COIMBATORE: Joint aches caused by chikungunya or other viral infections can be debilitating. But drugs to kill the pain can cause severe damage to the gastro intestinal (GI) system if proper safeguards are not provided. Prescribing a ranitidine alone, along with the painkiller, may not offer enough protection to the GI system.

Citing gastro-intestinal bleeds in recent chikungunya cases, gastroenterologist Dr V.G. Mohan Prasad says conventional non-steroidal anti-inflammatory drugs such as diclofenac attach themselves to receptors found on the mucosal surfaces in the body and spaces in the joints and stomach.

The receptors are also found in the GI tract. If the NSAIDS attach themselves to these receptors, they can cause ulcers. So, drugs called Cox II inhibitors that act selectively on the intended areas should be prescribed. These drugs can block an enzyme called cyclooxygenase that triggers pain and inflammation.

Conventional NSAIDs, or Cox I inhibitors, should not be given to people with previous history of peptic ulcer, bleeding of the upper GI and dyspeptic symptoms for more than three months. It is risky for elderly people and those suffering from rheumatoid arthritis, he says.

The doctor says that most of the chikungunya cases had been treated with NSAIDs but given only a small dose (150 mg) of ranitidine. "Normally, a painkiller and a ranitidine are prescribed. But first the potential ulcer cases should be identified before prescribing the ranitidine."

Dr. Mohan Prasad says that instead of ranitidine, proton pump inhibitors such as omeprezol, pantoprezol, rabeprezol or lansoprezol drugs should be prescribed to prevent damage to the gastro intestinal system. The proton pump inhibitors, preferably a double dose, will help strengthen the gastric mucosal barrier or suppress acid and thereby prevent damage. If acid combines with NSAIDs, the damage will be severe.

The doctor says that he treated recently two ulcer perforations and also ulcer bleeds in elderly persons, caused by NSAIDs. The point is that in providing effective treatment to cure someone of chikungunya the risks from drugs to the GI system should not be overlooked.

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