Painkiller choice can make difference

June 01, 2003|By Suzy Cohen, R.Ph., Tribune Media Services.

Q. I went out looking for an over-the-counter pain reliever, and there were so many to choose from. What's the difference between aspirin, acetaminophen and ibuprofen?

--E.B., Ft. Lauderdale

A. Aspirin and ibuprofen (Motrin or Advil) are used to reduce inflammation of painful, swollen joints. Acetaminophen (Tylenol) reduces fever and helps with body aches and pains.

Aspirin and ibuprofen are notorious for their ability to cause stomach problems, such as bleeding, ulcers, nausea and abdominal pain. Because both of these drugs can thin the blood, don't use them if you have a history of stomach ulcers, gout or bleeding disorders. And don't take either drug if you are taking prescribed arthritis drugs such as Vioxx, Bextra, Celebrex or Mobic.

Acetaminophen is much kinder on the stomach than aspirin or ibuprofen, but it takes its toll on the liver, especially if you take high doses of the drug or if you take it regularly. If your liver is damaged from drinking alcohol or taking large amounts of other medications, you also are at higher risk.

The kidneys get their fair share of insult too. Ibuprofen can make an existing kidney problem worse, as can the over-the-counter drugs Orudis KT and naproxen (Aleve).

You have to think when choosing one of these OTC drugs for your children. Aspirin is not used in kids with viral diseases such as the flu or chickenpox. It can cause Reye's syndrome, a rare and dangerous disorder.

Acetaminophen and ibuprofen do not cause Reye's syndrome and are preferred agents when treating sick children. Ask your pediatrician or pharmacist to be sure which products are safe.

Be warned. Aspirin and ibuprofen can inhibit clotting, so don't take them within a week of surgery or if you take the prescription blood-thinners Coumadin (Warfarin) or Plavix.

Q. Do I really have to stand up after taking my medication? I was warned to stand up after taking my osteoporosis medicine, Fosamax. Also, I take this weekly. What if I forget to take my medicine?

--L.L., Littleton, Colo.

A. If you forget your dose, take it the next morning. Then return to taking your tablet once per week on your regular chosen day.

Never take two tablets on the same day.

There are other cautions while taking Fosamax and the other bone-building drug, Actonel. Take these meds first thing in the morning. Wait two hours before eating breakfast and you'll get more bang for your buck. After taking your medication, you should remain sitting upright for about half an hour. If you don't, you run the risk of irritating your esophagus, the tube that connects your mouth to your stomach. You don't have to actually stand up; just don't lie down after you take it.

These medications interact with antacids and vitamins that contain calcium, magnesium or iron supplements.

To avoid interactions, don't take such supplements, or any dairy products, close to the time you take your medication.

Did you know?

Garlic and ginkgo biloba have anti-clotting properties. They should be avoided or used cautiously if you are taking daily aspirin or prescribed blood-thinning drugs.


Write to Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 6061. This column is not intended to take the place of consultation with a health-care provider.