When our pediatrician in Brazil recommends a medicine, it never crosses my mind to see what the United States thinks about it. I mean, a medical professional told me it is the best thing to give to my kid, can't be that different, right?
Wrong. I have given my children two different medications that are illegal in the states. Say what?! The first time this was pointed out to me was during a visit to the states, shocker.
My youngest had Infant Reflux and was on Motillium (Domperidone). He had pneumonia, awesome during vacation, and I had to inform the US doctor of all medication he took on a regular basis. Her response was that Motillium is not allowed in the US, she hoped I brought enough for the trip (I did, duh), and that it works wonderfully for gastrointestinal issues.
Not too bad. Of course, I got online to search why. And you know, it was nothing too shocking. Just the American system taking care of it's people and anything that may be questionable. Heaven forbid let the people it could really help use it. Of course not, we are not responsible, nor are our doctors, and nor are our pharmacies. No, I'm not being sarcastic. The nation of pill poppers needs to be watched by big brother.
The second medication is a smidgen more alarming. My oldest suffers from fever seizures, still at 4 yrs old. And it is a freakin' scary ass thing to see. Not to mention, how quickly his fever can go from 99 (37) to 103 (39.4). It just shoots right up like Hugh Hefner after a Viagra.
Our Pediatrician recommended we ditch the Ibuprofen and give him Nolvagina (Nolvagine). Ok, I really didn't want to experience the fright again so I was on it. When my 4 yr old had one while we were walking home from school, we were sent to a pediatric neurologist.
I was ready to hear anything she had to say. And you know, it was good. Tests came out clean. We just couldn't let him run a fever. Give Nolvagina at 99 (37) and repeat it every 4 hrs if need be, every 6 if the fever stayed under control.
So we're in the states for an extended vacation and low and behold, both kids get sick. No biggie but we have a fever situation for the oldest. Since it's not his first fever this trip, we are running low on our Golden Fever medicine. I figure, we must have it in the states, maybe it's just prescription or something.
Oh no it's not prescription. Nolvagina/Nolvagine (Metamizole) has been banned in the US since 1977. 30 other countries followed suit. And while Brazil isn't the only country that still allows it, it is one of the top users.
I bet you are wondering, well what's the problem. The story is that Metamizole causes Agranulocytosis. Agranulocytosis is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, causing a neutropenia in the circulating blood. It represents a severe lack of one major class of infection-fighting white blood cells. People with this condition are at very high risk of serious infections due to their suppressed immune system.
Well there you go. That's peachy with a side of pear. With a little more Wikipedia research, I found that the incidence rate of metamizole-induced agranulocytosis is between 0.2 and 2 cases per million person days of use, with approximately 7% of all cases fatal
Ok, nothing too shocking. Not 1 in 4 or anything crazy like that.
What now? I think I'm going to go with my doctors back in Brazil. At the very least, both these medications were given as a last resort after other things didn't work. And you know what, they do work well. Nolvagina kicks my kid's fever's ass every time, and that is not an easy feat.
Eventually, as my youngest, my oldest won't have the seizure issue, fingers crossed. Then it won't even be the issue. For the time being, it seems the lesser of two evils.
How would you feel about this? Would it freak you out if you were prescribed a medication that is banned in your home country?
profit over people is practical in the constitution, so banning of a medication in the U.S. is really touch and go (and calls for what you did personal research). However, when 30 countries ban a medication that's when you should ask the question, "why hasn't brazil"?
ReplyDeleteBrazil is not always ethnical either. While I think doctors are a lot better in brazil and open minded to different treatments. There can be medication that slipped through testing or a side reason why something is used.
When people with extreme amounts of power make rules I think we need to question them and do the leg work to question them. And drug companies in the U.S. have a ton of power.
Hopefully, there will be something else that works just as good for you little boy.
Novalgina....
ReplyDeleteI know this was a serious subject, but everytime you wrote Nolvagina made me laugh. It sounded the US gov had a problem with the name of the substance.
Rachel,
ReplyDeleteI am alergic to Novalgina.
When I was a kid I had a severe reaction to it, it wasn't pretty, my mother never allowed it in our house ever again.
However, I have to go with Nina on this, in other words, I am always suspicious of the US when it comes to approving or not a certain medication, it is clear that here MONEY and PROFITS for the DRUG companies come first and safety really comes second.
There has been several scandals recently about FDA employees being on DRUG company's payroll and taking bribes to approve or NOT approve some drug.
But, when 30 other countries follow the ban I would worry.
Perhaps it wouldn't hurt to ask your doctor or a second opinion, different doctor for an alternative.
My mother always gave me tylenol and a cold bath in the bath tube to help reduce the fever due to my allergy.
I think regardless if you are in Brazil or in the US a second opinion is always relevant.
Ray
Go the American way and bring back tons of children's motrin.
ReplyDeleteWhen a little kid gets a high fever in the US, they usually recommend Motrin (also know as Advil or Ibuprofen) over tylenol.
However, Ibuprofen is rarely found in Brazil. So for most doctors its tylenol or novalgina.
The next time your son gets a fever, try giving him Ibuprofin and watch the temp, if it doesn't drop or keeps going up, give him the novalgina and stick to that in the future.
What people often don't know, that was pointed out to me by my pediatrician when I was 15 and suffering from extreme joint problems, is that it is OK to take multiple pain killers of different typle (Tylenol and Motrin, or Novalgina and Motrin) as long as its at least 30-60min apart. It is actually preferable to megadosing one or the other.
I have to say lesser of the two evils. You said that Ibuprofen wasn't doing the trick and that Novalgina worked. Agranulocytosis vs risk of seizures.... I pick agranulocytosis.
ReplyDeleteIf you are really worried about the agranulocytosis then ask the doctor if your son can be checked for regular blood work. A Hemograma Completo will tell you how the drug is effecting your son's immune system. Prolonged periods of low nutrophils, esonophils, and basophils can contribute to infection and fever thus causing a negative cycle. Also ask if the pill comes in a lower mg dosing that way you can adjust the need easier and risk over medicating.
Your son is lucky to have you as mom. Good job researching things for his benefit :)
Sara
First off, I have no idea why my font is so little. I've check it three dozen times and nothing...
ReplyDeleteIbruprofen is very easy to find in Brazil. It goes under the brand name Alivium. I prefer this method for my youngest, and my oldest before the seizure problem showed itself.
But the problem with ibruprofen is that if you child actually has dengue fever, it's VERY bad to give it to them. Something about the liver or kidney or something. So tylenol or Nolvagina is safer in that respect.
Ray, I bet you are allergic to the diperona in it. My Brother in law is as well. Nasty allergy!
SN, he had blood work for some other reason done and it was good. I'm not too worried but it is enough to give the jumpy stomach feeling. The thing is, his last fever lasted 20 minutes and he was out of it for a couple of hours. Very uncommon for a fever seizure but nothing came up in ECG so it has to be fever related... unless someone can give me more info on that one. Oh, and I give it in liquid form so i have complete control of dosage :) And thanks for the compliment Sara :)
Hmmm. I am intrigued. The EEG (ECG is it portuguese for an EEG or did you really mean electrocardiogram?) will not show up seizure activity unless the person is experiencing one during the test. Did the doctor ever run more neurological testing like a CT scan without contrast or MRI? Sorry if I am asking to invasive of questions. Feel free to not answer if this is inappropriate.
ReplyDeleteSara
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ReplyDeleteNina, bag of worms lol. That topic could be a blog within itself, seriously. And I agree. My brother, who works for a top pharmaceutical company as a scientist totally agrees. But as he points out, if they don't make money, they don't have money for quality research. I don't necessarily agree with that one.
ReplyDeleteSara, Sorry, meant EEG. Actually, she didn't and I wondered about that. Hard because I was so happy to have a "clean" bill of health. He had to lay with his eyes closed for 30 minutes and they tested him. A tough task for his age but he managed. Should I ask for a CT scan? Even my pediatrician was saying how abnormal it is for a kid his age to have fever seizures, although not impossible. The thing is that his seizure was very abnormal... But both did happen in correlation to a fever spike. And in both situations, he only had a virus. Btw, there are very few questions I find invasive. I think you are being nice by caring :)
I took Domperidone to increase my milk supply! I had to order it from a pharmacy in New Zealand and pray that it didn't get stopped at customs. Doctors are now allowed to prescribe it here in teh US for stomach issues, but you have to have it made at a compound pharmacy, which is SPENDY. When we were in Brazil in November, I was planning to load up on antibiotics (no health ins in the States), only to find out that the law had recently been changed and you have to have a prescription now. My inlaws said that things are starting to change there and regulations on medicine are getting stricter.
ReplyDeleteLaural, it just passed the end of November or something. I was totally taken aback by it! I actually posted about it lol. Really pisses me off but I guess it's something that has to be done. I mean, even antibiotic creams are px only. Come on! Oh well...
ReplyDeleteSorry internet went out last night. The only reason why they would do a CT would be to rule out any anomalies that could be present and hiding only to emerge under certain circumstances. CT scan are completely non-invasive and once again he will have to lie down for a small amount of time. They tend to be expensive in the US so do it here if you have too.
ReplyDeletePersonally I think that you are managing the situation quite well. It never hurts to ask your doctor just to see what he/she says about a CT. The dr. may have just assumed since he is symptom free until a fever then that is the problem. In the US we tend to run too many test to rule out everything so don't think that your dr. here missed something :)
I always would tell mothers to use their gut instinct. Nobody diagnoses better than a mother. If you believe there is something more than always investigate. The Dr. only knows your child when they visit and you are with him everyday. Something that may be normal but is not normal for your son could be a clue to what is really wrong.
Sara
I think it would freak me out a bit. But i think you're doing the right thing by be dilligent and researching everthing
ReplyDeleteRachel, never give Nolvagina to your kids if you think they have dengue, because it's very dangerous. Only tylenol is allowed.
ReplyDelete