Tuesday, October 16, 2007
Tips for taking OTC pain meds
Just because something is available over the counter doesn't always mean it's safe. Case in point: NSAIDs. Never heard of NSAIDs? Well, you have probably heard of some of the specific brands: Aleve, Motrin, Naprosyn and many others. NSAID is an acronym for non-steroidal anti-inflammatory. About 14 million Americans take them on a regular basis, and get this, an astounding 60 percent experience some sort of side effect.

Many times, these side effects can be minor, but they can also be more serious. Significant gastrointestinal bleeding can result, as can problems with your kidneys or even your heart. Yep, just from taking simple over-the-counter medication. What's also problematic is that many patients never bother to mention that they are taking these medications to their doctors. And, that could result in even bigger problems.

It turns out that many of these medications can increase your likelihood of bleeding. Imagine that your doctor has scheduled you for surgery and thinks you are not taking any medications, but in fact you are on a blood-thinning medication such as aspirin or NSAIDS. You can imagine the type of complications that might arise. I have seen it firsthand.

There is no question that some people absolutely need their medications to ward off the aches and pains associated with arthritis. So, here are a couple of tips. Take the medication at the lowest dose for the shortest amount of time. You could also consider a different class of medications altogether, such as Tylenol. Finally, you could take a medication to coat your stomach, if you are taking anti-inflammatories long term.

Have you ever had any trouble with NSAIDs? What did you experience and what did you do about it? What is your best advice?
I have taken Ibuprophen and that makes my stomach hurt, unless I eat first. So I try not to take advil, or motrin or any form of Ibuprophen. I usually take Tylenol if I have pain. I still try to limit intake of that as well cuz I'm worried about liver damage. Do you recommend anything else?
Dr. Gupta: Is NSAIDS safe to take for pains such as headaches? I take Advil for my sinus headaches. Is this a danger? In the past I have taken Tylenol, but I heard it can danger your liver. What is your advice? My doctor treats me for my sinuses and just says "treat the symptoms".
I had a bad experience with Aleve, which I had been taking occasionally to relieve muscle pains. I had gone to a doctor thinking I had strep throat, but in fact I was told I had an absessed tooth. He told me to call my dentist but in the mean time take two aleve for the pain. When I got home that's exactly what I did, and within no more than 15 minutes I started scratching on my neck and soon the hives reached my face. I sent my son to the local drug store to get me some benedryl to offset the reaction. Needless to say, I will never take two Aleve again, I have since taken one of them for pain and have had no problem. This sudden reaction really scared me and thank goodness I didn't have a more severe one. It just goes to show that even if you've taken a drug before, it's not to say that a higher dosage is not going to create a problem.
I have recently read that people with type O+ blood are more likely to get stomach ulcers than people with other blood types. I would like to know if this is true Dr. Gupta. Can you do a report on this?

People who have gastric ulcers or who have had gastric surgeries such as gastric bypass probably shouldn't take a lot of anti-inflammatory such as aspirin, or ibuprofen, just because you're more susceptible to developing gastric ulcers or making the condition worse. Names of medications that can upset your stomach are Advil, Excedrin IB, Genpril, Haltran, Ibuprin, Ibuprohm, Ibu-Tab, Midrin 200, Medipren, Midol IB, Motrin, Nuprin, Pamprin-IB, Rufen, Trendar,
Aleve, Anaprox, Naprosyn, Amigesic, Anaflex 750, Marthritic, Mono-Gesic, Salflex, Salsitab, Disalcid, Anacin, Bayer, Bufferin, Ecotrin, Aspergum, Genuine Bayer, Bayer Childrens, Bufferin, Easprin, Ecotrin, Empirin, Genprin, Halfprin, Magnaprin, ZORprin, Butazolidin, Phenylbutazone,Cataflam, Voltaren Diclofenac Systemic, DayPro Oxaprozin, Dolobid Diflunisal
Feldene, Novo-Pirocam, Nu-Pirox Piroxicam, Indocin SR, Indocid, Novo-Methacin Indomethacin, Lodine Etodolac...more names of products and the effects they cause are:


Click link for website
Pain Relievers
OTC Drug Prescription Drug Adverse Effect



Acetaminophen (brand name:Tylenol)Antibiotics rifampin (brand names:
Rifadin, Rimactane) and isoniazid (INH)
Gets in the way of how the liver processes acetaminophen and increases the risk of liver
problems when taking acetaminophen.


Aspirin (two brand names: Bayer, St. Joseph) Diabetes medicines such as chlorpropamide (brand name: Diabinese), insulin and others Aspirin increases the bloodsugar-lowering effects of diabetes medicines. Anti-seizure drugs such as phenytoin (brand name: Dilantin) and valproic acid (brand name: Depakene) Aspirin gets in the way of the anti-seizure drugs binding
with proteins in the blood and leads to increased antiseizure drug levels in your blood.

NSAIDs, including:
􀁸 Aspirin
􀁸 Ibuprofen (two brand names: Advil, Motrin)
􀁸 Ketoprofen (brand name: Orudis KT)
􀁸 Naproxen (one brand name: Aleve)
Anti-cancer drug methotrexate (one brand name: Trexall) Drugs to suppress the immune system, such as cyclosporine (brand names: Neoral, Sandimmune)
Heart medicines such as digoxin NSAIDs reduce how the kidneys clear methotrexate out of the body. This can lead to having too much methotrexate in your blood.
NSAIDS reduce how the kidneys clear the immune system or heart drugs out of the body. This can lead to having too much of the drugs in your blood. Blood pressure drugs, such as propranolol (brand names: Inderal, Innopran XL), metoprolol (brand names: Lopressor, Toprol-
XL) and atenolol (brand name: Tenormin) NSAIDS reduce the bloodpressure- lowering effects of
the blood pressure drugs. Diuretics NSAIDS decrease effectiveness of diuretics.
Acetaminophen
NSAIDs Blood thinners such as warfarin
brand name: Coumadin)
Acetaminophen and NSAIDs increase blood-thinning effect of blood thinners.
Ibuprofen Naproxen sodium Lithium Ibuprofen and Naproxen reduce how the kidneys clear lithium out of the body. This can lead to having too much lithium in your blood.
http://familydoctor.org
Just wanted to mention an important note- tylenol can be an effective tool in combatting pain for some- however all too often physicians neglect to advise patients that drinking alcohol WITH tylenol can be deadly- the combined effects can bring about liver failure. So, if you drink, do NOT take tylenol.
Getting the same effect on the same pathways without the side effects, fish oil, or omega-3 essential fatty acids.

Deflaming (www.deflame.com) with the paleo diet (www.thepaleodiet.com) is the best natural anti-inflammatory approach.

As for the quick fix as well as support for long term health, fish oil.

The following is an excellent read and quite comprehensive with many clinical implications.

ω-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain
Surgical Neurology, Volume 65, Issue 4, April 2006, Pages 326-331
Dr. Gupta:

Good topic! I am waiting to have surgery and was in to see the doctor yesterday. I told her that I just stopped taking Motrin and was having a lot of pain. She told me "go on a head" and take the Motrin up until the morning of surgery.

I was shocked because I knew about this side effect from watching "House Call" from a few years back. I asked her about it and she said oh no problem.

Anyway, this along with other situations in the office have lead me to believe that my doctor and doctor's office is unorganized and unprofessional. I have been calling doctors for second opinions all day.

Thanks for the reminder that I am not nuts!
I am soo alergic to Naprosyn that my whole face blew up. I looked like ET.
Nice article. One thing missing, the adverse effect of NSAIDs on cartilage. Though advertised for arthritis pain, they actually accelerate cartilage loss. In Europe, there are other prescription anti-inflammatories that are not NSAIDs and have far better safety profiles. ASU, a derivative of plant oils is one. The clinical studies show a reduced need for NSAIDs in 30-60 days of use. There more info at drtheo.com
As for OVC meds...an alternative one for resistant staph infections that I've seen work is a combination of oil of oregano and alliciden (can get it from online alternative health company). This combo is amazing and saw it work wonders in a 3 year old who had staph infection and 2 antibiotics didn't touch it.
In my practice, I frequently find that patients have severe chronic daily headaches that have developed as a result of taking daily OTC pain medication. This is a problem that many health providers seem to know little about, and the general public knows nothing about.
To treat, it requires steroids for a week or occasionally as long as a month while being treated with a headache preventative such as a tricyclic medication or AED (antiepileptic drug). The offending OTCs must be stopped completely. Often , treatment of the H/A with DHE injections every 6-8 hrs for a few days is necessary. Usually, a week off work and away from all family obligations is required. Patients are usually shocked when they find than their H/A powders or acetaminophen, ibuprofen, aspirin, etc were responsible for such severe suffering.
Just another reason that OTCs are NOT harmless!
Yes, NSAID's can cause stomach irritation in a fairly small percentage of people, and can reduce the function of platelets causing potentially increased bleeding in surgery (though we can and do operate on patients taking NSAID's all the time).
However, Tylenol (acetominophen) is NOT an adequate substitute, and is not without its own serious risks. Yes, it can reduce fever, and is a (mild) analgesic, but it has no peripheral effects, and does not relieve the inflammation causing the pain.
It is often a better choice to allow a patient to continue taking NSAIDs before surgery and accept the minorly increased risk than to require the patient to stop their medication. Tylenol is often insufficient to relieve their pain, and the stress caused by chronic pain can be a far greater risk than that posed by NSAIDs.
Use your brain and common sense.Another thought..If Americans could go to doctors free (unlike individuals who don't even have a greencard who get FREE Medical care) There wouldn't be such a problem. Hey take all off the counter and you will have a problem with people drinking too much or using illegal drugs. Perhaps we should pay to put them all in jail or prison and raise taxes more! You dedcide.
i hope and pray for Kevin Everett"s recovery, it shouldn't matter if he can play football again, it's that he can get his mind, body and spirit healed.....
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