What is the appropriate medication for hyperthermia (fever)?

From the Guidelines

For fever management, ibuprofen is the most appropriate medication, and it can be used when the temperature is higher than 38.5 ℃, with a dose of 0.2 g per time, every 4–6 h in continuous fever, but no more than 4 times in 24 h, as recommended by the most recent guideline 1.

Key Points to Consider

• The temperature below 38 ℃ is acceptable, and much lower body temperature is not conducive to antiviral treatment, as stated in the guideline 1.
• It is essential to stay hydrated while taking these medications, as fever increases fluid loss.
• If fever persists or is accompanied by severe symptoms, seek medical attention immediately.

Medication Details

• Ibuprofen can be used for antipyretic purposes, with a dose of 0.2 g per time, every 4–6 h in continuous fever, but no more than 4 times in 24 h 1.
• The guideline does not recommend a specific medication for children, but it is crucial to consider the weight-based dosing for pediatric patients.

Important Considerations

• Fever management is critical, as increased body temperature can lead to poor neurological outcomes, possibly secondary to increased metabolic demands, enhanced release of neurotransmitters, and increased free radical production 1.
• The source of any fever should be ascertained, and treating the underlying cause is essential.
• Maintaining normothermia or lowering an acutely elevated body temperature has been hypothesized to improve the prognosis of patients with stroke, but the evidence is not conclusive 1.

From the FDA Drug Label

The pharmacological activity of naproxen in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, noninflammatory painful conditions Naproxen (PO) and ibuprofen (PO) are both NSAIDs that can be used to reduce fever.

• Key points:
  • Naproxen can reduce fever, but its use may diminish the utility of diagnostic signs.
  • Ibuprofen can also reduce fever, but its use is associated with risks such as GI ulcerations, renal toxicity, and anaphylactoid reactions.
• Clinical decision: Both naproxen (PO) 2 and ibuprofen (PO) 3 can be used to reduce fever, but the choice of medication should be based on individual patient factors and medical history.

From the Research

Appropriate Medication for Fever

• Acetaminophen (paracetamol) is a widely used and effective medication for managing pain and fever in patients of all ages 4, 5, 6.
• It is commonly recommended as first-line therapy for various patients and conditions, including the elderly, children with viral illnesses, and patients with osteoarthritis, gastrointestinal conditions, bleeding disorders, cardiovascular disease, or renal disease 4, 6.
• The use of acetaminophen is generally safe and well-tolerated at recommended doses (≤4 g/day) in healthy adults and may be preferable to non-steroidal anti-inflammatory drugs (NSAIDs) that are associated with undesirable gastrointestinal, renal, and cardiovascular effects 6.
• However, there are concerns about the potential hepatotoxicity of acetaminophen, particularly in patients with chronic liver disease 4, 7.
• Studies have shown that acetaminophen can be used safely in patients with liver disease at currently recommended doses, and it is a preferred analgesic/antipyretic due to the absence of platelet impairment, gastrointestinal toxicity, and nephrotoxicity associated with NSAIDs 4, 6.
• Other options for treating fever include the combination of paracetamol and ibuprofen, which has been shown to be effective in patients with bacterial fever 8.
• Ibuprofen has been found to have a low risk of bleeding events at over-the-counter doses used to treat pain and fever, and it may be a suitable alternative to acetaminophen in certain cases 7.
• The choice of medication for fever should be individualized based on the patient's underlying condition, medical history, and other factors, and should be made in consultation with a physician 6.