What Do They Do in the Body? Relieve pain from inflammation and lower elevated body temperatures.
What Are They Prescribed For? Rheumatoid arthritis, osteoarthritis, mild to moderate pain, tendonitis, bursitis, acute gout, fever, sunburn, migraine headaches, menstrual cramps and discomforts, and acne.
What Are the Possible Side Effects? The most common and one of the most dangerous side effects of the ibuprofen-like drugs is damage to the digestive system. They can cause nausea, vomiting, diarrhea, constipation, cramps, and gas, as well as serious bleeding and ulcers, particularly if you are elderly.
These drugs are hard on both the liver and kidneys. They can cause hepatitis, jaundice, and elevated liver enzymes, as well as urinary tract infections, urinary frequency, and a wide variety of kidney problems.
Other side effects include dizziness, headache, drowsiness, fatigue, and nervousness. They can aggravate a wide range of behavioral problems including depression and psychosis. They can also cause muscle weakness or cramps, numbness, changes in blood pressure, vision disturbances and damage, hearing disturbances, shortness of breath, rashes, blood sugar changes, weight gain or loss, mineral imbalances, menstrual problems, impotence and breast enlargement in men, and a wide range of blood disorders, including anemia. Like aspirin, these drugs can prolong bleeding time by as much as three or four minutes.
Piroxicam (Feldene) appears to be particularly likely to cause severe gastrointestinal problems, and the European equivalent of the Food and Drug Administration (FDA) has recommended that it not be a drug of first choice for most types of pain.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You are elderly. Serious side effects are more likely to happen to you if you are over the age of 65.
• You have had an allergic reaction to these or to other similar drugs such as aspirin.
• You have kidney or liver disease or dysfunction.
• You have an ulcer, inflammation, or a history of bleeding in your intestinal tract or rectum.
• You have a history of anemia, excessive bleeding, or poor clotting.
• You are scheduled for surgery in a week or less.
• You have a heart condition or pancreatitis.
• You have eye problems.
• You have an existing controlled infection. These drugs can mask the symptoms of infection.
• You are sensitive to sunlight.
What Are the Interactions with Food? Generally, anytime you eat food and take these types of drugs, the food will delay or decrease the absorption of the drug. Always take these drugs with food to protect your stomach.
What Nutrients Do They Throw out of Balance? Iron levels may be reduced because of blood loss due to gastrointestinal bleeding.
What Else to Take If You Take These Drugs. If you are a premenopausal woman and taking these drugs for more than a few days (which is not recommended), increase your intake of iron.
Examples of COX-2 Inhibitors
Celecoxib (Celebrex)
Both of the COX-2 inhibitors rofecoxib (Vioxx) and valdecoxib (Bextra) were pulled off the market due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke), but not before Vioxx raked in $2.5 billion in 2003 and was linked to more than 27,000 heart attacks or sudden cardiac deaths in less than four years in the United States alone.
The FDA put a black-box warning on Celebrex that reads as follows:
Celebrex is a NSAID. It may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (e.g., heart attack, stroke). The risk may be greater if you already have heart problems or if you take Celebrex for a long time. Do not use Celebrex right before or after bypass heart surgery.
Celebrex may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.
What Do They Do in the Body? They inhibit the production of COX-2 enzymes, which are involved in the production of pain and inflammation.
What Are They Prescribed For? Pain from osteoarthritis and rheumatoid arthritis, dysmenorrhea, and dental procedures or surgery.
What Are the Possible Side Effects? Increased risk of heart attack and stroke, the symptoms of which can include chest pain, weakness, shortness of breath, slurred speech, and problems with vision or balance. In addition to heart attacks and strokes, this drug can cause gastrointestinal bleeding; dizziness; headache; fluid retention (edema); increased likelihood of upper respiratory infection, indigestion, diarrhea, vomiting, abdominal pain, and flatulence; problematic changes in kidney and liver function tests; insomnia; menstrual and female gynecological problems; dermatitis; throat inflammation; runny nose; sinusitis; and accidental injury.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have kidney or liver disease. They should never be prescribed to people with severe kidney or liver disease.
• You have a history of peptic ulcer disease, especially if you are elderly, alcoholic, a smoker, or use anticoagulant drugs or steroid drugs.
• You are at high risk of heart attack or stroke, or have had a heart attack or stroke.
• You have aspirin-sensitive asthma.
• You are pregnant. These drugs have been shown to cause premature closure of a vital blood vessel in growing fetuses, and this can lead to very dangerous lung problems once the baby is born.
Examples of Nonnarcotic Painkiller Combinations
Nonnarcotic analgesic combinations (Vanquish, Pamprin, Extra Strength Excedrin, Midol, Cope, Anacin, Saleto, Gelpirin, Supac, Extra Strength Tylenol Headache Plus, Equagesic, Gensan)
Nonnarcotic analgesics with barbiturates (Fiorinal, Esgic, Fioricet, Repan, Amaphen, Butace, Endolor, Femcet, Two-Dyne, Bancap, Triaprin, Lanorinal)
These drugs generally combine acetaminophen or aspirin with a barbiturate, meprobamate, or antihistamine for sedative effects, caffeine to help constrict blood vessels and relieve headaches, belladonna alkaloids to reduce muscle spasms, and pamabrom as a diuretic. They are sold both as prescription and as over-the-counter drugs.
What Do They Do in the Body? These drugs are used as painkillers with specific added effects such as sedation or muscle relaxation.
What Are They Prescribed For? They are prescribed for a wide variety of pain conditions including arthritis, headaches, and muscle pain.
What Are the Possible Side Effects? The side effects can be severe because they are drug combinations and thus more dangerous. Many of these drugs are available without a prescription. If you are going to take them, read the directions!
Examples of Migraine Drugs (Serotonin Receptor Agonists)
Almotriptan malate (Axert)
Eletriptan (Replax)
Frovatriptan succinate (Frova)
Naratriptan (Amerge)
Rizatriptan benzoate (Maxalt)
Sumatriptan succinate (Imitrex)
Topiramate (Topamax)
Zolmitriptan (Zomig)
Other migraine drugs not covered here because they are so rarely used include methysergide maleate (Sansert), ergotamine drugs (Ergomar, Migergot, Cafergot), dihydroergotamine mesylate (D.H.E.45), and the combination drugs Cafatine PB, Cafetrate, Catergot, Ercaf, Midrin, and Wigraine.
In 2007 the FDA pulled 15 ergotamine drugs off the market because they had not been officially approved. Considering the length of time ergotamine drugs have been on the market, and considering that five ergotamine drugs were left alone, this was likely more a political move than an attempt to protect the public interest.
Many other types of pain drugs are used alone or in combination to treat migraines, including acetaminophen, naproxen, SSRI anti-depressants, seizure drugs, narcotics, caffeine, and antinausea drugs. None of these combinations are well studied, thus all are risky. The combination of SSRI antidepressants and the “triptan” migraine drugs is proving to be dangerous.
Do not combine them without asking your doctor and pharmacist to thoroughly research the possible side effects, as well as reports from the FDA.
What Do They Do in the Body? Serotonin receptor agonists relieve pain from migraine headaches by constricting the blood vessels in the brain.
What Are They Prescribed For? Relieving pain from migraine headaches.
What Are the Possible Side Effects? These drugs have a powerful constricting effect on the heart and blood vessels and as a result have caused fatal heart spasms and possibly fatal strokes. Palpitations, increased blood pressure, heartbeat irregularities, fainting, slow heartbeat, varicose veins, heart murmur, and low blood pressure have been reported. Migraine headaches are unbearable, but they aren’t worth dying over. If you have any type of heart disease or are at risk for heart disease or stroke, do not take these drugs. Your physician should fully evaluate your heart disease risk before prescribing these drugs, and the first dose should be given in the physician’s office.
Taken regularly, serotonin agonists can cause damage to the eyes.
They often cause a tingling sensation that is not harmful. They can also cause dizziness, a sensation of tightness or heaviness, numbness, coldness or warmth, drowsiness, and a stiff neck.
Other possible side effects include vertigo, aggression, hostility, agitation, hallucinations, panic, hyperactivity, tremors, disorders of thought, sleep disorders, anxiety, depressive disorders, detachment, confusion, sedation, coordination disorders, nerve disorders, suicidal tendencies, diarrhea, unusual thirst, asthma, blood sugar imbalances, weight gain or loss, intestinal bleeding, peptic ulcer, breast tenderness, abortion, speech or voice disturbance, allergy to sunlight, or shock. Dozens of other side effects affecting virtually every body system have been reported.
• Sumatriptan. May also cause flushing, nasal discomfort, eye irritation, vision disturbances, weakness, or dry mouth.
• Naratriptan. May also cause fatigue; pain or pressure in the neck, throat, or jaw; or nausea.
• Rizatriptan. May cause dizziness; sleepiness; headache; pain or pressure in the chest, neck, throat, or jaw; dry mouth; or nausea.
• Zolmitriptan. May cause heart palpitations; dizziness; sleepiness; chest, neck, throat, or jaw pressure; weakness; digestive problems (in 11 to 16 percent of users); muscle pain; and sweating.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have heart disease or have had a stroke, or are at risk for heart disease or stroke.
• Your migraine headache feels different than usual.
• You tend to have hypersensitivity or severe allergic reactions.
• You have kidney or liver disease.
• You have a history of seizures.
• You have eye problems, especially glaucoma.
Central analgesics
Tramadol (Ultram)
This drug isn’t technically classified as an opiate or narcotic, but it has an abuse and addiction profile similar to the opiates. Use with great caution. The only central analgesic commonly used these days is tramadol (Ultram), which will be covered here.
What Does It Do in the Body? It blocks the perception of pain and produces a state of euphoria.
What Is It Prescribed For? Pain management.
What Are the Possible Side Effects? Addiction, seizures, liver and kidney damage, respiratory depression, increased intracranial pressure, dizziness and vertigo, nausea, constipation, headache, sleepiness, vomiting, itching, nervousness and anxiety, weakness, sweating, heartburn, dry mouth, diarrhea, fainting, hypotension (low blood pressure), irregular heartbeat, loss of appetite, gas, stomach pain, rash, vision disturbances, urinary tract disturbances, and menopausal symptoms.
CAUTION!
Think Twice About Taking These Drugs If . . .
You have a history of substance abuse, or kidney or liver damage. In general, please try to avoid this drug if at all possible.
Examples of Narcotic Painkillers
Alfentanil (Alfenta)
Codeine
Combinations (Propacet, Roxicet)
Fentanyl (Sublimaze, Duragesic-25)
Hydrocodone (Lortab, Hydrogesic, Vicodin)
Hydromorphone (Dilaudid)
Levomethadyl (Orlaam)
Levorphanol tartrate (Levo-Dromoran)
Meperidine (Demerol)
Methadone (Dolophine)
Morphine sulphate (Astramorph, Duramorph, MSIR, MS Contin, Roxanol)
Opium (Pantopon, Opium Tincture, Paregoric)
Oxycodone (Roxicodone)
Oxymorphone (Numorphan)
Propoxyphene (Darvon, Dolene, Darvocet)
Remifentanil (Ultiva)
Sufentanil (Sufenta)
These are addictive, mind-altering drugs that are among the top-selling drugs in the United States. It’s likely that tens of thousands of people are addicted to these drugs. The fact that these drugs are such bestsellers tells us that this is an area where both the pharmaceutical industry and the conventional medical industry (physicians, hospitals, insurance companies, HMOs) are profiting from the addictive nature of these drugs. Hydrocodone and codeine are often found in combination painkillers, of which there are dozens, so if it’s not on this list, that doesn’t mean it’s not dangerous and addictive. Don’t let your physician become your drug pusher!
Please don’t avoid these drugs if you really need them for pain. Nobody should suffer unnecessarily. If you do need to take them for more than a few days, be aware that you will go through a withdrawal reaction.
Please don’t take these drugs unless absolutely necessary. If you have a history of drug or alcohol abuse, go off them gradually and under the close supervision of a health care professional.
What Do They Do in the Body? These drugs relieve pain and induce a state of euphoria.
What Are They Prescribed For? The relief of moderate to severe pain, as medication prior to and during surgery, and as cough suppressants.
What Are the Possible Side Effects? The most important side effect of these drugs is that they are addictive. For that reason alone, don’t take them unless you must! These drugs alter your perception of pain and reality. Some of their side effects are euphoria, drowsiness, apathy, and mental confusion. They also reduce your respiratory rate and heart rate, which can result in fainting, heart attack, shock, and seizures.
Because they slow down your digestive system, constipation and urine retention can also happen with these drugs, as well as nausea, vomiting, and abdominal pain. These drugs also cause allergic reactions such as skin rashes, water retention, and hypertension. Frequently these drugs cause light-headedness, dizziness, sedation, face flushing, and sweating. Other side effects include palpitations, allergic reactions, and jaundice.
The fentanyl skin patches (Duragesic) are particularly dangerous. The FDA issued a long black-box warning for them, which reads in part:
Duragesic contains a high concentration of a potent Schedule II opioid agonist, fentanyl. Schedule II opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Fentanyl can be abused and is subject to criminal diversion. The high content of fentanyl in the patches (Duragesic) may be a particular target for abuse and diversion.
Duragesic is indicated for management of persistent, moderate to severe chronic pain that:
• requires continuous, around-the-clock opioid administration for an extended period of time.
• cannot be managed by other means such as nonsteroidal analgesics, opioid combination products, or immediate-release opioids.
It’s important to avoid adding heat to a fentanyl patch, because that may cause the patch to release dangerous levels of the drug into the bloodstream. Examples of adding heat would be a heating pad, hot tub, hot shower, heavy exercise, and fever. Do not cut the fentanyl patch, as this could also cause it to release dangerous
levels of medication.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You are suicidal or prone to addiction. Drug abuse can and does happen with prolonged use of these drugs. People who are prescribed narcotics for medical purposes over a period of one or two weeks usually do not develop dependence. But prolonged use of narcotics can lead to psychological and physical dependence and then uncomfortable and difficult withdrawal.
• You are an alcoholic, have bronchial asthma or trouble breathing, have a head injury or brain tumor, have chronic obstructive heart disease, or have liver or kidney dysfunction.
• You are on monoamine oxidase inhibitors (MAOIs) or have been within 14 days. Do not take meperidine.
• You have an acute abdominal condition. These drugs can obscure an accurate diagnosis.
• You have lung or respiratory disease. Be careful—cough reflex is suppressed with these drugs.
The Signs of Withdrawal from Narcotic Drugs
The earliest signs include yawning, sweating, tearing eyes, and runny nose. Later the symptoms can include dilated eyes, flushing, heart palpitations, twitching, shaking, restlessness, irritability, anxiety, and loss of appetite. Signs of severe withdrawal can include muscle spasms, fever, nausea, diarrhea, vomiting, severe backache, abdominal and leg pains and cramping, hot and cold flashes, inability to sleep, repetitive sneezing, and changes in heart rate and breathing rate.
What Are the Interactions with Food? High-fat foods may increase the effects of morphine. Foods that acidify the urine cause a decrease of potency. Foods that alkalinize the urine decrease the ability of the body to excrete morphine.
Prescription Alternatives Page 32