Editing Antipyretic

{{short description|Substance that reduces fever}}
[[File:200mg ibuprofen tablets.jpg|thumb|300px|Tablets of [[ibuprofen]], a common antipyretic]]

An '''antipyretic''' ({{IPAc-en|ˌ|æ|n|t|i|p|aɪ|ˈ|r|ɛ|t|ɪ|k}}, from ''anti-'' 'against' and ''{{linktext|pyretic}}'' 'feverish') is a substance that reduces [[fever]].<ref>{{Cite web |url=http://www.merriam-webster.com/dictionary/antipyretic |title=Definition of antipyretic |website=Merriam-Webster Online Dictionary |access-date=2007-12-19}}</ref> Antipyretics cause the [[hypothalamus]] to override a [[prostaglandin]]-induced increase in [[Human_thermoregulation|temperature]].{{Citation needed|date=July 2024}} The body then works to lower the temperature, which results in a reduction in fever.

Most antipyretic medications have other purposes. The most common antipyretics in the US are usually [[ibuprofen]] and [[aspirin]], which are [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) used primarily as [[anti-inflammatories]] and [[analgesics]] (pain relievers), but which also have antipyretic properties; and [[paracetamol]] (acetaminophen), an analgesic without anti-inflammatory properties.<ref>"[https://pubchem.ncbi.nlm.nih.gov/compound/acetaminophen#section=Top Acetaminophen]", PubChem, National Center for Biotechnology Information, U.S. National Library of Medicine. Modified 2016-08-07, accessed 2016-08-16.</ref>

There is some debate over the appropriate use of such medications, since fever is part of the body's [[immune system|immune response]] to infection.<ref>{{Cite web |url=http://www.mayoclinic.com/health/fever/ID00052 |title=Fever treatment: Quick guide to treating a fever |website=Mayo Clinic |url-status=live |archive-url=https://web.archive.org/web/20131115193926/http://www.mayoclinic.com/health/fever/ID00052 |archive-date= 2013-11-15 }}</ref><ref>{{Cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/003090.htm |title=Fever |website=MedlinePlus Medical Encyclopedia }}</ref> A study published by the [[Royal Society]] claims that fever suppression causes at least 1% more [[influenza]] deaths in the United States, or 700 extra deaths per year.<ref>{{Cite news |url=https://www.science.org/content/article/fight-flu-hurt-society |title=Fight the Flu, Hurt Society? |last=Kupferschmidt |first=Kai |date=2014-01-21 |work=Science |url-status=live |archive-url=https://web.archive.org/web/20230212114036/https://www.science.org/content/article/fight-flu-hurt-society |archive-date= 2023-02-12 }}</ref>

==Non-pharmacological treatment==
Bathing or sponging with lukewarm or cool water can effectively reduce body temperature in those with [[heat illness]], but not usually in those with fever.<ref>{{Cite web |url=https://www.uptodate.com/contents/fever-in-infants-and-children-pathophysiology-and-management |title=Fever in infants and children: Pathophysiology and management}}</ref> The use of alcohol baths is not an appropriate cooling method, because there have been reported adverse events associated with systemic absorption of alcohol.<ref>{{Cite journal |last1=Sullivan |first1=J. E. |last2=Committee On |first2=H. C. |last3=Sullivan |first3=J. E. |last4=Farrar |first4=H. C. |year=2011 |title=Fever and Antipyretic Use in Children |journal=Pediatrics |volume=127 |issue=3 |pages=580–587 |doi=10.1542/peds.2010-3852 |pmid=21357332|doi-access=free }}</ref>

==Medications==
The list of medications with antipyretic effects includes many common drugs that also have analgesic and anti-inflammatory activity, several of which are commonly sold [[over-the-counter]] (OTC).

* [[NSAIDs]] (non-steroidal anti-inflammatory drugs), a broad class of medications that in addition to their defining effect of reducing inflammation, also tend to be potent analgesics and antipyretics. The majority work by inhibiting the activity of the [[cyclooxygenase]] (COX) family of enzymes in the body.
** Nonselective COX enzyme inhibitors like [[ibuprofen]] and [[naproxen]].<ref name="CryerFeldman">{{cite journal |vauthors=Cryer B, Feldman M |title=Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs |journal=Am J Med |volume=104 |issue=5 |pages=413–21 |date=May 1998 |pmid=9626023 |doi=10.1016/s0002-9343(98)00091-6 |url=}}</ref>
** [[Salicylate]]s, including [[aspirin]] (acetylsalicylic acid), [[magnesium salicylate]], and [[sodium salicylate]]. These are also primarily nonselective COX inhibitors, but also work through other mechanisms including activating [[AMP-activated protein kinase]].<ref>{{cite journal | vauthors = Hawley SA, Fullerton MD, Ross FA, Schertzer JD, Chevtzoff C, Walker KJ, Peggie MW, Zibrova D, Green KA, Mustard KJ, Kemp BE, Sakamoto K, Steinberg GR, Hardie DG | display-authors = 6 | title = The ancient drug salicylate directly activates AMP-activated protein kinase | journal = Science | volume = 336 | issue = 6083 | pages = 918–22 | date = May 2012 | pmid = 22517326 | pmc = 3399766 | doi = 10.1126/science.1215327 | bibcode = 2012Sci...336..918H }}</ref>
** COX inhibitors that are relatively selective for the [[COX-1]] enzyme, such as [[ketoprofen]] and [[flurbiprofen]].<ref name="CryerFeldman" />
** Conversely, COX inhibitors that are relatively selective for [[COX-2]], including [[nimesulide]], [[diclofenac]] and [[celecoxib]].<ref name="CryerFeldman" />
** [[Phenazone]]-like drugs ([[pyrazolone]]s), many of which have been largely phased out of used owing to safety concerns in most countries (including [[metamizole]], banned in over 30 countries for causing [[agranulocytosis]]), but remain available in some locations or for specific purposes such as for treating [[otitis media]] in the form of [[Antipyrine and benzocaine ear drops |ear drops]].
* [[Paracetamol]] (acetaminophen) class antipyretics, which have negligible anti-inflammatory activity. Apart from paracetamol itself, the medications in this class are mainly previously marketed drugs which were withdrawn owing to safety concerns, one example of this being [[phenacetin]].
* A few other medications have antipyretic effects of varying strength. While these medications tend to have too weak fever reducing effects or too many adverse effects to use primarily as antipyretics, their antipyretic effect may occasionally be useful. For example, there are theoretical reasons to believe,<ref name="clonidinetheory">{{cite journal |vauthors=Madden CJ, Tupone D, Cano G, Morrison SF |title=α2 Adrenergic receptor-mediated inhibition of thermogenesis |journal=J Neurosci |volume=33 |issue=5 |pages=2017–28 |date=January 2013 |pmid=23365239 |pmc=3711400 |doi=10.1523/JNEUROSCI.4701-12.2013 |url=}}</ref> as well as slight evidence from one human trial,<ref name="clonidineantipyretic">{{cite journal |vauthors=Mokhtari M, Sistanizad M, Farasatinasab M |title=Antipyretic Effect of Clonidine in Intensive Care Unit Patients: A Nested Observational Study |journal=J Clin Pharmacol |volume=57 |issue=1 |pages=48–51 |date=January 2017 |pmid=27264198 |doi=10.1002/jcph.776 |s2cid=3741978 |url=}}</ref> that [[Alpha-2 adrenergic receptor|α<sub>2</sub>-adrenergic agonist]]s, and particularly [[clonidine]] (a common drug used to treat [[high blood pressure]], [[ADHD]], [[spasticity]] and several other conditions), may have antipyretic effects, which if verified could potentially be useful in patients with [[septic shock]] or [[acute respiratory distress syndrome]].<ref name="clonidineards">{{cite journal |vauthors=Petitjeans F, Leroy S, Pichot C, Geloen A, Ghignone M, Quintin L |title=Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome? |journal=Temperature (Austin) |volume=5 |issue=3 |pages=224–256 |date=2018 |pmid=30393754 |pmc=6209424 |doi=10.1080/23328940.2018.1453771 |url=}}</ref>

===Use in children===
The U.S. [[Food and Drug Administration]] (FDA) notes that improper dosing is one of the biggest problems in giving [[acetaminophen]] (paracetamol) to children.<ref>[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm263989.htm Reducing Fever in Children: Safe Use of Acetaminophen]</ref> The effectiveness of acetaminophen alone as an antipyretic in children is uncertain, with some evidence showing it is no better than physical methods.<ref>{{Cite journal |vauthors=Meremikwu M, Oyo-Ita A |year=2002 |editor-last=Meremikwu |editor-first=Martin M |title=Paracetamol for treating fever in children |journal=The Cochrane Database of Systematic Reviews |volume=2002 |issue=2 |pages=CD003676 |doi=10.1002/14651858.CD003676 |pmc=6532671 |pmid=12076499 |quote=Trial evidence that paracetamol has a superior antipyretic effect than placebo is inconclusive.}}</ref> Therapies involving alternating doses of acetaminophen and [[ibuprofen]] have shown greater antipyretic effect than either drug alone.<ref name="Cohen">{{Cite journal |last1=E. Michael Sarrell, MD |last2=Eliahu Wielunsky, MD |last3=Herman Avner Cohen, MD |year=2006 |title=Antipyretic treatment in young children with fever: acetaminophen, ibuprofen, or both alternating in a randomized, double-blind study |journal=Archives of Pediatrics & Adolescent Medicine |volume=160 |issue=2 |pages=197–202 |doi=10.1001/archpedi.160.2.197 |pmid=16461878|doi-access=free }}</ref> One meta-analysis indicated that ibuprofen is more effective than acetaminophen in children at similar doses when both are given alone.<ref name="Kauffman">{{Cite journal |last1=Kauffman |first1=Ralph |last2=Sawyer, L.A. |last3=Scheinbaum, M.L. |year=1992 |title=Antipyretic Efficacy of Ibuprofen vs Acetaminophen |journal=American Journal of Diseases of Children |volume=146 |issue=5 |pages=622–625 |doi=10.1001/archpedi.1992.02160170102024 |pmid=1621668}}</ref>

Due to concerns about [[Reye syndrome]], it is recommended that aspirin and [[combination drug|combination products]] that contain aspirin not be given to children or teenagers during episodes of fever-causing illnesses.<ref>[https://www.cdc.gov/ncidod/diseases/reye.htm CDC Study Shows Sharp Decline in Reye's Syndrome among U.S. Children] {{webarchive |url=https://web.archive.org/web/20141115203654/http://www.cdc.gov/ncidod/diseases/reye.htm |date=November 15, 2014 }}</ref><ref>[http://www.nhs.uk/Conditions/Reyes-syndrome/Pages/Prevention.aspx Reye's syndrome - Prevention]</ref>

==Traditional medicine==
Traditional use of [[vascular plant]]s with antipyretic properties is a common worldwide feature of many [[ethnobotanical]] cultures. In ethnobotany, a plant with naturally occurring antipyretic properties is commonly referred to as a ''febrifuge''.<ref>{{Cite journal |last1=Schultes |first1=Richard Evans |last2=Raffauf |first2=Robert F. |date=1994 |title=De Plantis Toxicariis e Mundo Novo Tropicale Commentationes XXXIX Febrifuges of northwest Amazonia |journal=Harvard Papers in Botany |volume=1 |issue=5 |pages=52–68 |issn=1043-4534|jstor=41761491 }}</ref>

==References==
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[[Category:Antipyretics| ]]