Posts Tagged ‘ibuprofen’

Topical NSAIDs for Aches and Pains

December 5th, 2016. Filed Under: Uncategorized.
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Q: I’ve taken Aleve® or Motrin® for years for my bad knee, but now my stomach burns whenever I take them. My doctor tried me on Celebrex®, which didn’t burn my stomach but didn’t work for me. I’ve already tried Icy-Hot® and capsaicin but they burn my skin. Are there any other creams that could help my joint pain?
Yes. Motrin®, also called ibuprofen, is related to Aleve® (naproxen) and Celebrex® (celecoxib) which are Non-Steroidal Anti-inflammatory Agents, or NSAIDs. In the United States most people take NSAIDs by mouth as tablets, but in the UK and Europe they have used NSAID creams, gels, ointments and sprays for many years.

NSAIDs are very good at treating most types of swelling and pain, whether from a sudden injury like a muscle sprain or strain or a chronic inflammation such as arthritis. Using an NSAID cream or gel directly to your sore muscle or joint can relieve pain and inflammation without the side effects that NSAIDs often cause, like stomach burning, stomach pain, kidney or heart problems. For people who take a blood thinner, using a topical form of NSAID helps avoid an increased risk of bleeding.

You are not alone in noticing side effects from taking an oral NSAID like Aleve® or Motrin®. Many Americans with ulcers, kidney or heart problems could benefit from using an NSAID instead of a dangerous narcotic pain reliever. Sadly, diclofenac is the only commercially available topical NSAID in the United States and it requires a doctor’s visit for a prescription.

With so many other NSAIDs available, why is diclofenac the only one marketed in United States as a cream, gel or spray? I suspect the pharmaceutical companies haven’t bothered to develop or market topical versions of their NSAIDs in America because there’s not enough patent protection to make it profitable.

Another roadblock to the availability of topical forms of NSAIDs is whether it can penetrate the skin. Grinding a medicine up into powder and adding it to a cream or ointment doesn’t guarantee that enough of it will merrily move through the skin to cause a measurable decrease in pain. In some cases, the drug company has decided that the topical version of their NSAID medicine isn’t effective enough to justify the huge investment needed to pursue approval from the Food and Drug Administration (FDA).

Some topical NSAIDs have been shown to ease the acute pain of sprains and strains as well as the chronic pain of osteoarthritis. In September 2012 the Cochran Institute published a review of multiple studies called a meta-analysis on this topic, called Topical NSAIDs for chronic musculoskeletal pain in adults. They collected and evaluated lots of studies done with topical NSAIDs, many of them unpublished work from the files of drug companies. Two NSAIDs stood out as effective in chronic musculoskeletal pain: diclofenac and ibuprofen. Not only that, but diclofenac was shown to be just as effective applied to the skin as in a pill form, and with minimal side effects. Both ibuprofen and diclofenac gel are available without a prescription in the UK and Europe.

While visiting Germany a couple of years ago, I saw Voltaren® gel advertised in the windows of several Apotheks (German pharmacies). The day before we flew home I stopped at a busy Apothek to see if I could purchase some Voltaren®. Pointing at the boxes of gel displayed in their window, I rubbed my elbow and stammered, “Voltaren®, bitte?”

With our daughter Maureen translating, I discovered from the German pharmacist that generic ibuprofen gel had been available in Germany for over 10 years, and neither it nor the Voltaren® gel in the window required a prescription. I walked out triumphantly clutching a tube of each. Too bad the patient information leaflet inside the box was only printed in German.

You can get topical diclofenac in the U.S. in several formulations and brand names, but it is expensive and available only by prescription. Diclofenac comes as Voltaren® 1% gel, applied 4 times daily; Pennsaid® 1.5% solution, applied 3-4 times daily; Pennsaid® 2% solution in a pump applied twice daily; and Flector® 1.3% as a patch applied twice daily. It’s also available as Solaraze® 3% gel for rosacea.

Now, here’s some good news: Voltaren® gel is now available as a generic! This usually means it costs less and will be added to most prescription insurance plans. Check with your doctor for a prescription for generic Voltaren® (diclofenac) 1% gel for your knee pain.

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Choosing a Medicine for Your Aches and Pains

Q: There are so many choices out there for aches and pains. Which medicine is best for me?

When you have mild to moderate pain like a headache, sore muscles or aching joints there are 4 pain medicines you can buy without a prescription: aspirin, acetaminophen (Tylenol®), ibuprofen (Advil®), and naproxen (Aleve®). Which one should pick?

Aspirin is the oldest of these four options and is available in two strengths: low dose or “baby” aspirin which are 81mg each and the adult dose of 325mg, which is exactly 4 times the 81mg dose. Many Americans take one aspirin a day to prevent heart problems because of how it works as a blood thinner. If you take any prescription blood thinner medicine like Plavix®, warfarin (Coumadin®), or one of the newer ones advertised on the television, don’t take more aspirin for relief of your headache pain. Since aspirin can upset your stomach it’s best to take it with food or a full glass of water.

Whether sold as Tylenol® or by its generic name acetaminophen, Tylenol® is the most popular and common painkiller sold in America. Although it is safe enough for kids to take, Tylenol® has a dark side: taking too much acetaminophen is deadly to your liver. Being available in over 200 different non-prescription products the popularity of acetaminophen makes it dangerous because its so easy to get too much.

If you take a prescription pain medicine you may already be getting acetaminophen. Look for the abbreviations APAP or ACET on the prescription label, or ask your pharmacist. If you have liver disease, don’t take Tylenol® until you talk to your doctor about whether taking it is safe for you and how much you can safely take for pain.

The other two pain relievers available without a prescription are closely related to each other and also to aspirin. Ibuprofen and naproxen were originally only given as prescription medicines, but now they are available in non-prescription products in addition to their stronger prescription doses. Aspirin, naproxen and ibuprofen relieve muscle aches and swelling better than acetaminophen and belong to a group of medicines called NSAIDs, or non-steroidal anti-inflammatory drugs.

When taking ibuprofen, also known as Advil® or Motrin-IB®, or its close cousin, naproxen, sold as Aleve® be careful to take it with food to avoid stomach pain and bleeding. NSAID medicines can also damage your kidneys, especially if you have kidney problems or take it when you are dehydrated.

Taking too much of an NSAID is particularly dangerous because it can cause stomach bleeding and kidney failure. In addition to the non-prescription NSAID remedies there are several prescription NSAIDs commonly prescribed. Ask your pharmacist if you are already taking a prescription-strength NSAID and if you are, avoid taking the non-prescription versions.

7 Tips for Taking OTC (over-the-counter) Pain Relievers Safely:

  1. For aching muscles and swelling, ibuprofen or naproxen usually works better than acetaminophen. Some people get more relief with one or the other. Ask your pharmacist before taking ibuprofen or naproxen to make sure that you’re not already getting a prescription product doing the same thing.
  2. Avoid taking an NSAID if you already take a blood thinner. Taking 81mg of aspirin daily is ok, though. Ask your pharmacist if you aren’t sure if you are on a blood thinner medicine.
  3. Watch out for taking too much Tylenol®. Healthy adults can take up to 4 grams per day, or the equivalent of 8 tablets of extra-strength acetaminophen. Older adults are should limit their Tylenol® use to 3.1 grams daily, or 6 tablets of extra-strength Tylenol®. If you take a prescription pain reliever ask your pharmacist to find out if it has acetaminophen in it, and how much.
  4. If you take aspirin daily for your heart, talk to your doctor o pharmacist before taking it for pain relief. It’s safer to take Tylenol® or another NSAID like naproxen instead.
  5. You can take both acetaminophen and an NSAID for pain at the same time, as long as you don’t take more than is safe for you. Your pharmacist is a medication expert and can advise you as to which one is best for you.
  6. If you have kidney disease avoid taking ibuprofen or naproxen for mild to moderate pain, and make sure that you stay well hydrated when taking either one.
  7. If you have liver disease, ALWAYS check with your doctor before taking Tylenol® or acetaminophen.

 

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A Safer Way to Take NSAIDs for Pain

Q: I’ve taken Aleve® for years for a bad knee, but now my stomach burns whenever I take it. Ibuprofen doesn’t work as well. My doctor gave me a prescription for Celebrex® which didn’t cause burning but only helped a little bit. Icy-Hot® didn’t help and capsaicin cream burns like fire. Are there any other creams out there to help joint pain?

In other countries, gel or creams containing medicines like ibuprofen have been available for years. Ibuprofen, also called Motrin®, is related to Aleve® (naproxen), and Celebrex® (celecoxib). These medicines are called NSAIDs, which stands for Non-Steroidal Anti-inflammatory Agents.
NSAIDs treat the swelling and pain of muscles or joints from either sudden injuries like a muscle sprain or strain, or chronic inflammation such as the joint swelling of arthritis. In the United States most people take NSAIDs as tablets, but both tablet and topical (gel, cream, ointment or spray) versions have been used for decades in the UK and Europe.
The advantage to using an NSAID cream or gel over a tablet is that relief goes directly to your painful areas without the side effects that NSAIDs can often cause, like stomach pain, kidney or heart problems. For people who take a blood thinner, using a topical form of NSAID avoids the risk of bleeding.
You’re not the only one who has side effects from an NSAID medicine. Americans with ulcers, kidney or heart problems would benefit from having safer forms of NSAIDs, but the only topical NSAID currently available is diclofenac, and it requires a prescription.
I believe pharmaceutical companies haven’t marketed any topical versions of their NSAIDs in the U.S. because there’s not enough patent protection to make it profitable. Ibuprofen and naproxen became available as non-prescription (OTC) tablets only after the U.S. patents for their prescription forms expired.
Another roadblock to making topical forms of NSAIDs available is whether it can penetrate the skin. Grinding up a medicine into powder and adding it to a cream or ointment doesn’t guarantee that it’s going to work; a drug company may decide that   the topical version of their NSAID isn’t effective enough to justify the investment needed to pursue approval from the FDA.
Topical NSAIDs are used to ease the acute pain of sprains and strains as well as the chronic pain of osteoarthritis. A study called Topical NSAIDs for acute pain: a meta-analysis published in 2004 looked at many different studies of various NSAIDS, with successful treatment being able to decrease pain at least 50% within 1 week. This analysis found ketoprofen gel best at relieving acute pain with ibuprofen gel a distant second. Full details are available at http://www.biomedcentral.com/1471-2296/5/10.
In September 2012 the Cochran Institute published the meta-analysis Topical NSAIDs for chronic musculoskeletal pain in adults. It collected various studies; many of them unpublished work from the files of drug companies. Two NSAIDs stood out as effective in chronic musculoskeletal pain: diclofenac and ibuprofen, with diclofenac being just as effective topically as in a pill form, yet with minimal side effects. Both ibuprofen and diclofenac gel are available without a prescription in the UK and Europe.
Last week while visiting my daughter Maureen in Germany, I saw Voltaren® gel advertised in the window of several German pharmacies. The day before we left to go home I walked into a German pharmacy, called an Apothek to buy some. Pointing at the boxes of gel displayed in their window, I rubbed my arm, saying, “Voltaren®, bitte?” With Maureen translating, I discovered that ibuprofen gel had been available for over 10 years and was now generic, Voltaren® gel was the more popular of the two gels, and both were for sale without a prescription. I walked out of the Apothek triumphantly clutching a tube of each, even though all the directions were in German!

German Gels for Pain

German Gels for Pain

Topical diclofenac is available in the U.S., by prescription only, as: Voltaren® 1% gel applied 4 times daily; Pennsaid® 1.5% solution applied 3-4 times daily; Pennsaid® 2% solution in a pump applied twice daily; and Flector® 1.3% patch applied twice daily. Diclofenac is also available as Solaraze® 3% gel for rosacea.
Check with your doctor to see if one of these would be helpful for you; because they are brand name products, there should be samples you can try.

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