salicylates and pyrazolone

The nonsteroidal anti-inflammatory drugs are one of the most commonly prescribed classes of drugs used in medical practice. This review discusses the diverse cutaneous reactions associated with nonsteroidal anti-inflammatory drugs. Adverse cutaneous reactions occur most frequently with benoxaprofen, piroxicam, sulindac, meclofenamate sodium, zomepirac sodium, and phenylbutazone. The most serious adverse cutaneous reactions, Stevens-Johnson syndrome and toxic epidermal necrolysis, appear to be most often associated with sulindac and phenylbutazone. Tolmetin and zomepirac sodium, two structurally similar pyrrole derivatives, have been associated with a disproportionate number of cases of anaphylactoid reactions. Among the currently marketed nonsteroidal anti-inflammatory drugs, piroxicam appears to have the highest rate of phototoxic reactions. This phototoxic eruption is most often vesiculobullous.

Topics: Acetates; Anti-Inflammatory Agents; Aspirin; Drug Eruptions; Humans; Ibuprofen; Indomethacin; ortho-Aminobenzoates; Piroxicam; Propionates; Pruritus; Pyrazoles; Pyrazolones; Salicylates; Skin; Skin Diseases; Stevens-Johnson Syndrome; Thiazines

Based on the radioallergosorbent test (RAST), the authors have developed a series of assays to detect IgE and IgG antibodies against a number of frequently used drugs. In this system drugs bound covalently to cellulose paper are incubated with serum and washed; the hapten-specific IgE and IgG antibodies are then qualified and quantified by means of 125I-labelled anti-human IgE and IgG respectively. Thus far the sera of 1,228 patients have been analyzed following therapy with betalactam antibiotics, co-trimoxazole, salicylates, pyrazolones, flavonoids and tetrahydroisoquinoline. The induction of IgG antibodies is a frequent occurrence and that of IgE rare. Isolated high titers of IgE are associated mainly with anaphylactic reactions; in the presence of simultaneously raised IgG titers such side reactions are often absent. Highest IgG titers were found in patients with immune hemolysis after betalactam antibiotics, flavonoids and tetrahydroisoquinoline. In the other types of side reaction specific IgG titers were not significantly higher than in patients without side reactions. The estimation of circulating antibodies against drugs cannot yet be utilized diagnostically except in the rare cases of anaphylactic side reactions. However, the method described permits specific and sensitive detection of sensitization and is suited for scientific purposes.

Topics: Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Drug Hypersensitivity; Flavonoids; Humans; Immunoglobulin E; Immunoglobulin G; Penicillins; Pyrazoles; Pyrazolones; Radioimmunosorbent Test; Salicylates; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The fact that aminopyrine is readily nitrosated and that the nitrosation product, dimethylnitrosamine, is potentially carcinogenic has led to the drug being withdrawn from therapeutic use. In the case of the other analgesics, nitrosation is not of any importance, neither in toxicological nor quantitative terms. The characteristic features of the metabolic pathways of phenacetin, paracetamol, and aspirin can occasionally entail toxicological consequences, such as methaemoglobin formation, liver damage, and long presence in the body, respectively. The prolonged and continuous administration of any of the three classes of drugs is not without risk. Adverse reactions of the allergic type cannot be detected by animal experiments.

Topics: Acetaminophen; Aminophenols; Analgesics; Animals; Biotransformation; Carcinogens; Dipyrone; Lethal Dose 50; Liver; Mutagens; Nitrites; Nitroso Compounds; Phenacetin; Pyrazoles; Pyrazolones; Rats; Salicylates

In 282 patients presenting with adverse reactions to mild analgesics, prick tests were performed with components of analgesic drugs; in some of them, commercial preparations were also tested. In 19 patients (7%), a total of 40 conclusively positive immediate reactions was found: there were 22 reactions to pyrazolone derivatives, 14 reactions to commercial preparations, and one singular reaction to phenacetin, phenobarbital, carbromal and vitamin B1, respectively. Cross-sensitivity to different pyrazolone derivatives was observed in only 5 of 15 patients with a positive reaction to at least one of these substances. One of the patients with a positive immediate reaction and 2 further individuals developed positive test reactions after 4 to 24 h. Within 117 patients who gave a clear-cut history of anaphylactoid reactions to mild analgesics, there were conclusive immediate prick test results in 15 cases (13%). In these patients, the diagnostic relevance of the prick test increased with the severity of symptoms in the history, and a conclusive immediate reaction was obtained in 25% of those with full shock in the history.

Topics: Adolescent; Adult; Aged; Aminophenols; Analgesics; Anaphylaxis; Child; Drug Eruptions; Female; Humans; Hypersensitivity, Immediate; Intradermal Tests; Male; Middle Aged; Pyrazoles; Pyrazolones; Salicylates; Skin Tests

Topics: Acetaminophen; Analgesics; Dental Care; Drug Combinations; Humans; Pain; Pain, Postoperative; Pyrazoles; Pyrazolones; Salicylates

Topics: Anti-Inflammatory Agents; Humans; Indoles; ortho-Aminobenzoates; Phenylacetates; Phenylbutazone; Piroxicam; Pyrazoles; Pyrazolones; Salicylates; Thiazines

Topics: Aminopyrine; Encephalitis; Encephalitis, Arbovirus; Epidemics; Humans; Pyrazolones; Salicylates