MANAGEMENT OF FEVER

Role of anti-pyretics in fever

• The most commonly preferred anti-pyretics are Paracetamol, Mefenamic Acid, Ibuprofen, etc.

Ideal anti-pyretic

• An anti-pyretic which offers relatively fast and a longer duration of temperature reduction providing necessary comfort (symptom reductions like – body ache, headache, myalgia and improving sleep quality).

Mefenamic Acid as an anti-pyretic

• Mefenamic Acid, a non-steroidal anti-inflammatory drug (NSAID), has an established anti-pyretic, anti-inflammatory and analgesic effect.
• Mefenamic Acid has dual site of action, both central and peripheral inhibition of PG synthesis.
• Mefenamic Acid is unique due to its dual mode of actions- inhibition of PG synthesis and blockage of E-type prostanoid (EP) receptors.
• Additionally it has also been found to possess a novel inhibitory action on the NLRP3 inflammasome.
• As compared to Paracetamol and Ibuprofen, Mefenamic Acid has been demonstrated to achieve superior 24 hours temperature reduction.

Mefenamic Acid vs. other anti-pyretics

• Mefenamic Acid has both central and peripheral action, whereas, Paracetamol has only central action.
• Mefenamic Acid is unique in blocking the EP receptors which is not possessed by other NSAIDs (Non-steroidal anti-inflammatory drugs) including Paracetamol.
• Besides, it has a novel inhibitory action on NLRP3 inflammasome which helps in attenuating fever and inflammation effectively; whereas the same is not the case with Paracetamol, Ibuprofen and Nimesulide.
• As compared to Paracetamol, Mefenamic Acid has been found to demonstrate better antipyresis at 1 hour.
• Mefenamic Acid exhibits a comparable anti-inflammatory effect to Ibuprofen, according to studies.
• Comparing Mefenamic Acid to Paracetamol and Ibuprofen, the former has greater efficacy and tolerability. While Nimesulide and Mefenamic Acid have comparable anti-inflammatory, anti-pyretic, and analgesic efficacy, Nimesulide may cause fulminant hepatitis.