Codeine Preparations
When Tylenol is not enough, more potent medications such as
Tylenol with Codeine may be prescribed. Codeine is a narcotic
that helps reduce pain. It is rarely addictive when used for
pain relief. However, when codeine is used regularly for a long
time, you develop a tolerance to it - you need larger amounts
of the medication to relieve the pain. Since osteoarthritis is a chronic
condition, save codeine preparations for your really bad days.
Tylenol 1 contains a low dose of codeine - 8 mg. Tylenol 2 contains
15 mg of codeine & Tylenol 3 contains 30 mg of codeine.
Acetylsalicylic acid (Aspirin), and Ibuprofen with codeine are also available
Side effects of codeine are constipation, which can be counteracted
with fiber, stool softeners, prune juice, lots of fluids
NSAIDs
(Non-steroidal anti-inflammatory drugs) are medications
used to treat pain and inflammation.
Non-prescription NSAIDs:
- Acetylsalicylic acid (ASA), Brand names: Aspirin, Anacin
- Ibuprofen, Brand names: Advil, Motrin, Nuprin
- Naproxen, Brand names: Aleve
Prescription NSAIDs:
Diclofenac (Voltaren, Arthrotec), Celebrex, (Vioxx and
Bextra have been recalled):
Side effects of NSAIDs:
Side effects are dose related:
Short-term use may cause upset stomach, nausea, and heartburn.
Long-term use can cause erosion of the stomach lining and potentially
life-threatening bleeding ulcers in some people. Medications to
reduce the risk of ulceration can be prescribed. NSAIDs should be
taken with a meal to reduce the risk of stomach upset.
Slow release NSAIDs dissolve mostly in the small intestine, past
the stomach, decreasing the chance of stomach upset - however, the
gastrointestinal effects of these medications are not eliminated.
NSAIDs decrease inflammation by decreasing prostaglandins (natural
substances involved in inflammation) and certain prostaglandins
are required to protect the stomach lining from stomach acid. Some
NSAIDs have less severe gastrointestinal side effects than others
because they have less effect on the stomach prostaglandins (e.g.
Cox-II Selective Inhibitors)
COX-2 Inhibitors:
The COX-2 inhibitors are commonly prescribed for osteoarthritis
because they are less likely to cause stomach ulcers with long-term
use than the other NSAIDs.
Vioxx and Bextra, two COX-2 inhibitors,
are no longer on the market in the United States. Celebrex
is still on the market.
Vioxx was recalled Sept 30, 2004 after a study
showed an increased risk for heart attack and stroke, beginning
after 18 months of taking Vioxx. Vioxx had been on the market since
1999. Questions were raised as to the safety of Bextra and Celebrex,
both of which are in the same class of medications.
Bextra: The Food and Drug Administration requested
Pfizer to voluntarily suspend sales in the United States on April
7, 2005. (Bextra's labeling was updated in December 2004 - warning
of cardiovascular risks and an increased risk of serious skin reactions.)
The risks appear to outweigh the benefits. Bextra has a higher risk
of rare but serious, life-threatening skin reactions than other
NSAIDs and offers no benefits over other NSAIDs.
Celebrex: is in a subset of NSAIDs called COX-2
inhibitors. Upon the request of the
Food and Drug Administration, April7/05, Celebrex will expand its
risk information to include a boxed warning highlighting the potential
for increased risk of cardiovascular (CV) events and gastrointestinal
(GI) bleeding.
Celebrex remains on the market. The FDA has concluded "The
benefits of Celebrex outweigh the potential risks in properly selected
and informed patients." ( December 17 2004 - Celebrex linked
to increased risk of heart attacks and strokes in large clinical
trial.)
Based on the currently available data FDA has concluded
that the potential for increased risk of serious cardiovascular
adverse events may be a class effect of NSAIDs - excluding aspirin.
Non-prescription NSAIDs (including of ibuprofen
and naproxen) are of a lower dose and do not appear to significantly
increase the risk of serious cardiovascular events. Click
here for FDA alert.
THE FDA will require boxed warnings of potential cardiovascular
risk for all prescription COX-2 pain relievers and non-selective
NSAIDs, including older non-specific drugs such as ibuprofen and
naproxen. Some drugs are available in both prescription and non-prescription
form. The FDA has asked manufacturers of non-prescription NSAIDs
to revise their labeling to include more specific information about
potential cardiovascular and gastrointestinal risks and a warning
about potential skin reactions.
Topical Medications
Some prescription topical creams contain
an NSAID that is absorbed through your skin directly
to the area where it is needed. The amount of
drug absorbed by the bloodstream is minimal,
eliminating or significantly reducing the side
effects associated with oral NSAIDs. Because
some medication still gets into the bloodstream,
if you are taking oral NSAIDs for spinal osteoarthritis
you may have to reduce the dosage of your medication.
Corticosteroids
In severe cases of spinal osteoarthritis, where mobility is severely
restricted, corticosteroids (steroids) can be injected into the
facet joints (spinal joints) for quick relief that can last from weeks to months
to years. Steroid medications have powerful anti-inflammatory properties
but also can have serious side effects. Used too frequently, they
can actually lead to more cartilage degradation. In osteoarthritis,
corticosteroids are not given orally because the side effects outweigh
the benefits.
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