Over-the-counter pain killers are in the news again. The
group called NSAIDs — which are derivatives of aspirin
— were introduced about twenty years ago and made quite
a splash. They were best sellers, and every major drug
company had its own brand. Of course, as time went by, these
drugs became very cheap and now, there are some that are over-
the- counter already, meaning that a prescription is not
necessary. For example, the well-known Advil and, in the USA,
Naproxen has also gone OTC (called Aleve).
These medications are great for relieving pain, especially
from stones, that is kidney stones and gallstones that cause
pain. They work well against menstrual cramps and headaches
as well. They reduce fever well, too.
The down side we always knew. They can cause bleeding in the
stomach, especially in the elderly and in those with ulcers.
They can cause kidney failure with regular use, and people
with diabetes and marginal kidney function should avoid these
drugs.
Now we are learning that they can cause worsening of
congestive heart failure through fluid retention and that
they increase the risk of heart attack. Scary, it is true,
but these problems appear more in those at risk and those who
use these drugs often — let's say every day or two. We
have not seen too much danger in kids who are healthy.
What about good old Acamol (paracetamol or in the states
acetaminophen)? This drug was always thought to be the
safest. It doesn't cause any of the above problems and can
even be taken in pregnancy. It is a good pain reliever and it
reduces fever. Recently though, there have been scattered
reports of it also causing bleeds in the stomach, but these
reports are not enough to condemn the drug. We knew it was a
problem in folks with liver disease, but now we are learning
it can cause worsening of asthma and lung function if taken
regularly and it can cause increases in blood pressure.
Aspirin is a safe drug, but it can cause bleeds and kidney
problems as well. It should not be used in kids with fever
and chicken pox — or any viral infection — for
fear of a bad disease called Reyes syndrome. It, however, is
great in preventing heart attacks.
What about Optalgin? This very old drug is not approved in
the United States, but it can cause a lot of the same
problems as Advil with the additional problem of causing
aplastic anemia, that is, suppression of blood cell
production.
So if you are in pain what is the best bet? Funny as it may
sound, narcotics are probably the safest, but not always the
most practical.
You can use all these drugs as needed, as long as you are
healthy and not taking them on a regular basis.
When do you need your tonsils out? If you suffer from many
infections over the course of the year and are under forty,
then you should be in touch with your ear, nose and throat
doctor. A great drug that might prevent relapses is
clindamycin, which has worked for me in preventing this pesky
disease. We are doing this operation less and less and it is
not without risk, although it is a low one, so give it some
thought. Write me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Requip can really make a difference in a
Parkinson's sufferer's life. The shaking and falling are
reduced, and one can return to activities of daily living.
Think Requip and think of a better life.
