Klin Onkol 1999; 12(6): 200-205.
Backgrounds: Fever and its symptomatic therapy are very frequent problems in oncology. The type of drug and way of its administration are limited both by inability of peroral intake (due to vomiting and /or mucositis) and by severe trombocytopenia with disorder in coagulation. Design and Subjects: The taim of this study was to compare single-dose administered intravenous antipyretic drugs in efficacy, tolerance and in adverse effects in 254 febrile events. Our study had five arms in which the following drugs were evaluated: metamizol 2500 mg versus metamizol 1000 mg versus diclofenac 75 mg versus propacetamol 1000 mg versus propacetamol 2000 mg. Methods and Results: The efficacy of antipyretics was evaluated on the basis of decrease of body temperature in time. The temperature was measured before administration of drug, ad time O in time 0 minutes and at 30, 60, 90 and 120 minutes after administration. We also observed the following parameters: the elimination of symptoms associated with fever and tolerance during application of drug. The reduction of body temperature was statistically meaningful after administration of each drug in this study, however, there are significant differences found among arms. Metamizol 2500 mg affected most powerfully and rapidly (average reduction of temperature was in time T60 min. 1.06 degreeC and in time T120 min. 1.62 degreeC), diclofenac, metamizol a 1000 mg and propacetamol a 2000 mg were less efficient, propacetamol a 1000 mg had the significantly weakest efficacy (average reduction of temperature was in time T60 min. 0.69 degreeC and in T120 min. 1.10 degreeC). Diclofenac and metamizol (both in dose 2500 mg and 1000 mg) were tolerated best. The elimination of symptoms accompanying fever was at least mild in 82% patients, and at the same time without significant differences among arms of study. Conclusions: All examinated drugs were sufficiently efficient in symptomatic antipyretic therapy. Metamizol 2500 mg was found the most efficient and with diclofenac were the best tolerated drug. A considerable degree of subjective relief was observed after all antipyretics. From the clinicical point of view, we recomend in this indication diclofenac, propacetamol 2000 mg and metamizol 1000 mg too. The administration of metamizol 1000 mg has sufficient antipyretic effect and considerable lower risk of agranulocytosis.
