acetaminophen

When the simple is complex

When Something so SIMPLE is NOT so simple – Tylenol®

Posted on by Michelle Fritsch, Pharm.D.
When the simple is complex
When simple pain meds aren’t so simple

How often have you reached for simple acetaminophen (brand name Tylenol®) in your life? It is the go-to remedy for so many symptoms. It will reduce a fever, help with a headache, and help with general aches and pains.

Note, acetaminophen is the generic name. The generic version works just the same as the brand Tylenol® version. It is sometimes abbreviated APAP. So, Tylenol® = acetaminophen = APAP.

#1 treatment of osteoarthritis

Do you have arthritis? I know I do. Most of us (about 90%) have osteoarthritis. This is a condition where the cartilage coating our joints has worn away. There is now pain where bone is rubbing against bone. Your main symptoms are usually pain when you use the joint, stiffness, weakness (from your tendency to use it less), and crackling sounds.

I know I can no longer sneak up on my teenagers when I climb the stairs. My gravely sound in my knees is easy to hear.

The American College of Rheumatology, the main group of specialist doctors who treat arthritis, recommends acetaminophen for osteoarthritis.

Safer than NSAIDs (ibuprofen = Motrin®, Advil®; naproxen = Aleve®, Naprosyn®)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain. They treat pain in a way just like acetaminophen, and they also help with inflammation.

There are three big risks associated with these that I want you to know about:

  1. They can be hard on your kidneys. Be sure your doctor and your pharmacist know that you take these, how much you take, and which ones you take. They will monitor your kidney function and likely ask you to stop taking them if your kidneys show signs of injury.
  2. They can be hard on your stomach. Your risk of stomach ulcer goes up when you take these. ALWAYS take them with FOOD. If you develop stomach pain, more indigestion, reflux, or burning, tell you doctor.
  3. They can raise your blood pressure. This in turn can increase the stress on your heart. If you have high blood pressure or a heart condition, talk with your doctor and pharmacist BEFORE choosing to take an NSAID.

Risks of acetaminophen – not so simple

Acetaminophen is safe, but not completely safe. It has some risks. The biggest risk is when we take too much. And taking too much, is VERY EASY to do.

Sometimes people don’t realize that Tylenol® and acetaminophen are the same thing. When in pain, they take both thinking they are different medicines.

Many opioid pain medicines contain acetaminophen (APAP). Here are some examples:

  • Percocet® (oxycodone and APAP)
  • Roxicet® (oxycodone and APAP)
  • Endocet® (oxycodone and APAP)
  • Norco® (hydrocodone and APAP)
  • Vicodin® (hydrocodone and APAP)
  • Lortab® (hydrocodone and APAP)
  • Lorcet® (hydrocodone and APAP)
  • Tylenol #3® (codeine and APAP)
  • Tylenol #4® (codeine and APAP)

Many cough/cold/flu medicines also contain APAP. Some examples are:

  • Contac Cold & Flu
  • Theraflu
  • Alka Selzer plus Cold
  • Vicks Sinex
  • Comtrex

Too much acetaminophen in a day can damage your liver. The most that should be taken in a day is 4,000 mg (8 Extra Strength 500mg tablets). A group of experts is supporting a change so people use 3,000 mg or less. This will decrease the chance of people taking too much if their combination medicines have some ‘hidden’ acetaminophen.

The other important factor is alcohol. It is best to not drink alcohol when taking acetaminophen. Both make the liver work hard. Each can damage the liver when the liver is overworked. It can hurt your kidneys, too. If drinking while taking acetaminophen, please not every day and not beyond 1-2 drinks.

For more information about best use of acetaminophen, contact us at www.medsmash.com/contact, 410-472-5078, or michelle@medsmash.com. We can assess all of your medication regimen to screen for hidden acetaminophen.

BIBLICAL APPLICATION

Oh my, isn’t this also true of our Christian walk? The rules are ‘simple’ – Love the Lord your God and your neighbor as yourself.

Love, love, love!

It is good for you, it is good for others, it’s so simple!

I can give a list of the people I have hurt, offended, taken for granted, or overlooked in the last day or two.   I get distracted, frustrated, caught up in work, or frazzled. There is no excuse. My intention is to spend each day expressing God’s love. And, each day, I fall short of my well-intentioned goal.

Paul describes his own struggle with this in Romans Chapter 7.

Romans 7:14-25 NIV (underline emphasis mine)

We know that the law is spiritual; but I am unspiritual, sold as a slave to sin. I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me.  For I know that good itself does not dwell in me, that is, in my sinful nature.[c] For I have the desire to do what is good, but I cannot carry it out. For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it.

So I find this law at work: Although I want to do good, evil is right there with me. For in my inner being I delight in God’s law;  but I see another law at work in me, waging war against the law of my mind and making me a prisoner of the law of sin at work within me.  What a wretched man I am! Who will rescue me from this body that is subject to death?  Thanks be to God, who delivers me through Jesus Christ our Lord!

So then, I myself in my mind am a slave to God’s law, but in my sinful nature[d] a slave to the law of sin.

Why can’t we follow this simple rule of love?

Living in love means turning away from fear and selfishness*. We are so hardwired to think of ourselves first and foremost. It is a true choice (sometimes a very difficult choice) to put other people first. True love as demonstrated by Jesus is not selfish.

1 Corinthians 13:4-7 NIV

Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.  Love does not delight in evil but rejoices with the truth.  It always protects, always trusts, always hopes, always perseveres.

Can you imagine our world if we all lived in perfect love, as we were designed to live? Can you imagine each person you see treating you with love and respect? Can you imagine a world without conflict?

It is coming!

Blessings,

Michelle

* This is a reminder of a book I have been recommending that addresses this conflict between fear/selfishness and love. The God-Shaped Brain by Timothy R. Jennings, MD.

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Medication Choices for ‘Everyday’ Pain

Posted on by Michelle Fritsch, Pharm.D.
otc-pain-meds
Everyday pain meds are important to discuss with your doctor and pharmacist.

Do you ever have pain when you wake up?   Do you have pain when you sit too long? Does your back bother you on a long car ride? Do you get a headache when the weather changes? Do your muscles hurt the next day when you overdo it?

What do you do about this ‘everyday’ sort of pain? 

You have many choices. Walk in to any pharmacy, grocery store, or super store and you will find several shelves of options. You will find brand name pain medications next to generic, or store, versions of the same medication.

Which ones do you pick? Do you have a ‘stand by’ favorite or do you like to keep switching to try something new? I have had many clients with either of these philosophies.

Here are a few things I want you to know about these options so you can make an informed decision.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are medications such as ibuprofen (brand names Motrin and Advil), naproxen (brand name Aleve), and aspirin (brand names Bayer, Excedrin, Bufferin). These can relieve pain, fever, and inflammation. The over-the-counter doses are lower than the prescription doses.

There are three big risks associated with these that I want you to know about:

  1. They can be hard on your kidneys. Be sure your doctor and your pharmacist know that you take these, how much you take, and which ones you take. They will monitor your kidney function and likely ask you to stop taking them if your kidneys show signs of injury.
  2. They can be hard on your stomach. Your risk of stomach ulcer goes up when you take these. ALWAYS take them with FOOD. If you develop stomach pain, more indigestion, reflux, or burning, tell you doctor.
  3. They can raise your blood pressure. This in turn can increase the stress on your heart. If you have high blood pressure or a heart condition, talk with your doctor and pharmacist BEFORE choosing to take an NSAID.

Another important tip is to make sure your doctor and your pharmacist know you are taking any NSAID and how much. There are many of these available by prescription. I have seen many people who are taking a prescription and an over-the-counter NSAID at the same time. They had no idea because the names are different. So, share all of your medications – prescribed and self-selected – with your healthcare team. Too much NSAID makes the three risks stated above worse.

Acetaminophen

Acetaminophen (brand name Tylenol) is similar to the NSAIDs without the anti-inflammatory part. Acetaminophen can relieve pain and fever. Studies have found it is just as effective as NSAIDs for relieving pain not associated with inflammation.

There are two primary risks with acetaminophen:

  1. Too much can hurt your liver. The current guideline is to take no more than 3 grams (3,000 mg) per day.
    1. Drinking alcohol can make the damage to your liver even worse.
    2. If you already have liver problems, talk with your doctor and pharmacist BEFORE taking acetaminophen.
  2. It can increase the blood thinning effects of warfarin.
    1. If you are on a blood thinner, talk with your doctor and pharmacist about taking acetaminophen.

Note, acetaminophen can be found in many combination products. Please look for it in your headache, cold, flu, sinus, and prescription pain medications. The TOTAL amount for the entire day should be 3,000 mg or less.

Some other options

Sometimes there are simple things you can do that will relieve the pain without the use of medication. Here are just a few:

  • Stretching – for sore muscles and back pain
  • Icing – for sprained or strained muscles
  • Applying heat – for back pain
  • Drinking plenty of water – for headache
  • Closing the eyes and covering with warm compress – for headache
  • Exercising – even a stroll can help with some muscle and back pain and relieve tension related headaches

Your physical therapist is a wealth of information about stretches and exercises to relieve many types of pain. In many states, you can call and make an appointment with your physical therapist without a referral.

For more information about pain treatment options, contact us at Meds MASH at www.medsmash.com/contact.

BIBLICAL APPLICATION

What are the spiritual pains you have experienced or are experiencing now? Life brings plenty of pain and turmoil and struggle. NSAIDs and acetaminophen won’t do much for this type of pain. So what are your options?

Jesus, his disciples, and Paul provide us with a lot of instruction and comfort to guide us through these life pains.

2 Corinthians 4:8-10 ESV

We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies.

1 Peter 5:10 ESV

And after you have suffered a little while, the God of all grace, who has called you to his eternal glory in Christ, will himself restore, confirm, strengthen, and establish you.

If you’ve experienced painful experiences in your life, you are certainly not alone. We are guaranteed hardships. Our choice is how we deal with them. Most importantly, it’s how much we lean on God through them that matters.

Romans 8:18 ESV

For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us.

Romans 5:3-4 ESV

More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope,

I think the following is a very comforting verse to memorize and lean on in difficult circumstances.

John 16:33 ESV

“I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world.”

Blessings,

Michelle

When repetition causes pain – osteoarthritis

Posted on by Michelle Fritsch, Pharm.D.
OA hand
Late stage hand osteoarthritis

Osteoarthritis (OA) is a very common and painful condition. One way to explain it is that the cushion, or cartilage, lining bones wears away leaving bone to wear on bone.

Some of the most common causes of osteoarthritis are:

  • Injury to the joint– e.g. sports or motor vehicle accident
  • Repetitive use of a joint
    • In your job
    • In hobbies
    • In sports
  • Being overweight

Currently, there is not a way to rebuild the cartilage that wears away. So, the goals of treatment are:

  • to maintain what cartilage is left,
  • avoid making it worse,
  • keep you doing what you need to do during your day
  • control pain

Occupational and physical therapists can help.  They are experts in helping you find new ways to perform tasks without making the joint worse. There are many tools that can help support painful joints such as knee braces and thumb splints.

Ways to manage osteoarthritis pain without medication include:

  • heat application to the painful joint
  • lose weight if overweight (especially helpful for foot, knee, and hip arthritis)
  • swim – less wear on the joint than land-based exercise
  • find new ways to do tasks that don’t wear on the joint

OSTEOARTHRITIS MEDICATION THERAPY

The number one, gold-standard therapy for OA is acetaminophen. (A common brand name is Tylenol). Acetaminophen can help manage the pain. It is most effective if it is taken regularly (two extra strength 500mg tablets three times daily). This works better than waiting for pain to get really bad then taking a dose.

Note, be sure to check with your doctor to make sure your liver is healthy. And, limit or avoid alcohol to further protect your liver while taking acetaminophen.

The other medications commonly used for OA are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (brand names such as Motrin and Advil) and naproxen (brand name Aleve). These are also good for reducing arthritis pain. They can raise blood pressure, so avoid them if you have high blood pressure, heart failure, or a strong family history of heart attack. They can worsen kidney function, so talk with your doctor to be sure your kidneys are healthy. They can irritate your stomach, so always take them with food. Another option in this class of medicine is celecoxib (brand name Celebrex) that has less stomach irritation.  There are also topical versions that avoid some of the side effects.  You rub these onto the joint area that is in pain.

So, first and foremost, stop doing repetitive activities that are hurting your joint(s). Second, take steps to preserve the joint function you still have. Third, medication can help with the pain association with osteoarthritis. Be sure to discuss the pros and cons of the medication options with your doctor and/or with us.

For more information about osteoarthritis and treatment, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Insanity: doing the same thing over and over again and expecting different results. Albert Einstein

Just as repetitive movement can worsen osteoarthritis, repetitive approaches to anything can ultimately lead to harm if those approaches are not productive.

  • In your spiritual life, how responsive are you to God’s call?
  • How much do you vary your Bible study?
  • What types of worship have you experienced?
  • How does your prayer life vary in the seasons of your life?

It is so easy to fall in to a rut. You are busy; daily tasks use up all of your time. Prayer becomes relegated to particular times or left out completely. Sunday worship becomes your primary connection to God. Fellowship with other believers only occurs walking in and out of church.

Paul has some ideas about the many ways to worship in his letter to the Colossians:

Colossians 3:14-17 ESV

And above all these put on love, which binds everything together in perfect harmony. And let the peace of Christ rule in your hearts, to which indeed you were called in one body. And be thankful. Let the word of Christ dwell in you richly, teaching and admonishing one another in all wisdom, singing psalms and hymns and spiritual songs, with thankfulness in your hearts to God. And whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.

I encourage you to get creative and deliberate in your spiritual life. God has so much to share with you as you let Him in. His joy, peace, and love can change everything!

Blessings,

Michelle

Image Source:  National Library of Medicine; National Institutes of Health; U.S. Department of Health and Human Services