The doctor body warns government on World Kidney Day

Pain Killers in the Hands of Ayush Doctors—Recipe for Disaster – IMA

New Delhi, March 12, 2015: The Government of India will be ill advised to allow AYUSH doctors to prescribe over the counter available painkillers such as Paracetamol and Aspirin.

Indian Medical Association has warned the union government, saying pain killers in the hands of Ayush doctors might prove recipe for disaster. Kidney, liver and heart specialists have advised there is need even to use these innocuous seeming pain killers judiciously to save kidney, liver and heart from adverse effect.

On World Kidney Day, Dr A Marthanda Pillai, National President and Dr KK Aggarwal, Secretary General, IMA today issued an advisory regarding use of pain killers. They have said there is nothing like safe and unsafe pain killers. All need to be used judiciously. They said there are a lot of misconceptions regarding painkillers which need to be dispelled to save people from their adverse effects.

The Indian Medical Association (IMA) has released pointers on the safety and efficacy of common non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers in an attempt to clear common misconceptions that people have regarding their usage for pain and fever management. The most prominent members of this group of drugs are Paracetamol, Aspirin, Ibuprofen and Nimesulide.

Pain is one thing, which is bound to affect each and every individual at some point of life. Mild pain can often be ignored but when it becomes severe, NSAIDs become indispensable. NSAIDs suppress pain by inhibiting the enzyme cyclo-oxygenase and reducing synthesis of prostaglandins, which promote the inflammatory process. Since a few years, NSAIDs have been under constant scrutiny and criticism due to their alleged negative effects on the liver, kidney and heart.

Dr Pillai and Dr KK Aggarwal, in a joint statement, said, ‘The Indian Medical Association is of the view that it is not right to classify certain NSAIDs safe and others as unsafe for they all have different functions and if used for the right duration, they can be extremely effective in providing pain relief. It is however important to raise awareness amongst the public that they must not self-medicate themselves for the underlying condition as it can cause more harm than good’.

It is a common perception that OTC drugs like Paracetamol or Aspirin can be taken for pain relief without consulting a doctor. Paracetamol has little anti-inflammatory activity and should be used more to manage fever than pain relief. It also is the number one suicidal agent in the west and the US FDA recommends that not more than 325mg of the drug should be used in any combination tablet.

Similarly Aspirin if self administered in children can precipitate liver failure, a condition called Reye’s syndrome. IMA believes that both Paracetamol and Aspirin should be used under medical supervision.

The Government of India is envisaging that AYUSH doctors be given the right to prescribe over the counter available painkillers such as Paracetamol and Aspirin. However the same may not be in the public interest as they have little knowledge about when not to use these drugs.

IMA’s statement said that both Nimesulide and Aspirin be administered only to people above the age of 12 years. Nimesulide is an analgesic NSAID that was approved by Drug Controller General of India (DCGI) in 1993 for fever, pain and inflammation. It can be safely prescribed to adults up to 15 days.

According to Dr. Ramesh Hotchandani, Nephrologist, Moolchand Hospital, ‘Pain is a condition that affects almost everybody at some point of time in his or her life. In India itself, 76% of professionals who are regular computer users suffer from muscular pain, 15%-20% from acute pain and 25%-30% from chronic pain at least once in their lifetime. This makes effective and safe pain management an extremely important topic of debate around the globe today. However painkillers should be used judiciously as even one tablet can precipitate kidney failure in susceptible individuals.’

‘Every year 12th March is observed as World Kidney day, and this day should be dedicated to creating awareness about drugs, which can precipitate kidney failure’, added Dr Hotchandani.

The IMA has underlined that all NSAIDs and other medicines come with some side effects making it extremely important to take them under the guidance of a doctor. Some molecules sometimes do not suit a person’s biological composition and in cases where one sees any evident side effects, they must immediately consult their doctor.

IMA Guidelines on NSAIDS 

• Do not administer Aspirin to children as it can cause fatal liver failure. Children and teenagers recovering from chickenpox or flu-like symptoms should never take Aspirin
• Paracetamol should not be taken without medical consultation. It is number one suicidal agent in the west. As per US FDA, combination products that contain paracetamol should not contain paracetamol salt dose more than 325 mg in each tablet or capsule
• Drug Controller General of India approved Nimesulide on 13^thJanuary 1995 for painful and inflammatory conditions as well as fever and it can be safely prescribed to people above the age of 12 years for up to 15 days.
• Nimesulide is a European drug and is available and approved in 54 countries worldwide. It has never been banned in India. It is not available in USA being a European drug and has never been banned there
• In general, painkillers are safe drugs when used in patients who are not at high risk for gastrointestinal, renal, or cardiovascular reactions
• All heart patients should consult their doctor before taking a painkiller especially if they are on low dose aspirin.
• Even one tablet of pain killer in susceptible kidney patients can precipitate kidney failure.