People’s Pharmacy: Doctor discourages overuse of fever reducers

Q. The French Ministry of Health warned against using ibuprofen to lower a fever from COVID-19. They might be right.

Americans often worry about fever. Many families and some institutions do their best to get it down. However, fever is a basic part of the immune system.

A miserable patient taking Tylenol, NSAIDs or even aspirin every once in a while is rarely a problem. How the drugs are used is critical. Generally, fever is your friend in case of infection.

When I was in medical school, sick children, babies and nursing home patients received alternating aspirin and Tylenol every four hours until well or dead. Too many patients did poorly.

In 2018, I found that some nursing homes in Missouri were still attacking fever vigorously. I think that is probably a mistake.

A. A few generations ago, healers recognized fever could be an ally in fighting off an infection. They would pile on the quilts to try to keep patients warm when they had the chills.

When drugs like aspirin, acetaminophen and ibuprofen came along, many health professionals started recommending them to lower fevers.

However, in the case of infections, fever might indeed stimulate the innate immune system (Nature Reviews Immunology, June 2015). The authors of this analysis point out using drugs to lower fever increases the likelihood of death from influenza by about 5% and “negatively affects patient outcomes in the intensive care unit.”

Of course, a really high fever requires medical attention. It can be quite dangerous.

Q. Three years ago, I developed a lung infection. The pulmonologist prescribed a short course of prednisone without any mention of side effects, which I promptly developed. Since I couldn’t get any answers from him or my primary care physician, I stopped taking the drug.

Last year, the infection came back. The symptoms had me worried about a heart attack. The emergency room and the pulmonologist put me on an aggressive tapered course of prednisone but didn’t talk about side effects. I experienced dry mouth, frequent urination, blurry vision, dizziness, constipation and mouth sores.

After 15 days of this, I went back to the emergency room. They apologized for not telling me the prednisone would raise my blood sugar, which was at 605 when they checked. They administered insulin and showed me how to use it for the rest of the prednisone course. Let others know that prednisone can definitely raise blood sugar!

A. Your blood sugar was critically high. Thank goodness you received emergency treatment.

You are correct that prednisone and other corticosteroids can raise blood sugar. Even inhaled steroids can have this effect (Diabetes, Obesity & Metabolism, online, April 1).

Dozens of other drugs, including statins and diuretics, also can interfere with blood glucose control. You can learn more about these in our eGuide to Preventing & Treating Diabetes.

We also discuss nondrug approaches such as cinnamon, vinegar, curcumin and coffee, or supplements like selenium, bitter melon, fenugreek or nopal cactus. You will find it in the Health eGuides section of peoplespharmacy.com.

Physicians should alert patients to the possibility that a medication could raise blood glucose when they prescribe it.