Acetaminophen reaffirmed as first-line medication for treating pain and fever during pregnancy

In continuation of my update on acetaminophen 

Acetaminophen remains the recommended first-line medication to treat pain and fever during pregnancy, according to an updated statement from the Society for Maternal-Fetal Medicine (SMFM). A comprehensive review of the available scientific evidence does not establish a causal relationship between acetaminophen taken during pregnancy and an increased risk of autism spectrum disorders and attention deficit and hyperactivity disorder (ADHD) in children, according to SMFM. The work is published in the journal Pregnancy.

SMFM's statement is based on a thorough review of recent studies and earlier research on acetaminophen during pregnancy. The newest studies vary in their findings on the potential association between prenatal acetaminophen exposure and risk of childhood neurobehavioral issues and have significant limitations in their study design.

"After another careful review of the existing research, we continue recommending acetaminophen as a safe treatment for our pregnant patients who need it for pain relief and to reduce fever," said Judette M. Louis, MD, MPH, chair of the SMFM Publications Committee.

Acetaminophen is a commonly used non-opioid analgesic during pregnancy. An estimated 65% of pregnant women use acetaminophen at some point during pregnancy, mostly to treat headache and fever. Acetaminophen is the active ingredient in many over-the-counter and prescription medications, including Tylenol.

"Both untreated fever and pain during pregnancy carry potential health risks, so you shouldn't just 'tough it out,'" said Louis. "Untreated fever, particularly in the first trimester, is known to be linked to birth defects and miscarriage. We also know that maternal fever during labor can be associated with poor neonatal outcomes."

Along with acetaminophen, SMFM recommends nonpharmacological interventions, including hydration and physical therapy, to help manage pain during pregnancy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are not recommended to treat fever and pain during pregnancy. NSAIDs increase the risk of fetal renal impairment, premature closure of the ductus arteriosus, oligohydramnios, and maternal bleeding. Opioid medications taken during pregnancy are associated with neonatal abstinence syndrome, addiction, and sedation, and are also not recommended as first-line treatments for pain during pregnancy.

https://en.wikipedia.org/wiki/Paracetamol

Acetaminophen reaffirmed as first-line medication for treating pain and fever during pregnancy

MNK-795 for acute pain management: an interview with Dr Lynn Webster

MNK-795 is an investigational, extended-release, oral formulation of oxycodone  (left) and acetaminophen (right) that has been studied for the management of moderate to severe acute pain where the use of an opioid analgesic is appropriate. 

MNK-795 is a product in development that is intended to be used for acute pain. It has some unique properties. First, it is an extended release formulation, meaning that it’s going to last more than three to four hours. It was studied to be dosed once every 12 hours, and that is unique for an acute pain formulation.

Secondly, it has abuse deterrent properties which mean that the new design and technology within this formulation may prevent people who try to manipulate, alter or convert the extended release into an immediate release in order to achieve a greater high.

Research has found that when the formulation is manipulated, when it’s crushed in some way or ground up, it actually delays the onset of some of its properties, the liking properties. So rather than causing more liking, more of a high, it actually causes less of a liking and less of a high when it’s manipulated.

This is the first time I’m aware that any technology has delayed and lessened the liking once it’s manipulated. I must, however, stress that at present these are only research results and we cannot yet confirm how MNK-795 will perform in the real world.

MNK-795 for acute pain management: an interview with Dr Lynn Webster

Scientists set out to develop safer versions of acetaminophen

Acetaminophen (ApAP) is an electron donor capable of reducing radicals generated by redox cycling of hemeproteins. It acts on the prostaglandin H synthases (cyclooxygenases; COXs) to reduce the protoporphyrin radical cation in the peroxidase site of the enzyme, thus preventing the intramolecular electron transfer that generates the Tyr385 radical required for abstraction of a hydrogen from arachidonic acid to initiate prostaglandin synthesis. Unrelated to this pharmacological action, metabolism of ApAP by CYPs yields an iminoquinone electrophile that is responsible for the hepatotoxicity, which results from high doses of the drug. Researchers synthesized novel heterocyclic phenols predicted to be electron donors. Two of these inhibited the oxygenation of arachidonic acid by PGHS-1 and myoglobin and also were shown to be more metabolically stable and exhibited less direct cytotoxicity than acetaminophen. They are leading candidates for studies to determine whether they are free of the metabolism-based hepatotoxicity produced by acetaminophen.....

Ref : http://pubs.acs.org/doi/pdf/10.1021/ml4000904

Scientists set out to develop safer versions of acetaminophen