Induction of Tolerance to Non Steroidal Anti Inflammatory Drugs Might Be an Alternative Therapeutic in the Painful Crisis of Sickle Cell Disease

Background and Aims: In Ivoirian’s school, the management of vaso-occlusive painful crisis in sickle cell disease requires non steroidal anti inflammatory drugs (NSAIDs). Although their effectiveness, these drugs may be accompanied by intolerance reactions. When these occur, no codified alternative therapeutic seems to be used to our knowledge. Authors aimed to evaluate the induction of tolerance to NSAIDs as an effective alternative therapeutic. Methods: 22 patients (15 men and 7 women aged from 12 to 39 years with mean age: 22.41 ± 7.88) suffering from vaso-occlusive painful crisis were enrolled. They were known to have a history of sickle cell disease and at least one episode of adverse reactions following the Ibuprofen or Diclofenac intake. A rapid protocol of oral challenge was used in patients to induce tolerance to NSAIDs. The first day, initial doses (8.82 mg for Ibuprofen and 2.20 mg for Diclofenac) were given and gradually increased at intervals of 1 hour over a total period of 6 hours. On the second and third days, the therapeutic dose has been orally administrated with an interval of 6 hours over a period of 12 hours. Results: Despite of some cases of failure that might be related to the severity of symptoms or possible patho-physiological mechanism, more than 80% of patients have successfully tolerated Diclofenac and Ibuprofen. Conclusion: This experience appears to be the first in our context. It might be used as a solution in the lack of alternative therapeutic in the management of vaso-occlusive painful crisis of sickle cell disease as well as in other diseases such as HIV infection where patients often develop intolerance to none alternative antibiotics.

A survey of analgesic and anti-inflammatory drug prescription for oral implant surgery

Aim:This study was conducted to determine the preferred analgesic and anti-inflammatory drugs prescribed by oral implantologists in India.Methods:A structured questionnaire was distributed to 332 dentists to gather information regarding their prescription habits for analgesics and anti-inflammatory drugs.Frequency distributions were computed by type of drug being prescribed and the protocol followed.Results:Analysis of data showed that majority of dentists(85.8%,n=285)prescribed conventional non-steroidal anti-inflammatory drugs(NSAIDs)for implant surgery.The most common prescription was ibuprofen with paracetamol combination(32.2%,n=107)followed by diclofenac(20.2%,n=67).Most dentists reported prescribing different NSAIDs for the same procedure in different patients(64.7%,n=215).Only,35.5%(n=118)followed the peri-operative protocol.Adjunctive prescription of steroids was done by only 33.7%(n=112).Conclusion:Our study illustrates that the general trend of analgesic and anti-inflammatory drug prescription for dental implant surgery among Indian dentists is mostly in accordance with the guidelines for pain management worldwide.However,it is noteworthy that a few dentists do prescribe drugs not primarily indicated for dental pain management and use widely varying protocols for the same.Therefore,in order to avoid potential complications,it is essential to raise awareness of among the dental practitioners of the appropriate indications and dosage regimen of specific drugs.