Posts Tagged ‘naproxen’

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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The Best Non-Prescription Pain Relievers

Q:             Which non-prescription pain medicine is the best to use?

There are 4 pain medicines you can buy without a prescription: Tylenol®, Aleve® Advil®, and Motrin-IB®. Which would be best for you to use depends on what type of pain you need it for and whether you have certain kinds of medical conditions.

Tylenol® is oldest of the pain medicines available over-the-counter (OTC). Also known by its generic name acetaminophen, Tylenol® is very safe to use as long you avoid taking too much of it. Taking more than 8 Extra-Strength tablets of 500mg acetaminophen or 12 tablets of regular strength or 325mg Tylenol® in one day can permanently damage your liver, especially if you do it frequently.

The other 3 pain medicines you can buy without a prescription are closely related to each other and all work in the same way. The active ingredient in Aleve® is naproxen and the active ingredient in both Advil and Motrin-IB is ibuprofen. Ibuprofen and naproxen are called non-steroidal anti-inflammatory drugs or NSAIDs for short. NSAIDs are powerful painkillers that are quite effective for certain types of pain associated with inflammation: muscle aches, sprains or strains, tension headache, and dental pain.

Pain medicines with anti-inflammatory action like ibuprofen or naproxen are much better than Tylenol® or acetaminophen for menstrual cramps and especially to prevent swelling and pain after a tooth extraction, but it comes with a price. NSAIDs can cause stomach pain and bleeding, interfere with how your kidneys work, or trigger heart failure from retaining excess water.

I recommend naproxen (Aleve®) over ibuprofen because it lasts longer. Naproxen lasts 8-10 hours while ibuprofen wears off in 6 hours. Years ago I tore a ligament in my right wrist while chopping wood in weather 20 degrees below zero. Some people should NOT be allowed to swing an axe, and I’m one of them! Even taking the most potent prescription strength of ibuprofen three times a day I’d wake up in excruciating pain night after night at exactly 3:25 am. After switching to the OTC strength of naproxen I slept blissfully through the night.

Always take an NSAID with a full glass of water or right after a meal to reduce your risk of stomach problems like burning, cramps, heartburn or bleeding ulcers. The extra water or food will dilute the medicine as it dissolves in your stomach, decreasing your chances of developing pain or bleeding.

When taking naproxen or ibuprofen it’s extremely important to drink plenty of water and avoid them if you are having vomiting or diarrhea. NSAIDs can cause problems with your kidneys, especially if you become dehydrated.

If you have a certain type of heart condition called congestive heart failure (CHF), you should avoid NSAIDs completely. Just ONE DOSE of ibuprofen or naproxen can trigger a deadly build up of fluid in your lungs.

If you have stomach or kidney problems, Tylenol® will be the safest medicine for you to treat mild to moderate pain… unless you take too much of it.

Unfortunately, taking more acetaminophen than you should is MUCH easier than you’d think. Following the dosing recommendations on your bottle of Tylenol® is not enough to prevent problems because acetaminophen is already in many commonly prescribed prescription pain medicines like Vicodin® and Percocet®.

You can also end up taking too much NSAID medicine without realizing it. In addition to OTC formulations, higher strengths of ibuprofen and naproxen along with several other prescription-only NSAIDs are widely prescribed as anti-inflammatory medicines. Taking an OTC and prescription NSAID at the same time increases your chances of having side effects like stomach pain, kidney problems or bleeding ulcers.

 

To choose the best OTC pain medicine for you, follow these guidelines:

  1. For muscle aches, sprains and strains, dental pain or menstrual cramps taking an NSAID like ibuprofen or naproxen will usually work much better for you than Tylenol® or acetaminophen. I recommend naproxen because it lasts 8-10 hours, but either naproxen or ibuprofen should help.
  1. If you have a stomach ulcer, kidney problems, congestive heart failure (CHF), or are taking a blood thinner, you should stick with Tylenol® or acetaminophen regardless of the type of pain you have, because it’s is a safer choice.

 

  1. Don’t double up on painkillers. Although it’s safe to take an NSAID anti-inflammatory medicine at the same time as Tylenol®, you should NEVER take more than one NSAID at a time or more than one medicine with acetaminophen in it at a time. Ask your pharmacist if you’re not sure if your prescription pain medicine has either acetaminophen or an NSAID in it.

 

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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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Which Medicines to Pack?

Q: What medicines should I travel with? We have several vacations planned this summer and I want to make sure I pack the right stuff.

Vacations are wonderful opportunities to get away from your usual routine and see new horizons. Just because you are on vacation doesn’t mean you can’t get injured or sick. Motion sickness, aches and pains and intestinal disturbances can derail your vacation if you aren’t prepared.

First, before you walk out the door make sure you’ve packed all of your regular prescription medicines plus a current list of all your medications and your doctor’s name. Using pillboxes for taking your medicines on the road keeps your main bottles at home (less hassle in case you accidently leave your pills behind) and takes up less space. Filling up your pillboxes before you leave also alerts you to whether you’ll need any refills before you return.

If you’re going to need a refill before you get back into town you can either ask for a larger quantity from your doctor or ask if your pharmacist could refill your medicine a little early. Some insurance programs have a grace period of one “vacation refill” per year. If you take prescription pain or anxiety medicines, talk with your doctor or pharmacist beforehand about what to do about refills during the time you will be gone. Some medicine requires a new printed prescription each time you get it filled, which can be very difficult to get if you need another fill while out of town.

When traveling outside the United States, you can avoid spending your vacation visiting the local bathrooms instead of the beaches or museums by being extra cautious about your food and drinks. My daughter made it through 9 months as an exchange student in Bangkok, Thailand with no sickness until buying a snack from a street vendor. She got so sick her host family had to take her to a hospital. Avoid unpeeled fruits, uncooked veggies like salads, and prepared meals that may have been stored at improper temperatures or not completely cooked. With beverages, “boil it, cook it, open it, or forget it”. And watch out for ice cubes or shaved ice: don’t drink a freshly opened bottle of water or soda that has been poured over ice!

If you do end up with nausea, vomiting or diarrhea, DON’T take NSAIDs (non-steroidal anti-inflammatory drugs) such as naproxen (Aleve®) or ibuprofen (Advil®, Motrin-IB®) for pain, swelling or fever. Taking an NSAID like naproxen or ibuprofen while dehydrated can damage your kidneys. Take acetaminophen (Tylenol®) instead.

Along with your prescription medicines be sure to pack some non-prescription medications for common conditions.

Here’s what I bring with me when I travel:

1. Acetaminophen (Tylenol®). Good for tension headache from staring at maps, backache from riding all day in a car, or fever.
2. Meclizine (Bonine®, Dramamine® Non-Drowsy Formula). The chewable 25mg tablets are my go-to motion sickness medicine for trains, planes, boats and cars. Also helpful for amusement park roller coasters that go backwards and upside down.
3. Loperamide (Imodium®-AD). This is the very best way to stop diarrhea in its tracks. I NEVER leave home without it.
4. Pseudoephedrine (Sudafed®). Since my ears can really plug up when traveling by plane, I make sure I have the original (most effective) formulation with me since in some states it’s now only available by prescription.
5. Diphenhydramine (Benadryl®). This is a miracle worker for bee stings, bug bites, minor rashes and allergic reactions. If you have any swelling around your face or tongue, though, seek medical help immediately.
6. Naproxen, 220mg tablets. This NSAID is great for emergencies like tooth pain or muscle aches. Avoid if you take a blood thinner (like aspirin, warfarin or clopidogrel), have serious heart failure, are allergic to aspirin, or have had a bleeding ulcer. Use acetaminophen (Tylenol®) for aches and pains if you can’t safely take an NSAID like naproxen or ibuprofen.
7. Dried Prunes. Prunes, you ask? I pack these as insurance against constipation. It’s been shown that eating 5 prunes is just as effective as taking a stool softener, and I can adjust the “dose” up or down according to my needs. You can pack your favorite laxative instead. I recommend Miralax® because it’s powerful yet gentle on the body.
Bon voyage and safe travels!

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