What Painkiller Should I Take?Feb 25, 2014
Joint pains, colds, discomfort. You’re going to the store for medication to treat your aches and pains, but what medication should you take? Dr. Tom Miller and Dr. Erin Fox discusses the two types of painkillers and how to choose the proper pain medication when you’re at the pharmacy. They also talk about the potential side effects that can happen from taking the wrong medication, or taking too much of the right medication.
Dr. Tom: You go to the store. You're looking for a medication to treat your pains and aches. Which medication should you take? We're going to talk about that next on The Scope. This is Dr. Tom.
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Dr. Tom: I'm here with Erin Fox, who's the Director of Drug Information Services. She has a doctorate in Pharmacy, and she's going to talk to us about the issue of how to choose the proper pain medication when you're in the pharmacy. Erin, you know, people will have joint pain or they'll have colds, they'll have discomfort. I think it's kind of daunting when you go into the pharmacy and look, and there are so many different choices. There's Aleve. There's Aspirin. There's Tylenol. Then there are the generics of those different medications. Where does one start in picking the right pain medication?
Dr. Fox: I think a nice way to think about it is that there are two kinds of these medicines. There's basically the Tylenol kind of medicine. Acetaminophen is the generic. And then there's what are called NSAIDs, and that is rolls of Aspirin, Ibuprofen, and Aleve. All of those medications fall into that category.
Dr. Tom: So there's two classes you're basically saying that are available without a prescription?
Dr. Fox: That's right.
Dr. Tom: So does one look on the label to sort that out?
Dr. Fox: Yeah. You really need to read the label. Take a look. Acetaminophen or Tylenol, it should say acetaminophen on it. But with acetaminophen, you might have other things in your cupboard at home that also contain acetaminophen. On your prescription medicines, it won't say acetaminophen. It might just say APAP, A-P-A-P. So you got to be careful about taking too much Tylenol.
Dr. Tom: Let's say that my mother goes into the store, and she has a painful knee. She sprained her knee on the ice, and it's not bad enough to see the physician or the doctor. What's best?
Dr. Fox: I think it depends on you personally. Tylenol, in general, is the safest unless you have some liver problems or you drink a lot of alcohol. If you drink more than three drinks a day, you probably don't want to take Tylenol every day because that really can cause some liver damage.
Dr. Tom: What about if you're taking other medications? Is that a concern? I mean, if you're taking prescription medications, can you talk to the pharmacist about whether Tylenol is better than the other class of medications?
Dr. Fox: Absolutely. The pharmacists is always willing to check into interactions and see if which medicine is safer. But it also depends on your pain. Tylenol works, but if you're more worried about swelling or inflammation, then you might want to go with one of the NSAIDs.
Dr. Tom: So the swollen knee might respond better to something like Aspirin or Naproxen, perhaps?
Dr. Fox: Or even Ibuprofen. But, again, you need to take into consideration what the risks are. The NSAIDs can cause stomach bleeding, and it really depends on what other medicines you're taking if you're going to have stomach bleeding and also how old you are. Older people can have more stomach bleeds than other people.
Dr. Tom: I have people that have taken non-steroidals like Naproxen and Ibuprofen for years and not had any problems, but that doesn't necessarily take anyone off the hook in terms of having a stomach bleed.
Dr. Fox: If you're over 75, for every 10,000 people taking an NSAID, about 91 people can have a stomach bleed, and 15 of those people will die from that stomach bleed.
Dr. Tom: A lot of people will have sore throat and kind of the malaise and discomfort associated with a cold in the winter. Do you think Tylenol or acetaminophen is better than the other class of medications?
Dr. Fox: You know, it may or may not be better, but it's going to work well. It's also going to work just as well at reducing your fever.
Dr. Tom: I got a patient come in the other day, and they were saying to me, and she was taking Ibuprofen 'I've heard in the news that non- steroidals can be dangerous than Tylenol. Acetaminophen can be dangerous.' So she started alternating them. What do you think about that? She was trying to alternate them because she thought that might lower the risk of side effects from the other one alone.
Dr. Fox: That's an interesting way to do it. You know, they both have their risks. Another risk that we didn't talk about with NSAIDs is it can increase your risk of a heart attack. Some of them can do that, and others don't really have that problem.
Dr. Tom: Have you heard anything about the FDA removing any of these medications from the shelves?
Dr. Fox: That's interesting. The FDA recently decreased the amount of Tylenol that you can have in prescription medicines.
Dr. Tom: What do you think the reason they did that was? I mean, if they're not going to take it off the shelves, then why did they take it out of certain prescription medications?
Dr. Fox: You know, the FDA found that some people were taking their prescription medicine that also had Tylenol in it along with regular medicine that they bought at the grocery store. So, together, they were inadvertently taking too much Tylenol, which does cause liver problems.
Dr. Tom: Erin, if these medications can be dangerous, then why are they available to people over-the-counter without a prescription? Is that maybe because people might take more than the recommended dose than you read on the package? Is that the reason?
Dr. Fox: Yeah. I think people do sometimes take more than is on the package, but what's on the package is really the very safe dose that has been evaluated. It's the dose that's good for using without talking to your doctor. For higher doses, you really want to talk to your doctor.
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