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Prescription-free isn't risk-free with pain Meds: over-the-counter pain relievers aren't harmless, so know which one is best for you and your medical condition.

When your joints hurt or your head aches, you may not hesitate to reach for acetaminophen or a nonsteroidal anti-inflammatory drug (NS/UT)).

While these over-the-counter (OTC) pain medicines may occupy the same shelves of your local pharmacy, they're not the same when it comes to relieving your arthritis pain. And although they're available without a prescription, they're not completely innocuous, especially if you misuse them or have a history of certain medical problems.

"There should be no problems, as long as you're letting your physician know you're using these in the short term," says M. Elaine Husni, MD, Vice Chairman of the Department of Rheumatic and Immunologic Diseases and Director of the Arthritis and Musculoskeletal Treatment Center at Cleveland Clinic. "The long-term use of NSAIDs is where concerns come into play, so it's best to be monitored closely."


Acetaminophen (Tylenol[R]), a pure analgesic, eases pain but doesn't fight inflammation associated with arthritis or acute injuries. The drug has few side effects and few interactions with other medications, so many experts consider it a safe, first-line option for treating arthritis pain. The maximum daily dose of acetaminophen is 3,000 mg to 4,000 mg (about six to eight extra-strength pills), depending on your other medical conditions.

Problems can arise, though, if you take too much of the drug over the long term, drink alcohol excessively, or have liver disease. Acetaminophen is metabolized primarily in the liver, and excessive doses (more than 4,000 mg a day) can cause liver damage.

Acetaminophen is found in more than 600 products, ranging from OTC painkillers and cold remedies to prescription pain medicines. In many cases, patients overdose by unknowingly taking multiple products containing acetaminophen.

"You have to be careful reading labels and making sure other medications don't already have acetaminophen in them," Dr. Husni cautions.

Check your medications, and look for the abbreviation "APAP," used by many doctors and pharmacists to identify acetaminophen. Also, if you regularly use alcohol or have a weakened liver, ask your doctor if you should use acetaminophen.


NSAIDs double as analgesics and anti-inflammatories, making them effective for pain and fever relief.

Aspirin, the oldest NSAID, is also prescribed to prevent heart attacks and strokes because it inhibits your blood's clotting ability. As such, aspirin can raise the risk of bleeding, especially if you use it along with other blood-thinning medications, such as warfarin (Coumadin[R]).

Aspirin and the other OTC NSAIDs--ibuprofen (Advil[R], Motrin[R]) and naproxen (Aleve[R])--may cause gastrointestinal (GI) side effects: stomach upset, ulcers, and bleeding. The risks are greater among older adults, people with a previous stomach ulcer, those who consume three or more alcoholic drinks daily, and patients taking blood-thinning drugs or multiple NSAIDs. "If you fall into the higher-risk category, look at alternatives to NSAIDs," Dr. Husni says. "If you don't fall into the higher-risk category, NSAIDs are still OK, but you need to be monitored."

NSAIDs also may cause kidney damage and blood pressure rises.

While aspirin is used to prevent heart attacks and strokes, a meta-analysis published May 29 in The Lancet, found that high-dose ibuprofen, but not naproxen, increased the risk of heart attacks or coronary death. All NSAIDs were associated with a greater risk of GI complications and hospitalizations for heart failure, the researchers reported.

Although the study included prescription-strength NSAIDs, the labels of all OTC ibuprofen and naproxen products nonetheless recommend talking to your doctor before using them if you have a history of heart, kidney or liver disease, high blood pressure, or GI problems.

"If you have uncontrolled high blood pressure, taking any of the NSAIDs is not a good idea, unless you can get your blood pressure under better control," Dr. Husni says. I'd also be more reluctant to recommend them to anyone with a previous ulcer. Alcohol is also something to closely monitor. People who consume a lot of alcohol tend to have more problems with NSAIDs."


To minimize the adverse effects of NSAIDs or acetaminophen, Dr. Husni recommends alternating between the two drug types--such as taking 400 mg of ibuprofen three times a day or twice-daily naproxen and then 500 mg of acetaminophen every four to six hours if you need more pain relief. "Or, on days when you have more activity, take the NSAID, but maybe don't take it when you're less active," she says.

She also cautions against doubling up on NSAIDs: "A lot of patients take both ibuprofen and naproxen and don't understand they're the same drug class."

For patients with localized aches and pain, especially in joints near the skin's surface, topical OTC pain relievers may provide relief without the side effects of NSAIDs or acetaminophen.

If you're overweight, shedding pounds can ease the stress on your arthritic joints and reduce your reliance on pain medications. And, stay active to preserve your joint function, Dr. Husni advises.

"If you're not spending any time exercising, you have to inv to keep up your range of motion and flexibility, both of which are very important to keep the joint healthy," she says. "You have to work to keep your joints healthy."



Analgesic  Acetaminophen    First choice of   Toxic to liver in
           (Tylenol,        many physicians;  doses more than 4,000
           Tylenol PM,      few side          mg/day; increased
           Dayquil,         effects, drug     risk of accidental
           Excedrin,        interactions      overdose

Aspirin    Anacin, Bayer,   Safe for many     Bleeding risk;
           Bufferin,        people; long      stomach irritation,
           Ecotrin,         track record;     ulcers, or bleeding;
           Excedrin,        used for cardiac  more adverse drug
           others           protection        interactions than
                                              other OTC pain meds

NSAIDs     Ibuprofen        Effective pain    Gl side effects; may
           (Advil, Motrin)  reliever; fights  raise blood pressure;
           Naproxen         inflammation      may cause kidney
           (Aleve)          while providing   damage; potential
                            analgesic pain    increased
                            relief            cardiovascular risk
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Publication:Men's Health Advisor
Date:Oct 1, 2013
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