The risks of phenacetin use

Article Abstract:

It was almost 25 years ago that Ulrich Dubach and his colleagues first noticed that women working in Swiss watch factories took an especially large quantity of analgesic drugs such as aspirin for their job-related pains. Since the abuse of analgesics had already been suggested to be related to increased risk of kidney disease, Dubach took advantage of an unusual opportunity for research and began a 20-year study of these women. The results of this study are reported in the January 17, 1991 issue of The New England Journal of Medicine. The researchers periodically conducted urinalysis of the women participating in the study, which provided an objective indication of recent use of analgesic drugs. In particular, the researchers measured N-acetyl-p-aminophenol, which is a metabolite of phenacetin, and salicylates, which indicate aspirin consumption. (It should be mentioned that often, particularly in former years, phenacetin was a common component of some aspirin formulations.) The results of the study indicated that the subjects who took larger amounts of phenacetin developed kidney disease more often than those who took less or no phenacetin. The results are particularly disturbing in light of the rising popularity of acetaminophen. Since salicylates have been linked with Reye syndrome in children, aspirin-free analgesics such as acetaminophen have become more popular. Acetaminophen is, however, an important metabolite of phenacetin, and it is easy to imagine that the distressing news about phenacetin may be true for acetaminophen as well. It is not easy to accumulate satisfactory data about the use of a drug like acetaminophen, since the risk is small among large numbers of patients. However, a study similar to that conducted by Dubach to determine the risk associated with acetaminophen use should be given high priority. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acetaminophen, Analgesics, editorial, Phenacetin, Salicylates

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Cyclosporine therapy for autoimmune disease

Article Abstract:

Many immunosuppressant drugs used to treat patients with autoimmune disorders cause severe side effects that outweigh their benefits. Doctors have been interested in the use of cyclosporin since the 1970s to treat these patients because it did not appear to cause any severe side effects. In studies using cyclosporine to treat patients with psoriasis or rheumatoid arthritis, those treated with higher doses experienced greater or more rapid improvement in their condition than those treated with lower doses. It has been effective in treating patients with insulin-dependent diabetes mellitus and Behcet's syndrome, an inflammatory disease. A research study has found that long-term treatment with cyclosporine may increase the risk of kidney disease, but discontinuation of treatment may reverse any kidney damage that has occurred. Doctors should decide whether the benefits of cyclosporine outweigh the risk of kidney disease before prescribing it to their patients.

Health aspects, Drug therapy, Autoimmune diseases, Cyclosporine, Cyclosporins

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The disappearance of Reye's syndrome -- a public health triumph

Article Abstract:

Reye's syndrome is now very rare. It is characterized by liver and brain dysfunction and high blood levels of ammonia. Reye's syndrome was first defined in 1963 and emerged as a major disease of children in the 1970s. The first report linking it to aspirin use was published in 1980. Although many doctors doubted that aspirin could cause such a serious condition, evidence began to build up and in 1986, a warning was placed on aspirin labels. However, the CDC began educational efforts in 1980, and the incidence of Reye's syndrome began decreasing that year.

Prevention, Reye syndrome

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