Analgesic use and chronic renal disease in patients with headache.
The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.
Rahman
A
A
Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur.
Segasothy
M
M
Samad
S A
SA
Zulfiqar
A
A
Rani
M
M
D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced*; D007677:Kidney Function Tests; D008134:Long-Term Care; D008881:Migraine Disorders / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications; D014567:Urography
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal