Doubts about a particularly high nephrotoxicity of combination analgesics

Fox, Johannes M.

doi:10.1093/ndt/14.12.2966

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…Patients with non-oncological illnesses as opposed to patients with cancer are older and have many comorbidities and cognitive impairment. The barriers in home care assistance for the recipients with non-cancer illnesses include less predictable trajectory, the lack of knowledge regarding the care needs of end-stage period, the low use of and late referral to palliative care [83], the possible overwhelm of the palliative care services, the necessity of knowledge in different specialties and the necessity of training in the areas of symptom control [84], and prognostication in non-malignant disease tends to be less accurate than in cancer [85]. These recipients require a multidisciplinary home care team, because they have a multidimensional area of caring.…”

Section: Family Caregivers For Home Care Recipients With Advanced Non-cancer Diseasesmentioning

confidence: 99%

The Family as Recipient and Provider of Home Care: A Primary Care Perspective

Florea¹,

Puia²,

Pop³

2021

Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care

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Advances in modern medicine, effective medication and high-technology interventions contribute to the growth of chronic comorbidities among older people, and many children with chronic diseases that reach adulthood require long-term care at home, provided by formal and informal caregivers and coordinated by primary healthcare professionals. Home caring, performed under different conditions from those of hospital care, requires the involvement of the family that is recipient and provider of home care. This chapter discusses the contribution of family caregivers to personalized home care of dependent children and elderly recipients, coordinated by primary health professionals. Children and youth with special healthcare needs and children abused and neglected require special involvement of family caregivers. The use of digital healthcare for recipients with medical complexity is a modern way to connect home care patients to specialized care, reducing the costs of the hospital care system. However, the burden in home care should be recognized by the general practitioner. Specific interventions are addressed to the unsupportive families and real hidden patients to help maintain their health and functionality. Future family doctors’ interprofessional communication skills and resourcefulness should meet the societal changes, and the burden of home care in the modern family is approached from the perspective of academic medicine.

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Section: Family Caregivers For Home Care Recipients With Advanced Non-cancer Diseasesmentioning

confidence: 99%

The Family as Recipient and Provider of Home Care: A Primary Care Perspective

Florea¹,

Puia²,

Pop³

2021

Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care

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“…13 [59] None [49,50], no data; see Table S1 Stewart 1978 Kidney Int. Schwarz et al [97] did not mention caffeine as a promoter of analgesic overuse, but they claimed the ban on caffeine-containing combination analgesics, which was criticized by Fox [98] because of the lack of evidence for such claim. Schwarz et al [97] did not mention caffeine as a promoter of analgesic overuse, but they claimed the ban on caffeine-containing combination analgesics, which was criticized by Fox [98] because of the lack of evidence for such claim.…”

Section: Discussionmentioning

confidence: 99%

“…Year [19] constitutes an indicator of a high risk of dependence' is invalid [26]. Schwarz et al [97] did not mention caffeine as a promoter of analgesic overuse, but they claimed the ban on caffeine-containing combination analgesics, which was criticized by Fox [98] because of the lack of evidence for such claim. The reply of Schwarz [99] did not reveal any further information.…”

Section: Authormentioning

confidence: 99%

Caffeine as a promoter of analgesic‐associated nephropathy – where is the evidence?

Fox

Siebers²

2003

Fundamemntal Clinical Pharma

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Individual groups of nephrologists - in their responsibility for their patients - initiated a most controversial discussion whether or not caffeine - coformulated to analgesics - might initiate or sustain analgesic overdosing. The original sources (data) of such suspicion have got lost during the debate of the last two decades. Therefore, it seemed to be appropriate to investigate the original data background and the reasons why nephrologists started to suspect caffeine as a stimulant of analgesic overdosing by employing a systematic and exhaustive review of primary nephrological publications. Their selection followed a precise selection plan, including all epidemiological studies on analgesic-associated nephropathy, the original papers of all groups having been involved in those studies, further originals from the mainly involved countries (academically, politically), and any literature thereof cited as a proof. The following results emerged from the investigation: (i) The epidemiological studies warranted no conclusion about a role of caffeine in prompting excessive analgesic use. (ii) The identified groups of nephrologists provided not substantial data to advocate the said suspicion, except for the observation of a preferential choice of phenacetin-containing combinations, especially powder preparations. (iii) Only two cited original data sources revealed drug-seeking behaviour with phenacetin-containing preparations which subsided, after phenacetin was banned from the respective markets. Conclusively, it appears that there is no substantial data to support a pivotal role of caffeine in initiating or sustaining analgesic overdosing. However, there is strong data that phenacetin, by its psychotropic properties, may have caused drug-seeking behaviour and thus led to analgesic overdosing. This conclusion is convincingly supported by thorough pharmacokinetic investigations. Note: All caffeine-related statements within the reviewed literature have been collected in tables (referred to as Table SX) which are provided in full text for check on the following website: http://www.blackwellpublishing.com/products/journals/suppmat/FCP/FCP174/FCP174sm.htm

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“…Another fear is that, because prognostication in nonmalignant disease tends to be less accurate than in cancer, 29 resources will be saturated by chronically ill patients with heart or lung or liver disease at the expense of those dying with cancer. 5 However, if the service is truly needs-based, a patient with heart failure and a prognosis of six months may gain more benefit from specialist palliative care input than a patient with lung cancer who has a prognosis of a few weeks; what matters is the severity and complexity of the patient's troubles.…”

Section: Barriers To the Expansion Of Palliative Care For Non-malignamentioning

confidence: 99%