Drug Safety Q&A
Q: If I have arthritis or other bone/joint pain, how do I know what's the best medicine for me?
A wide variety of therapies have the potential to be helpful for bone, muscle, and joint disease. The choice of medicine corresponds to the severity of the pain and the degree it affects daily function. Many times, medicines that are available without a prescription (over-the-counter) can be very effective at controlling these every day symptoms. Your doctor will know best whether these OTC medicines can be effective for your problem.
Q: Do over-the counter (OTC) medicines work? How can I be sure I am taking the right amount of medicine for my pain?
OTC medicine can be very effective when taken in the appropriate manner. The best information about taking OTC medicines is found on the label on the box. The Food and Drug Administration is careful to make the label understandable to the usual patient. The combination of OTC and prescription medicines may increase the risk associated with taking each drug individually. You should inform your doctor if you take OTC medicines to be sure that the combination is safe.
Q: Over time, if I have a chronic condition - like arthritis or low back pain - will I need to increase the amount of medicine I need to take? What are the risks associated with increasing the dose?
The recommendation when taking OTC or prescription medicines is to take the smallest amount that makes the symptoms disappears. The temptation is to increase the amount of OTC medicines when the pain problem does not go away. These chronic conditions can be very bothersome. The usual thought is that more medicine will make the problem go away. In fact, more medicine may cause only more toxicity without any increased benefit. You should never exceed the maximum dose of OTC medicine that is listed on the drug label.
Q: With all the attention being paid in the past year to the safety issues related to the group of drugs known as "Cox-2 inhibitors" - which includes Vioxx, Celebrex, and Bextra - what is the heart-related risk?
Recent studies have reported on the potential heart risks associated with the aspirin-like medicines, the nonsteroidal anti-inflammatory drugs or NSAIDs, for short. NSAIDs, including aspirin, have been available for decades. Most patients have no difficulties taking these medicines. That means these medicines cause no side-effects in the vast majority of patients who take them. The cardiovascular toxicity associated with NSAIDs is related to elevation in blood pressure. Increased blood pressure, hypertension, increases the risk of heart attack or stroke. NSAIDs may increase the risk for hypertension.
The only COX-2 inhibitor available at this time is Celebrex. Celebrex has a low level of cardiovascular events. Vioxx was removed from the market when increased heart attacks and strokes were associated with taking the medicine for over 18 months at very high doses. Bextra was removed from the market because of increased risk of a serious skin rash.
The general recommendation is that NSAIDs should be taken at the lowest effective dose for the duration of the problem. NSAIDs taken on a regular basis should be monitored by a physician to minimize the risk of toxicities.
Q: If I don't have a history or any evidence of cardiovascular (heart) risk, are these medicines okay for me?
The risks for cardiovascular side effects are decreased in you have no history of heart problems. The difficulty is knowing your cardiovascular risk. NSAIDs should be used at the lowest dose.
Q: If I've been taking Advil or Tylenol but now need to take a prescription, can I keep taking the OTC medicine along with my prescription?
This is question best answered by the physician giving you your prescription medicine. Some individuals are able to take Tylenol along with their prescription medicine. Advil is ibuprofen, an NSAID. The risks for gastrointestinal toxicities are increased when two or more NSAIDs are taken at the same time. This is a combination that should be avoided.
Q: I've heard from friends that there are some herbal remedies - such as Glucosamine - that are good for easing arthritis aches and pains. Does it work?
Glucosamine is an OTC remedy. It does not work for aches and pains in joints and muscles. Osteoarthritis (OA) is the most common cause of arthritis. Osteoarthritis is an arthritis that occurs in older individuals. Glucosamine is used for the treatment of osteoarthritis of the hip or knee. A recent study conducted by the National Institutes of Health reported that glucosamine had a minimal effect on the pain associated with knee osteoarthritis. Studies from Europe have reported greater beneficial effects on knee OA . Additional studies will need to be completed before a definite answer about the benefits of glucosamine can be determined. For the most part, glucosamine has very little toxicity. People who are allergic to shellfish (the source of glucosamine) or diabetics (glucose is a major component of glucosamine) should be cautious taking glucosamine.
Q: What are the dangers of "self-prescribing" or experimenting with herbal remedies, or other OTC products?
Herbal remedies are not benign. Some herbal remedies are associated with increased toxicities. Some interactions include the risk of increased bleeding in individuals taking blood thinners. Also the manufacture of herbal medicines is not monitored by the FDA. The amounts of herbal medicines in individual pills may vary to a significant degree. In addition, some herbal medicines are manufactured in other countries. These medicines may include other drugs that are not included in the label. For example, an herbal medicine from Asia included heavy metals that are potentially toxic to the human body. If you use herbal medicines, make sure that the source is a reputable company.
Q: Besides OTC medicines or whatever prescription drug might be prescribed for me, what else can I do to ease my muscle/joint/ bone pain?
Many non-drug therapies are effective for pain in the musculoskeletal system. The application of cold or heat can have a pain-relieving effect. Cold is pain relieving. Heat speeds healing. Topical creams spread over the painful area can have soothing effect. Exercise can also have a beneficial effect. Exercises should be completed in a gradual program to gradually improve the function of damaged structures