Health: Today, we threw away the Alleve at our house
MOHLER’S MEDICATION MAXIMS
There is a persistent myth among many patients and physicians that the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), including Alleve, Ibuprofen, are better pain relievers than acetaminophen (Tylenol). Further, the last two years have seen a barrage of concern about the side effects of acetominophen.
So, which over-the-counter pain pill should you have in your medicine cabinet for the occasional headache, ankle sprain or sore throat? Perhaps more importantly, what’s the appropriate choice for the wear and tear arthritis pain in your low back that bothers you every day?
Here’s what we know
For mild to moderate pain of all types, acetaminophen works as well as the NSAIDs, even for pain in muscles and joints. For more severe musculoskeletal pain, NSAIDs edge acetaminophen in effectiveness. NSAIDs are also superior to acetaminophen in situations where pain is mediated by body chemicals called prostaglandins. The common ones are menstrual cramps and kidney stone pain.
The recent publicity about the dangers of Tylenol have focused on intentional or unintentional overdoses. Taking more than 3-4 grams of acetaminophen (6 or 8 of the 500 mg “extra- strength” Tylenol) can cause liver damage and death. Patients with underlying liver disease or those who imbibe alcohol in excessive quantities are more prone to liver side -effects when they take acetaminophen.
NSAIDs increase the risk of G.I. ulcers, bleeding and death. Taking a stomach protective drug with a NSAID or using a subclass of the NSAIDs, called COX-2s, that are easier on the gi tract, are strategies employed to decrease these risks.
In July 2015, the FDA strengthened their existing warning that NSAIDs increase the chance of a heart attack or stroke. The new warnings:
The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
The risk appears greater at higher doses of NSAIDs.
NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease.
The new information is confusing about whether any one NSAID is safer than another from a cardiac standpoint.
In this column on May 11, 2012, I voiced my stance that acetaminophen is the pain pill of choice for your medicine cabinet. The most recent data suggest that, in most situations, acetaminophen remains the product to start with if you are hurting. Taken in daily doses of 3-4 grams or less in people with normal livers, acetaminophen is extraordinarily safe.
The heart attack and stroke risks of NSAIDs do not predict disasters for all users, but simply put the relative benefits/side-effects into perspective. If there is an available product (acetaminophen) that works as well most of the time, is safer and of comparable cost, it is the drug to start with!
I do not own McNeil stock (manufacturer of Tylenol). Always buy generic.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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