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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Phillipa on December 5, 2013, at 11:19:41
Seems the docs discourage the use of Motrin or any of the derivatives due to bleeding of stomach which is legitimate. Now it's can be a cause of heart disease. I keep telling an old poster that taking 2400mg of Ibuprofen a day is not good. I know I was told Tylenol arthritis formula. Which doesn't work for me. Occasionally I will take a motrin generic. So what are your feelings on this high dose? Also aren't they still using Celebrex that is technically the same as vioxx that there are lawsuits on for cardiac damage and even death. Thanks Phillipa
Posted by Phillipa on December 5, 2013, at 11:29:30
In reply to Thoughts on Ibuprofen for arthritic pain + doses, posted by Phillipa on December 5, 2013, at 11:19:41
http://www.mayoclinic.com/health/drug-information/DR602345/DSECTION=side-effects
How interesting had no idea so many drugs interact or side effects of any sort other than what I listed. Phillipa
Posted by jono_in_adelaide on December 5, 2013, at 21:28:45
In reply to Thoughts on Ibuprofen for arthritic pain + doses, posted by Phillipa on December 5, 2013, at 11:19:41
I beleive the best option so far as NSAID's go is naproxen 500mg twice a day with a PPI (eg ompeprazole 20mg/day) to protect from stomach ulcers
Posted by jono_in_adelaide on December 6, 2013, at 16:52:49
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by Phillipa on December 5, 2013, at 11:29:30
Hi Jan
just read your post re ibuprofen and joint pain
Before mum had her hip replacement, she was taking naproxen 500mg twice a day (its the NSAID with least problem with heart attack) plus Prilosec 20mg/day to protect the stomach.
She was a pharmacist, and read of this combination is a report by the American FDA, it gave her good relief of her hip pain until she ended up falling and breaking it and needed surgery.
On days when the pain was breaking through, she would take a coule of Extra Strength Acetaminophen for extra relief.
Hope you're well
Jon
Posted by sigismund on December 6, 2013, at 17:30:47
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 6, 2013, at 16:52:49
The trouble for me with NSAIDs and arthritis is that the condition is continuous and over decades, and the effects of taking the NSAID are simply too deleterious. Therefore I take boswellia (and other things) which has been known since before it was given to baby Jesus.
Posted by Phillipa on December 6, 2013, at 18:19:16
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 6, 2013, at 16:52:49
Jon I forgot your Mum was a pharmacist. So she took something to protect her stomach with the med. What a great idea. How's the nardil going? Jan
Posted by jono_in_adelaide on December 6, 2013, at 21:52:01
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses » jono_in_adelaide, posted by Phillipa on December 6, 2013, at 18:19:16
Hey Phillipa - Nardil is still going really well.
I just did a bit of googling, and the idea of taking Prilosec or another PPI with your anti-inflammatory is also endorsed by the National Institute of Clinical Excellence in England (equivalent to the US National Institutes of Health) as well as the FDA, so there must be something in it.
Posted by Phillipa on December 7, 2013, at 20:04:18
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 6, 2013, at 21:52:01
Thanks Jono. How bad is the heart attack risk and are you saying you must build up a level in the blood? I always thought it was immediate like an hour? Phillipa
Posted by ed_uk2010 on December 8, 2013, at 2:38:03
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 6, 2013, at 21:52:01
>I just did a bit of googling, and the idea of taking Prilosec or another PPI with your anti-inflammatory is also endorsed by the National Institute of Clinical Excellence in England (equivalent to the US National Institutes of Health) as well as the FDA, so there must be something in it.
Oh yes, it's standard practice, including all >60s. And you're right about the cardiovascular safety of naproxen, but some people do find it causes dyspepsia even with a PPI. Worth a try though. It is no more analgesic than ibuprofen in the short-term, but its anti-inflammatory properties in arthritis are superior.
As for ibuprofen. 200-400mg up to three times a day tends to have a pretty good safety record, both gastric and cardiovascular. Total doses above 1200mg, especially up to 2400mg cause far more adverse effects. Ibuprofen may be less effective for severe arthritis pain than some of the stronger NSAIDs, but is a very useful pain reliever for other types of pain.
Diclofenac is a very effective NSAID but its cardiovascular safety is poor. Very suitable for acute severe rheumatic inflammation eg. acute gout for a week or so.
Celebrex has a considerably better cardiovascular safety profile than Vioxx at its currently licensed dose. The dose should be kept as low as possible. Higher than recommended doses appear to have a poor cardiovascular safety profile. The gastric tolerability of Celebrex is usually quite good, but a PPI is still recommended in the elderly.
Etoricoxib (Arcoxia) is a potent long-acting NSAID sometimes used in Europe, but not in the US. Its cardiovascular safety profile is poor in the long-term, but it provides very good and sustained pain relief in the short-term esp. post-op pain, severe dental pain and gout attacks.
Hope this helps.
Posted by Phillipa on December 8, 2013, at 19:48:04
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses » jono_in_adelaide, posted by ed_uk2010 on December 8, 2013, at 2:38:03
Ed so what would you advise for me? Is it true it needs to build up in one's system for pain? As always thought it took an hour or so to relieve pain? Thanks PJ
Posted by jono_in_adelaide on December 9, 2013, at 20:15:40
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses » ed_uk2010, posted by Phillipa on December 8, 2013, at 19:48:04
Hi Phillipa
I'd suggest naproxen 500mg twice a day (prescription strength) ansd omepazole 20mg in the morning to protect the gut.
When you need somthing for breakthrough pain, 2 x 500g acetaminophen (generix extra strength tylenol) can be safely used upto three times a day long term.
Posted by Phillipa on December 9, 2013, at 20:53:37
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 9, 2013, at 20:15:40
Thanks Jon so you don't see the heart attack issue unless one has had one?
Posted by ed_uk2010 on December 10, 2013, at 14:38:58
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 9, 2013, at 20:15:40
Hi Phillipa,
I suggest the same as Jono, but the naproxen dose won't necessarily need to be 500mg twice a day. 250mg two or three times a day can work well for some people. If the pain is bad, you can take 500mg twice a day intially and then reduce (if possible) down to the lowest dose which is effective for you.
....and yes, you should also take omeprazole or a related drug to protect your stomach. The risk of bleeding into the stomach is increased by SSRIs, and pts over 60 should always taken a gastro-protective to prevent this.
Caution with naproxen in asthma, established cardiovascular disease, kidney impairment and history of peptic ulcers.
Naproxen starts to relieve pain after a few hours, but the full anti-inflammatory effect in arthritis may take a couple of weeks. If it has not helped after this time, it must be stopped, in which case you can try something else.
This is the end of the thread.
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