Effects Of Co-administration Of Antimalarial With Paracetamol

From my industrial training (IT) days down to internship, there is one practice that resonates with drug prescribers. They always give antimalaria with paracetamol or painkillers. The paracetamol is to be taken based on body weight every 6 or 8 hours for three days. This practice is done by medical doctors and pharmacists both young and old. What is the rationale behind this practice?

Rationale Of Co-administration Of Paracetamol With Antimalarial

I did a small questionnaire and pulled answers from some medical doctors and pharmacists within Nigeria. My findings showed that it was more of personal reason and not based on research and evidence based treatment plan.

Read Also: Pharmacotherapy/Treatment Of Malaria

To some, the paracetamol is to reduce the fever during treatment. To others, paracetamol reduces the side effects of antimalaria.

World Health Organization Recommendation Co-administration Of Paracetamol With Antimalarial

A look at the world health organisation standard showed that paracetamol was mentioned only once in the management of malaria. And the description was that the paracetamol should be taken for the period the fever is above 38.5⁰C. If the fever is less than that, there is no need for the paracetamol. And if the fever falls less than that during the course of treatment, the paracetamol should be stopped.

Headache

There is a lot of research done on this topic. Some use paracetamol alone to see if it has any little antimalarial properties. Others gave paracetamol along with antimalarial and others gave antimalarial alone without paracetamol. The result showed that the world health organisation will have to come together to deliberate on this issue.

Paracetamol Use In Reducing Fever In Malaria

The paracetamol did reduce the headache and fever but not statistically significant when compared to placebo. This means that with or without paracetamol, the patent will feel well within almost the same time. There is no evidence that reducing fever during malaria treatment reduces parasite clearance time. We all know that one of the mechanisms the body uses to protect itself from microorganisms is to increase body temperature. This may be beneficial in malaria infection. Reducing the temperature may help the parasite thrive.

Most of the research has shown that given antimalarials with paracetamol increase parasite clearance time even up to 16 hours. Paracetamol decreased significantly the production of oxygen radicals and tumour necrosis factor (TNF), mechanisms of the innate immune response, pivotal to combat infections.

Read Also: Preventing Malaria Without The Use Of Drugs

Animal studies showed that fever increases survival while antipyretic like paracetamol increases mortality. There are times when there is benefit of adding paracetamol such as in extreme temperatures where febrile convulsions are reduced. But the world health organisation recommends the use of anticonvulsant for seizure in severe malaria. This is because the febrile convulsions or seizures are not caused by fever but by falciparum malaria due to cerebral pathology. More than half of all malarial associated convulsions occur at rectal temperature below 38.5⁰c. This suggests that the pathogenesis of seizure in malaria is independent of body temperature.

Paracetamol Use In Reducing Fever Side Effect Of Antimalarial

Many drugs have fever as side effects. Many patients will not experience these side effects because it is uncommon. Side effects like this are mild and transient for those who even experience it. But it is not a norm to prescribe paracetamol along with those drugs. This practice is tied to only antimalaria. So paracetamol is not needed to drop the fever.

Benefits Of Paracemol Use With Antimalarial

But there is a reason paracetamol is beneficial when used with antimalaria. Paracetamol protects the kidney and prevents acute kidney failure in malaria treatment. It is understood that paracetamol reduces oxidative properties of haem. Fatal complications of kidney failure have been closely linked with the level of haemolysis. So a normal dose does protect the kidney. The decision to add paracetamol to antimalarial should be based on protecting the kidney instead of fever or side effects of antimalaria.