Anti Inflamatories, how long to take? - JP Fitness Forums

kinney1 · 12-10-2004, 06:29 AM

I have seen an ortho for a shoulder impingement, and the Dr. has a good reputation in North Jersey. He said it is ok to take anti inflamatories indefinetly. I have already been taking them for 4 months. However, I have also read that you don't want to take them for too long. Anyone have any experience with this?

Kaiser · 12-10-2004, 08:46 AM

I bet the doctors here will chime in, but from the doctors I've questioned on the source, the answers are all over the board.

Talking about NSAIDs, one doctor told me I could take 2 doses a day from 20 years and not develop any renal problems. Another, on the other end of the spectrum, said that taking it longer than 2 weeks is not a good idea. This issue at hand is renal failure - something NSAIDs tend to promote. Long-term damage, I'm told, is something that is very individual to the person, and so there haven't been a lot of studies done on it (not the the pharmaceutical companies are rushing out to do them either). That is why you have warnings for people who could potentially have compromised function to stay away from them.

My point is that if you ask 5 different doctors, you're likely to get 3 different opinions. I did. I was even given Vioxx (a COX-2 inhibitor) to try after I had already used Celebrex, and told I could take that safely for months at a time - of course we see that the product has since been pulled (luckily, I didn't take it but once).

Is it possible to start incorporating an anti-inflammatory diet into your foods? Items like ginger and turmeric have excellent anti-inflammatory qualities - they just take much longer to act than pharmaceutical agents.

kinney1 · 12-10-2004, 09:11 AM

Thanks for the detailed response Kaiser. I think you are correct, there is a lot of conflicting information on NSAID's. I guess I have to just use a little common sense with them as well. I do not need them for arthritis or any lifelong condition, so the sooner I can stop taking them the better. I just need this damn shoulder to start responding to my rehab more!

bkred · 12-10-2004, 11:05 AM

I take a NSAID named Naprelan. It's a 500 mg time-released version of a NSAID named Naprosyn which has been around a long time. I believe it's the same stuff that is the over the counter medication Alleve, at a stronger dosage. I take 2 of the 500 mg pills with food whenever my back is bothering me. I've been on the stuff for 10 years since rupturing a disk in my low back, having surgery, and developing arthritis.

I haven't had any trouble with the Naprelan. As I said I take it only when needed and not everyday. Sometimes I'll go weeks without taking the stuff, other times I'll take it everyday for a month.

About 3 months ago I was experiencing a lot of pain and spoke to my Rheumatologist about trying something else. I was concerned I had developed somewhat of a tolerance to Naprelan and it wasn't dulling the pain like it once did. The doctor put me on Vioxx. After taking Vioxx for a week the first articles started coming out about the possibility of it raising the risk of heart trouble. I called the doctor and he put me on Celebrex. My pharmacist expressed some concern that Celebrex being a COX-2 inhibiter like Vioxx, there could be similar health issues with it. So I went back to the Naprelan.

I visit the Rheumatologist every 6 months and my blood is checked to make sure the Naprelan isn't messing up my kidneys or anything else. I think the bottom line on the NSAIDs is that every doctor has there favorites based on their experience with patients. I also think different patients may respond better, or worse, to different NSAIDs. My doctor said it was kind of a process of elimination to see what would work best for me. I also agree with kinney1's statement that some common sense is in order. All these drugs will have some type of side effects that could be nasty. So I'd say take them only when needed and only as long as needed. I've personally got my qualms about taking anything "indefinitely" unless it's beer and pizza.

zlightning · 12-12-2004, 09:24 PM

I took Vioxx and it was awesome, to bad it could have hurt me and I'm only 19. I was on it for about a year. I now take naprosin(sp Aleve).

russ · 12-13-2004, 12:22 AM

Generally speaking, the longer one takes just about any pharmacologically active product, the greater the likelihood of an adverse event. When it comes to NSAIDs, I don't think that one can give a specific cut-off as to long they can be safely used without a break. It really depends on how much risk you're willing to take. If you really like the beneficial effects and are willing to take your chances, then I suppose you can take them for years at a time. The likelihood of an adverse outcome (e.g., renal toxicity), however, increases with time. Personally, I try not to take them for more than a couple of weeks at a time, but that's just my own comfort level.

kinney1 · 12-15-2004, 02:05 PM

thanks for the responses. i even discussed it with a doctor. it sounds like it is not a problem for most, but for a select few it can be. more research needs to be done. in the meantime, it sounds like minimizing the intake is the best policy.

kev

bryanc · 04-06-2005, 09:57 PM

Sorry to bring this up, but the renal exam is tomorrow/Friday, and this is what we've been taught--so take it as you will.

Acetominaphen does have toxic effects on the kidneys. The nephrologists here say on average, 5 years of taking 2 tablets of regular strength a day can result in signs of renal failure. It is not an uncommon etiology (i.e. not rare).

Acetominphen AND ibuprofen have a syngeristic effect on deterioration of renal function.

All NSAIDS are associated with (whether causally or not) several renal diseases as well.

If you or your physician are concerned, then you should probably have a urineanalysis done every year for proteinuria and/or hematuria.

kinney1 · 04-07-2005, 06:46 AM

Thanks for the update Bryan.

aidan · 04-10-2005, 02:14 AM

Acetaminophen (Tylenol) very rarely causes renal problems. You need to be concerned about liver toxicity with this. NSAIDS are more likely to cause the kidney problems (2 separate mechanisms). I rec tylenol to my pt's with chronic pain as needed, but you should follow your MDs advice. Where do you go to medical school? I'm a resident at UT. Slow night, as I am surfing the net at 2AM. Good luck on your nephro exam (possibly the most difficult section of the curriculum).

bryanc · 04-10-2005, 10:26 PM

In acute overdoses, the liver becomes more of an issue, but the nephrologists here say that they see both acetominaphen and NSAID related renal failure quite often, not always accompanied by liver failure. Mind you, they're specialists, so the risk always appears higher, since they see more, and worse cases.

I'm at med school at U of Calgary. From what I hear, neuro is the worst exam of all. Renal was fine, but we had great teachers.

aidan · 04-12-2005, 10:49 PM

Be careful. I have seen hepatic toxicity from chronic tylenol use. Now, acetaminophen metabolism used to produce phenacetin (a few years ago), which caused acute renal failure from papillary necrosis. Acetaminophen can cause ATN during an acute intoxication (hepatocellular damage is almost always seen at these levels), but there is no definitive literature that supports analgesic nephropathy unless used with NSAIDs. Of course there is suggestive literature for interstitial disease. On the other hand, there are volumes of literature on NSAID induced ARF. I have seen interstitial nephritis from NSAIDs but not acetaminophen. I'm not a nephrologist though, so I am not exposed to the volume of ARF pts that they see. Your nephrology attendings are much more wise than I, but just wanted to share my experience (albeit small).
Yeah neuro kind of sucked, especially neuroanatomy.