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Letter to the Editor
Editor, – The article on paediatric analgesia (Aust Prescr 2008;31:63-5) provides a valuable quick reference on the subject. There is an additional purported mechanism of action for paracetamol, which may have implications in the setting of polypharmacy, especially perioperatively, or associated with chemotherapy.
A serotonergic mechanism of action has been reported for paracetamol.123 The inhibition or obliteration of paracetamol-induced analgesia by 5-HT3 antagonists, commonly used as antiemetics perioperatively, may warrant consideration when prescribing paracetamol concurrently with drugs from this class. Ondansetron, perhaps the most likely drug from the class to be prescribed to a child, may be less likely to inhibit analgesia, particularly in comparison to tropisetron.4
Department of Anaesthesia and Pain Management
Concord Hospital, Sydney
- Pickering G, Esteve V, Loriot MA, Eschalier A, Dubray C. Acetaminophen reinforces descending inhibitory pain pathways. Clin Pharmacol Ther 2008;84:47-51.
- Pickering G, Loriot MA, Libert F, Eschalier A, Beaune P, Dubray C. Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clin Pharmacol Ther 2006;79:371-8.
- Libert F, Bonnefont J, Bourinet E, Doucet E, Alloui A, Hamon M, et al. Acetaminophen: a central analgesic drug that involves a spinal tropisetron-sensitive, non-5-HT(3) receptor-mediated effect. Mol Pharmacol 2004;66:728-34.