, 2010, 11:14:38 AM: @ astrawinata : bukannya COX-2 saja yg ada di sel2 radang? COX-1 kan adanya di lambung,ginjal, n jaringan lain...dpt darimana sumbernya itu bro? thx.. ;D

@ riandono : phenazone? phenilbutazone kah maksudnya?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 28, 2010, 11:23:07 AM: bukan mbak, phenazone bukan Phenylbutazone. tp sama sama turunan Pyrazolidine
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 28, 2010, 02:27:21 PM: ooh...turunan pyrazolidine? saya baru tahu :) makasih Mas....

btw pyrazolidine itu NSAID ya Mas?selektif mana?

@Mas Lidya: memang saya juga pernah dengar statement tadi Mas, karena itu diperkenalkan NSAID selektif cox-2 yang digembar gemborkan memliki efektivitas lebih dan efek samping yang lebih kecil, ya kan Mas? ;)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Juni 28, 2010, 11:09:12 PM: Kutip dari: lidya handayani pada Juni 28, 2010, 11:14:38 AM
@ astrawinata : bukannya COX-2 saja yg ada di sel2 radang? COX-1 kan adanya di lambung,ginjal, n jaringan lain...dpt darimana sumbernya itu bro? thx.. ;D
hm.., COX-2 dan 1 bukannya ada di banyak sel?

Kutip dari Katzung Basic and Clinical Pharmacology 10th Ed.:
Kutip
PGH synthase-1 (COX-1) is expressed constitutively in most cells. In contrast, PGH synthase-2 (COX-2) is inducible; its expression varies markedly depending on stimulus

Kutip
For Example, endothelial COX-2 is the primary source of vascular prostacyclin, whereas renal COX-2-derived prostaniods are important for normal renal developtment and maintenance of function.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 29, 2010, 02:24:43 AM: ooh, saya kira Mbak LH menerjemahkannya sebagai COX-1 menghasilkan produk untuk fungsi tubuh dan cox-2 untuk peradangan :)
okeh Mas, tq tq....sekarang menunggu jawaban Mbak LH :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 29, 2010, 06:08:30 AM: - COX 1 dan COX 2 diekspresikan berbeda, COX 1= constitutively; COX 2= inducible
- COX 1 dan COX 2 sama-sama mengkatalisis pembetukan PGH2
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: lidya handayani pada Juni 29, 2010, 01:09:01 PM: Well... yg bener mbak LH yaa.... bukan mas LH.. ;D
ini dah saya baca lg...
" There has been great interest in the COX-2 enzyme because it is induced by a variety of inflammatory stimuli and is absent in most tissue under normal "resting" conditions. COX-1, in contrast, is produced in response to inflammatory stimuli and is also constitutively expressed in most tissues. This difference has led to the notion that COX-1 is responsible for the production of prostaglandins that are involved in inflammation but also serve a homeostatic function (e.g. fluid and electrolyte balance in the kidneys, cytoprotection in the gastrointestinal tract). In contrast, COX-2 stimulates the production of the prostaglandins that are involved in inflammatory reaction "
yup... brarti saya yg kurang dlm ngertinya selama ini...maklum dah byk lupa..he2 ::) jd kalo selektif COX-1 msi mungkin juga.. selama ini saya pikir NSAID lama (ibuprofen, aspirin dll) menghambat COX-1 n COX-2... jd ga mgk inhibisi COX-1 saja.. karena untuk efek antiradang dia harus bekerja menghambat COX-2 (krn awalnya saya pikir COX-2 saja lah yg diekspresikan dlm sel radang). Sementara COX-2 selektif inhibitor pasti bisa... n jelas efeksamping gastritis nya sangat minimal... hmmmm.... thx for discussing.. :angel:
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 29, 2010, 01:28:11 PM: efek samping gastritis berkurang dengan cox-2 inhbtr, tapi efek samping stroke, trombosis, iskemi sangat meningkat :)

yang paling bagus efeknya itu diclofenak :) menurut penelitian
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 29, 2010, 01:44:11 PM: @astra
kalo efek samping ke jantung, diklofenak dan ibuprofen hi dose sama jeleknya dengan coxib bang...
tuh diatas baru dipost ama Mr.Syx

Kutip dari: syx pada Juni 22, 2010, 10:05:56 PM
June 14, 2010 — The first study to examine the cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals has found increased morbidity and mortality with diclofenac, rofecoxib (Vioxx, Merck), and high doses of ibuprofen [1]. Naproxen, in contrast, has a safer cardiovascular risk profile, say Dr Emil Loldrup Fosbøl and colleagues in their paper published online June 8, 2010 in Circulation: Cardiovascular Quality and Outcomes.

The increased cardiovascular morbidity and mortality seen with diclofenac, which is similar to that observed with rofecoxib--a drug that was withdrawn from the market in 2004 because of poor cardiovascular safety--is particularly concerning.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 29, 2010, 02:09:43 PM: ya benar :) untuk menghasilkan resiko yang sama, butuh NSAID non-selektif dalam dosis besar :) tapi kalau dpakai dalam dosis yang rendah, resikonya juga turun. Pemakaian NSAID non-selektif dosis tinggi juga jarang diterapkan kok....
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juni 29, 2010, 02:17:29 PM: koreksi pakde: yg hi dose cuma utk ibuprofen. utk diklofenak dlm dosis lazim.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Juni 29, 2010, 02:37:10 PM: oke oke :) suatu koreksi bagi saya....

memang NSAID ini banyak lika-likunya :)

btw, paracetamol juga ada yang menggolongkan sebagai cox-2 selektiv lho.....kalau mau boleh coba cari penelitiannya :)
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Juli 25, 2010, 11:43:08 AM: Kutip dari: riandono pada Juni 29, 2010, 06:08:30 AM

- COX 1 dan COX 2 diekspresikan berbeda, COX 1= constitutively; COX 2= inducible
- COX 1 dan COX 2 sama-sama mengkatalisis pembetukan PGH2

Owh, iy2.., baru ngerti saya..,
berarti COX2 akan meningkat ekspresinya kalau ada stimuli inflamasi, dan COX1 inducible dan constitutive. Begitu ya?

Oia Om, mau tanya juga, mengenai ini
Bukankah COX1 dan COX2 itu enzim yang menkatalisa substrat yang sama untuk menghasilkan Prostaglandin yang sama. Tapi kok diatas dikatakan bahwa:
This difference has led to the notion that COX-1 is responsible for the production of prostaglandins that are involved in inflammation but also serve a homeostatic function (e.g. fluid and electrolyte balance in the kidneys, cytoprotection in the gastrointestinal tract). In contrast, COX-2 stimulates the production of the prostaglandins that are involved in inflammatory reaction

Soalnya waktu kemarin belajar COX, itu kok dari PGH2 klo g salah menghasilkan PGE2/PGEI2/PGD2/TXA2/PGF.
Apa mungkin maksudnya COX1 juga menghasilkan Prostaglandin lain yang berfungsi dalam homeostatis tubuh, atau mungkin PGE2/PGI2/PGD2/TXA2/PGF juga punya efek homeostatis?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Juli 25, 2010, 12:49:04 PM: itulah bang, knp juga tubuh kita iseng pake ekspresiin COX 2 kalo toh ntar cuma mengkatalisis produk PG yang sama dan dari substrat yang sama... ??

Aku jg bingung tuh hehehe..

Aku ga begitu tau perkembangan studinya, tp mungkin ini bisa menjelaskan dikit:
http://www.mc.vanderbilt.edu/reporter/index.html?ID=3110
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada September 25, 2010, 01:21:12 AM: Hm.., ok, terimakasih atas jawabannya Om,
harus lebih banyak baca lagi..,
Judul: Low-Dose Aspirin May Protect Against Colorectal Cancer
Ditulis oleh: syx pada Oktober 11, 2010, 09:53:02 PM: Low-Dose Aspirin May Protect Against Colorectal Cancer

September 21, 2010 — Low-dose aspirin (75 mg/day) may protect against colorectal cancer, according to the results of a case-control study reported online September 15 in Gut.

"Previous studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk," write Farhat V. N. Din, from the University of Edinburgh, Edinburgh, United Kingdom, and colleagues. "However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case-control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival."

The study sample consisted of 2279 patients with colorectal cancer and 2907 control subjects who completed food frequency and lifestyle questionnaires. NSAID use was defined as taking more than 4 tablets per week for more than 1 month and was classified as low-dose aspirin (75 mg), nonaspirin NSAIDs, and any NSAID. Logistic regression models allowed calculation of odds ratios (ORs) with adjustment for potential confounding variables, and log-rank tests and Cox hazard models allowed estimation of the effect of NSAID use on all-cause and colorectal cancer-specific mortality.

Low-dose aspirin use was reported by 354 patients (15.5%) and 526 control subjects (18.1%). A reduced risk for colorectal cancer, seen in low-dose aspirin users (OR, 0.78; 95% confidence interval [CI], 0.65 - 0.92; P = .004), was apparent after 1 year and was greater with increased duration of use (P for trend = .004). Use of any NSAID or nonaspirin NSAIDs was also inversely associated with colorectal cancer risk. There was no apparent effect of NSAIDs on all-cause survival duration (hazard ratio, 1.11; P = .22; 95% CI, 0.94 - 1.33) or colorectal cancer-specific survival duration (hazard ratio, 1.01; P = .93; 95% CI, 0.83 - 1.23).

"This is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population," the study authors write. "NSAID use prior to CRC diagnosis does not influence survival from the disease."

Limitations of this study include potential recall bias; inability to determine if patients continued to take NSAIDs after diagnosis; and lack of outcome measure, which reflects plasma levels of NSAIDs ingested.

"[H]igh aspirin doses are not required for protection against CRC and ... while protection increases with duration of use, there are effects apparent within 5 years," the study authors conclude. "This effect is apparent as early as 1 year but increases with time up to 10 years. Moreover, our results are applicable to the general population and not just high-risk groups."
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada November 12, 2010, 10:23:48 PM: Does Acetaminophen in Comparison to Ibuprofen Effectively Reduce Fevers in Children Younger than 18 Years of Age?

Fever phobia is a term used to describe parents' unrealistic concerns about fever (Crocetti, Moghbeli, & Serwint, 2001). Schmitt (1980) found that 94% of caregivers thought fever could cause side effects, 63% of caregivers worry a great deal about serious harm resulting from fevers, and 18% of caregivers thought brain damage and other consequences can be caused by fevers of 38.9 C or less. Crocetti et al. (2001) completed a similar study and found that 91% of caregivers believed fever could cause harmful effects, with 21% of caregivers believing brain damage could result from fever.

Both acetaminophen and ibuprofen are effective antipyretic agents in children with history of febrile seizures (Carson, 2003; Goldman, Ko, Linett, & Scolnik, 2004; Hay et al., 2008; Van Esch et al., 1995). For treatment of fever, ibuprofen is more effective than acetaminophen in reducing fever (Goldman et al., 2004; Perrott, Piira, Goodenough, & Champion, 2004; Van Esch et al., 1995; Wahba, 2004; Wong et al., 2001), and ibuprofen provides longer duration of antipyretic effect than acetaminophen – four hours after treatment (Wahba, 2004). Alternating acetaminophen and ibuprofen in febrile children appears to be a common practice among pediatric health care providers (Mayoral, Marino, Rosenfield, & Greensher, 2000) and among parents advised to do so by their health care provider (Wright & Liebelt, 2007).

Studies examining an alternating regimen have not been consistent regarding the dosage of the medications or the schedule of administration. Kramer, Richards, Thompson, Harper, and Fairchok (2008) utilized two groups. Group A received acetaminophen (15 mg/kg/dose) followed by a placebo at hour 3 and a second acetaminophen dose at hour 4. Group B received acetaminophen, followed by ibuprofen (10 mg/kg/dose) at hour 3 and a placebo at hour 4. Nabulsi et al. (2006) also used two groups. Group A received a dose of ibuprofen (10 mg/kg/dose) followed by acetaminophen (15 mg/kg/dose) at hour 4. Group B received a similar dose of ibuprofen followed by a placebo four hours later and acetaminophen, whereas Sarrell, Wielunksy, and Cohen (2006) used six groups to assess medication administration at six and eight-hour dosing intervals for acetaminophen alone (12.5 mg/kg/dose q 6 hour or 25 mg/kg/dose q 8 hour) and ibuprofen alone (10 mg/kg/dose q 6 hour or 5 mg/kg/dose q 8 hour), versus an alternating regimen at four-hour intervals of acetaminophen and ibuprofen. However, these authors consistently found that an alternating regimen of acetaminophen and ibuprofen to reduce fever in children is more effective than either drug alone (Hay et al., 2008; Kramer et al., 2008; Mayoral et al., 2000; Nabulsi et al., 2006; Sarrell et al., 2006).

There is no consistent recommendation regarding the antipyretic schedule to use when alternating medications. The most commonly cited method is giving acetaminophen every four hours and ibuprofen every six hours. However, this timing is problematic in that it exceeds the recommended daily doses of each medication and does not specify which medication should be given at the 12th hour (Carson, 2003; Mayoral et al., 2000). Due to safety concerns, such as potential dosing errors (under dosing and overdosing) and toxicity, monotherapy of antipyretics is recommended (Carson, 2003; Goldman et al., 2004; Hay et al., 2008; Kramer et al., 2008; Mayoral et al., 2000; Sahib & El-Radhi, 2008).

In studies where adverse effects of acetaminophen and ibuprofen were studied, authors reported no significance between the two, and the risk of adverse effects are small (Goldman et al., 2004; Lesko & Mitchell, 1999; Perrott et al., 2004). However, it is recommended to use the lowest therapeutic dose that provides sufficient antipyresis to prevent adverse effects or toxicity related to the medication (American Academy of Pediatrics [AAP], 2001; Carson, 2003). The use of ibuprofen does not exacerbate asthma morbidity and provides a possible therapeutic effect compared with acetaminophen. Acetaminophen use in children may lead to an increased risk for wheezing (Kanabar, Dale, & Rawat, 2007).
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Januari 28, 2011, 04:12:47 PM: Wa, artikel diatas kelihatannya penting juga,

tapi kenapa bisa begini ya? Kira2 mekanismenya apa y?
Kutip
For treatment of fever, ibuprofen is more effective than acetaminophen in reducing fever (Goldman et al., 2004; Perrott, Piira, Goodenough, & Champion, 2004; Van Esch et al., 1995; Wahba, 2004; Wong et al., 2001), and ibuprofen provides longer duration of antipyretic effect than acetaminophen – four hours after treatment (Wahba, 2004).
Kutip
However, these authors consistently found that an alternating regimen of acetaminophen and ibuprofen to reduce fever in children is more effective than either drug alone (Hay et al., 2008; Kramer et al., 2008; Mayoral et al., 2000; Nabulsi et al., 2006; Sarrell et al., 2006).

Oia Om, mau tanya juga. Klo Ibuprofen itu memang aman y untuk anak2. Kan bukannya dia ada efek ke gaster mukosa Om?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 28, 2011, 10:16:53 PM: pasti praktisi yang menganjurkan penggunaan ibuprofen di antara NSAID lainnya sudah mempertimbangkan risk and benefit, termasuk efek sampingnya terhadap mukosa saluran cerna. kalo semua melihat ke risk aja ga ada obat demam yang aman untuk anak.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Januari 29, 2011, 04:21:03 PM: Kutip dari: syx pada Januari 28, 2011, 10:16:53 PM
pasti praktisi yang menganjurkan penggunaan ibuprofen di antara NSAID lainnya sudah mempertimbangkan risk and benefit, termasuk efek sampingnya terhadap mukosa saluran cerna. kalo semua melihat ke risk aja ga ada obat demam yang aman untuk anak.
m.., berarti selama :
1. Orang itu tidak ada gangguan lambung
2. Dosisnya dalam batas wajar

maka tidak masalah menggunakan Ibuprofen
bgitu ya Om?

Oia Om, mau tanya juga, Kalau misalnya ada pasien, dia kena gangguan Liver + Ginjal yang berarti. Na kan itu berarti kita harus hati2 menggunakan obat2an kan, terutama yang ada kontra indikasi penderita gangguan hati dan ginjal. Untuk obat2an, kan banyak yang KI terhadap itu. Jika kita menemui pasien ini, apa sebaiknya yang kita lakukan jika memang dia benar2 butuh obat (misal, kena Gout dan harus dikasi Sulfynpyrazone, atau perlu Kortiko, padahal Kortiko ada efek retensi Na nya)?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Januari 31, 2011, 10:27:24 PM: yg pasti musti selektif dalam pemilihan obatnya. pertama mencari obat alternatif yang aman untuk kondisi tertentu, misalnya allopurinol untuk gout. kedua mempertimbangkan risk-and-benefit dari obat yang akan digunakan, apakah obat akan meringankan gejala ato malah memperberat penyakit dalam tubuh.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Februari 01, 2011, 10:11:46 PM: All Nonsteroidal Anti-Inflammatory Drugs Have Cardiovascular Risks

January 21, 2011 — New data showing nonsteroidal anti-inflammatory drugs (NSAIDs) have cardiovascular risks are putting the well-known pain relievers back in the headlines. Investigators evaluating available evidence report they have found little to suggest that any of the investigated options are safe.

Regulatory agencies have already pointed to cardiovascular signals with NSAIDs, but these concerns are based mainly on observational evidence. This new study provides a comprehensive analysis of all randomized controlled trials of the drugs.

During an interview with Medscape Medical News, senior investigator Peter Jüni, MD, from the University of Bern in Switzerland, said his team expected to see an increased risk but was surprised by the magnitude of the signal. "We never thought we'd see 2- and 4-fold increased risks," he said. "The doses were admittedly high," he pointed out, "however, this is clearly clinically relevant."

Several earlier meta-analyses were unable to resolve the debate over risk because they failed to include all randomized evidence in 1 study. This new network meta-analysis, published online January 11 in BMJ, includes all available evidence.

The team led by Sven Trelle, MD, also at the University of Bern, included 31 trials and 116,429 patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.

Investigators saw an increase in myocardial infarctions, stroke, and cardiovascular death in patients taking all of these NSAIDs. Not surprisingly, rofecoxib was associated with the highest risk for myocardial infarction, with a rate ratio of 2.12. The drug's manufacturer, Merck, voluntarily withdrew the product marketed as Vioxx in 2004 because of concerns over cardiotoxicity.

Lumiracoxib had the next highest rate of myocardial infarction in the current study. Ibuprofen was associated with the highest risk for stroke with a rate ratio of 3.36 followed by diclofenac at 2.86. Etoricoxib was linked to the highest rate of cardiovascular death at 4.07 followed by diclofenac at 3.98.

Dr. Jüni recommends that physicians take special care in evaluating patients prone to cardiovascular events. Those who require treatment should take the lowest possible dose for the shortest period.

Dr. Jüni says he would like to see black box warnings added to drug packaging for the products still available on the market.

Of all the NSAIDs, naproxen seemed least harmful in this study. The finding is in agreement with recommendations made by regulatory agencies when rofecoxib was first removed from the market and physicians were evaluating alternatives.

"I think we should reserve our final judgment on naproxen until after we've completed the overall safety study," Dr. Jüni said. His team is currently studying the gastrointestinal safety of the drug and weighing the benefits and risks from that perspective.

"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."

No Clear Link Between Specificity and Risk

In an interesting twist, investigators found no clear relation between specificity of cyclooxygenase-2 inhibitors and risk for cardiovascular events. This finding contrasts with previous claims that increased selectivity for cyclooxygenase-2 inhibitors is associated with cardiovascular risk.

Several mechanisms have been proposed, but the hypothesis of an imbalance between prostacyclin and thromboxane A2 leading to an increased risk for thrombotic events is the most well known.

The researchers suggest the lack of a clear association between specificity of cyclooxygenase-2 inhibitors and cardiovascular risk implies that other mechanisms should be considered. "Multiple effects most probably contribute to the increased risk of cardiovascular events, including differential effects on prostacyclin and thromboxane A2 synthesis, endothelial function, nitric oxide production, blood pressure, volume retention, and other renal effects," they note.

Millions of Patients Taking NSAIDs

In an accompanying editorial, Wayne Ray, PhD, from Vanderbilt in Nashville, Tennessee, pointed out that millions of patients with chronic musculoskeletal symptoms are long-term NSAID users.

In the United States, an estimated 5% of all visits to a physician are related to prescriptions of anti-inflammatories, and they are among the most commonly used medications.

"Given that both mechanistic and clinical data suggest that individual NSAIDs may have different cardiovascular risk profiles," Dr. Ray noted, "a natural question is, 'Which NSAID is safest for patients with high cardiovascular risk?'"

He points out the ongoing PRECISION trial, otherwise known as the Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen Or Naproxen, will eventually provide more information on the relative cardiovascular safety of these options. "Until these results become available, naproxen seems to be the best choice with regard to cardiovascular safety."

Dr. Ray says the controversy and confusion about the cardiovascular safety of these products provides an important lesson. "Drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety. Perhaps it is time for a larger more systematic evaluation of a broader range of alternatives."

This study was funded by the Swiss National Science Foundation. The researchers have disclosed no relevant financial relationships. Editorialist Dr. Wayne Ray has received funding from Pfizer. He served as an expert for the State of Texas in a lawsuit filed against Merck. Dr. Ray also works as an expert for an insurance company.

BMJ. 2011;342:c7086.
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Astrawinata G pada Februari 04, 2011, 01:01:58 AM: mau nanya , apakah setiap molekul prostaglandin akan menempati reseptornya sendiri? seperti PGF-alfa dsbg...kalau iya, bisa ga ya kita ciptakan obat yang khusus menghalangi menempelnya PG pemicu nyeri ini ke reseptornya? biar lebih selektif dan efek samping lebih sedikit ???
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Februari 04, 2011, 09:59:37 PM: Kutip dari: syx pada Januari 31, 2011, 10:27:24 PM
yg pasti musti selektif dalam pemilihan obatnya. pertama mencari obat alternatif yang aman untuk kondisi tertentu, misalnya allopurinol untuk gout. kedua mempertimbangkan risk-and-benefit dari obat yang akan digunakan, apakah obat akan meringankan gejala ato malah memperberat penyakit dalam tubuh.
M.., gtu y, ok mksi banyak Om..,

Kutip
"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."
Hm, bukannya Proton Pump Inhibitor itu mahal y Om, klo alternatif untuk inin apa ya Om?

Kutip dari: Astrawinata G pada Februari 04, 2011, 01:01:58 AM
mau nanya , apakah setiap molekul prostaglandin akan menempati reseptornya sendiri? seperti PGF-alfa dsbg...kalau iya, bisa ga ya kita ciptakan obat yang khusus menghalangi menempelnya PG pemicu nyeri ini ke reseptornya? biar lebih selektif dan efek samping lebih sedikit ???
menarik2, gimana om syx?
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: riandono pada Februari 05, 2011, 02:08:28 PM: @idad
Proton pump inhibitor kayaknya ngga mahal2 amat deh, udah banyak yg generik: omeprazole, lansoprazole
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: Idad pada Februari 05, 2011, 08:38:10 PM: Kutip dari: riandono pada Februari 05, 2011, 02:08:28 PM
@idad
Proton pump inhibitor kayaknya ngga mahal2 amat deh, udah banyak yg generik: omeprazole, lansoprazole
oya, wh, sepertinya sy harus update info lagi..,,
ok2, mksi bang rian..,
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada Maret 17, 2011, 10:14:35 PM: semoga tidak bikin para cowo takut minum obat analgesik-antipiretik, khususnya NSAID:

Regular NSAID Use Linked to Erectile Dysfunction

March 7, 2011 — Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with erectile dysfunction (ED), according to the results of a prospective cohort study reported online February 21 and in the April print issue of the Journal of Urology.

"This study is a great example of how we work to understand the safety and effectiveness of what we recommend for our patients," said senior author Steven J. Jacobsen, MD, PhD, an epidemiologist and director of research for Kaiser Permanente Southern California in San Diego, in a news release.

"We went into this study thinking we would find the opposite effect: that NSAIDs would have a protective effect because they protect against heart disease, which is also linked to ED. The next step is to dive a bit deeper to understand the underlying physiology of what might be happening with these drugs."

Beginning in 2002, the California Men's Health Study enrolled a large, ethnically diverse cohort of male members of the Kaiser Permanente managed care plans who were 45 to 69 years old. A questionnaire evaluated ED, and automated pharmacy data and self-reported use allowed evaluation of NSAID exposure.

NSAID use was present in 47.4% of the 80,966 participants, and moderate or severe ED was reported in 29.3%. NSAID use and ED correlated strongly with age. Regular NSAID use increased from 34.5% in men aged 45 to 49 years to 54.7% in men aged 60 to 69 years, and ED increased from 13% to 42% in these age groups.

Without adjustment for potentially confounding variables, the odds ratio (OR) for the association of NSAIDs and ED was 2.40 (95% confidence interval [CI], 2.27 - 2.53). A positive association persisted after adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease, and body mass index (adjusted OR, 1.38). A positive association also was evident when a stricter definition of NSAID exposure was used.

"There are many proven benefits of non steroidals in preventing heart disease and for other conditions," Dr. Jacobsen said. "People shouldn't stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it's worth a discussion with his doctor."

Limitations of this study include cross-sectional design, potential participation bias, and low original participation rate.

"These data suggest that regular NSAID use is associated with ED even after extensive adjustment for age and potentially confounding factors or comorbidities," the study authors write.

"While this raises the question of the role of inflammation and COX [cyclooxygenase] pathways in ED etiology, we cannot exclude alternative explanations. However, if this is a direct relationship, the current strategy of using NSAIDs for cardiovascular disease protection as well as other common uses of NSAIDs should be weighed against the potential side effects of ED. Studies are needed to elucidate this association in more detail."
Judul: Re: Obat Pereda Sakit dan Penurun Panas
Ditulis oleh: syx pada September 16, 2011, 12:26:04 AM: September 6, 2011 — Use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in early pregnancy is linked to twice the risk for miscarriage, according to the results of a nested case-control study reported online September 6 in the Canadian Medical Association Journal.

hati-hati penggunaan NSAID selain aspirin saat hamil muda...