Thomapyrin®

introduction

Thomapyrin® is a combination preparation consisting of the active ingredients: Paracetamol, acetylsalicylic acid (ASS) and caffeine. It is from the Boehringer Ingelheim Pharma GmbH & Co. KG (Vienna, Austria). It is one of the most widely used over-the-counter pain relieving drugs in Germany.

Thomapyrin® is mostly used to relieve mild to moderately severe pain.

composition

Thomapyrin® is in the form of Tablets with an active ingredient content of 250mg or 500mg expelled. The distribution of the three active ingredients in a 500mg tablet looks like this:

• ASS is the most concentrated at 250mg
• Then follows Paracetamol with 200mg
• caffeine makes up a relatively small proportion at 50mg.

Mode of action

The two pain reliever agents ASS and Paracetamol are among the very often used pain relieving preparations. Both belong to the group of Non-opioid analgesics; that is, they are not active ingredients that Morphine are related.

ASS becomes a subgroup of NSAIDs (Non-steroidal anti-inflammatory drugs / anti-inflammatory drugs) counted - that is, analgesics that are not on the active ingredient Cortisone based. It inhibits that enzyme Cyclooxygenasewhich for the production of various anti-inflammatory and anti-inflammatory factors is responsible, the Prostaglandins. By inhibiting the cyclooxygenase an attempt is made towards the balance between the factors produced anti-inflammatory (anti-inflammatory) to move.

In addition to the anti-inflammatory effect, ASA acts fever lowering (antipyretic) and inhibits blood clotting (anticoagulant). In the course of the inhibition of the COX, there is unfortunately also a lack of production of protective prostaglandinse.g. in the stomach, which is one of the reasons why various side effects are described.

The Paracetamol is within the group of Non-opioid analgesics to the "Non-acidic analgesics“Counted. The name results from the fact that NSAIDs, like ASS, Ibuprofen and Diclofenac (Voltaren), are chemically acids, while paracetamol is not. The exact function of paracetamol has not yet been conclusively clarified. It is known, however, that paracetamol fever lowering and pain reliever works, however not an anti-inflammatory Has an effect.

The third active ingredient, that Caffeine, has no known anti-inflammatory effects. The idea behind adding caffeine to the Thomapyrin® is that the two pain-relieving agents aspirin and paracetamol are so act faster and so the desired effect - pain relief - also occurs faster. In science and among pharmacologists, this effect is viewed critically and not confirmed from all sides. From different sides of increased side effects by combining the active ingredients, as well as increased risk of addiction, spoken. Other points of view state that due to the faster onset of action due to the caffeine, patients dose less frequently, i.e. take more tablets to achieve the effect. This would ultimately become a lower dose of possible harmful substances are ingested.

By adding caffeine it becomes no higher effect achieved; The positive effect is that with a lower dose of the analgesic together with 50mg of caffeine the same effect is achieved as with a higher dose of the analgesic without caffeine.

Some countries do not see the combination of various analgesic active ingredients as a starting point for today's medicine and prohibit approval, e.g. Switzerland.

Application and dosage

Thomapyrin® can occur in adults and adolescents from 12 years to treat mild acute pain to moderate pain be taken, e.g. head- and Toothache, at fever (for pain and fever treatment).

The intake of Thomapyrin® should no longer than 3-4 days take place unless there is a different specification from the attending physician. Can be seen throughout the day up to 6 tablets Thomapyrin® be taken. This maximum daily dose is based on the maximum doses for the active ingredients contained. Of ASA should not be more than 1500mg, of paracetamol daily no more than 1000mg and of caffeine daily no more than 300mg be taken.

Here you can 1-2 tablets every 4-8 hours be taken.

When taking it, make sure that in addition to the Thomapyrin® dosed as described above,Thomapyrin® intensive“There in the market. This is higher dose. Accordingly, the Number of tablets reduced to achieve the desired dose.

Side effects

When taking Thomapyrin® it can lead to various side effects come in almost every organ system in the human body. It is important to ensure that in addition to the Dosage amount also individual factors the user has a role to play, e.g. the enzymatic breakdown of the active ingredients. It can also help with the side effects differentiated between the triggers namely the individual active ingredients contained: ASS, Paracetamol and caffeine.

The likelihood of the occurrence of the side effects is classified into very common via frequent, occasional, rare and very rare.

Common side effects when taking Thomapyrin® are:

• dizziness
• nervousness
• Belly joking
• nausea
• Difficulty swallowing

Occasionally it can also:

• Vomit
• Palpitations (changes in the activity of the heart, such as stronger, faster or irregular beating)

come.

Users rarely report on:

• exhaustion
• Hyperhidrosis (increased sweating)
• agitation (Restlessness)
• Vomit
• Esophagitis (Inflammation of the lining of the esophagus)
• diarrhea
• tremor (Tremble)
• Tachycardias (increased heart rates).

Side effects associated with the Taking ASA are known are:

• increased tendency to bleed
• allergic reaction (Skin, respiratory tract)
• heartburn
• nausea
• Vomit
• Bleeding
• Perforations (Holes in the gastrointestinal wall)

There is also rarely talk of:

• a headache
• Fatigue and confusion of speech
• worsening of the liver and kidney values.

Due to that Paracetamol can it to Changes in blood count come, i.e. a changed composition of the blood from the blood cells and components it contains. You can also continue here allergic reaction occur on the skin and in the respiratory tract.

The use of paracetamol can be problematic damaging influence on the liver be: with one Overdose Of paracetamol, the liver enzymes are no longer sufficient for that Completely break down paracetamol. Therefore, other degradation pathways are used through which intermediate products toxic to the liver arise.

In the event of an overdose, Acetylcysteine (ACC). This has methyl groups, which can be used to break down the paracetamol into non-toxic products.

Interactions

In the simultaneous use various anticoagulants, such as ASS 100, Clopidogrel, Ticagrelor, Xarelto, Heparin or Marcumar®, a increased risk of bleeding.

Problems in the gastrointestinal tract (e.g. Ulcers) occur more often when others are parallel Non-steroidal anti-inflammatory drugs / anti-inflammatory drugs (NSAIDs) or Cortisone preparations (Corticosteroids) or alcohol is consumed.

The effect of Diuretics (diuretic drugs) and Antihypertensive drugs (Antihypertensive drugs) can be reduced.

There are also a large number of drugs that, together with Thomapyrin®, are a changed effect have: E.g. Rifampicin and Barbiturates the paracetamol concentration by modifying the activity of liver enzymes.

With simultaneous administration of drugs that the Reduce stomach activity it comes to one belated Onset of action of paracetamol while activity-enhancing pharmaceuticals the onset of action of paracetamol shorten.

Other drugs with known interactions include Chloramphenicol, Gyrase inhibitors (Antibiotics), various Sedatives, Zidovudine (Antiviral - Treatment of HIV), Cholestyramine (Cholesterol lowering drugs).

The included caffeine has an impact on Degradation and effects of sedatives (Sedatives), which are thereby reduced in their effect, and by the Sympathetic-stimulating-drugs (part of the nervous system that is responsible for increased activity in the body), the effect of which is increased (e.g. racing heart).

At long, permanent use of Thomapyrin® with other drugs that kidney damaging (nephrotoxic) Effects are at risk for one Analgesic nephropathy. The combined use of paracetamol and ASA in Thomapyrin® represents the main risk factor here. By blocking the Cyclooxygenase and the resulting lack of production of vasodilating messenger substances (Prostaglandins), it can be in the kidney too Circulatory disorders that lead to the destruction of the kidney tissue. Ultimately, the patient would become kidney failure and requires dialysis.

Because of this and possibly other as yet unknown or not mentioned interactions, if you are unsure or Inquiries with the attending doctor or pharmacist be asked.

Contraindications

Paracetamol should not be used if there are intolerances or allergies to the active ingredients it contains, i.e. aspirin, paracetamol and other components (lactose, caffeine).

Damage and functional disorders to the liver and kidneys are exclusion criteria for the use of Thomapyrin®.

In the case of heart failure and a tendency to bleed, the use of Thomapyrin® should also be avoided.

Children under the age of 12 are not allowed to take Thomapyrin®. ASA should not be used in children, as it can damage the liver and brain - Reye's syndrome. There is a particular risk in connection with febrile infections. For children, e.g. be treated with paracetamol.

During pregnancy, no more Thomapyrin® must be taken within the last 3 months. Due to the ASA contained in it, there is a risk of damage to the unborn child.

It is also contraindicated in the case of known gastric ulcers, bleeding and perforations in the gastrointestinal area.

Should a patient have a genetic deficiency in an important enzyme for the breakdown of paracetamol (Glucose-6-phosphate dehydrogenase), Thomapyrin® must not be used, as the lack of or slowed down or other enzymes using degradation of the ingredient paracetamol, toxic intermediate products are formed which destroy the liver cells.

In the case of additional medication with methothrexate, an immunosuppressive drug (e.g. for arthritis, lupus, tumors and other autoimmune diseases), Thomapyrin® must not be used.

Should the use of Thomapyrin® be necessary for one of the medications or illnesses, then this may only be done according to the instructions and under the supervision of the treating doctor.

pregnancy and breast feeding period

During the first 6 months of pregnancy Thomapyrin® should not be taken. By inhibiting the Cyclooxygenase due to ASA and the resulting lack of prostaglandins, it can Errors in the child's development come. Should an intake be necessary, then must the lowest possible doses be used.

During the third stage of pregnancy may under no circumstance Thomapyrin® be taken. The ASA induces prostaglandin deficiency leads to cardio-pulmonary undesirable developments, such as. the premature closure of the Ductus Botalli, such as Kidney failure. Furthermore there is the risk of Bleeding greatly increased in mother and embryo. In the last section, Thomapyrin® can be used for Inhibition of labor and thus lead to a delay in the birth.

With prolonged intake increases by the contained caffeine the Risk of miscarriage.

Since the ingredients of Thomapyrin® (aspirin, paracetamol and caffeine) are transferred through breast milk, they should be avoided during breastfeeding. Short-term use is not a problem; breastfeeding should be carried out for longer periods of time. The caffeine can have a negative impact on the infant's condition.