f13.net forums - OTC Pain meds and you (by popular request)

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July 21, 2025, 01:27:02 AM

we're back, baby

Since Haemish demonstrated interest, I'll just post some quick thoughts about common pain medications for the benefit of the f13 audience. I'm tossing this out off the top of my head, so I take no responsibility if I screw anything up.

Salycilates: Aspirin (ASA) is the prototype.

- Activity as an analgesic (pain), anti-inflammatory, and antipyretic (fever reducer). Chemically it's an acid (acetyl salycilic acid or ASA) which is one source of its potential toward gastric distress. ASA is a potent inhibitor of prostaglandin synthase and acts by acetylation of the enzyme. A primary target is the Cyclooxygenase enzyme (COX) which is the first enzyme in the prostaglandin synthesis pathway. COX has many isoforms of which COX 1 and COX 2 are the best understood. While COX 1 plays a role in inflammation, it turns out to also play a protective role in the GI tract. So inhibition of COX 1 by ASA is good in that it reduces inflammation, but bad in that it reduces gastric protection. ASA and only aspirin among the salycilates is also an irreversible inhibitor of platelet aggregation (7-10 days) by preventing COX mediated synthesis of thromboxane A2 – a mediator of platelet aggregation and a potent vasoconstrictor. This is why some docs prescribe low doses of ASA for people with heart issues.

There are tons of aspirin products on the market, some buffered (a crock since the small amount of buffered material can't do much to buffer the stomach), some enterically coated (to minimize stomach upset by delaying release until it reaches the small intestine), and some with caffeine (to increase circulation and speed delivery).

Non-salycilate NSAIDS: Advil, Motrin (Ibuprofen) and Aleve (Naproxen).

These agents act similarly to ASA in their mechanism of action and have mixed specificity for both COX 1 and COX 2 enzymes. Most are more potent as analgesics with moderate anti-inflammatory and antipyretic activity. I tend to think of these as "improved versions of aspirin" with decreased primary GI insult (most are more fat soluble acids) and improved efficacy. Unfortunately, many can be hard on the kidneys due to metabolites and long-term use can cause damage.

My rule of thumb is: If aspirin works for you, stick with it. If you need something more use ibuprofen. If you want something more with a long duration, use naproxen.

Centrally acting agents: Acetominophen - Tylenol (also called APAP).

APAP is not an anti-inflammatory and will do nothing to releive pain associated with inflamation. It maintains analgesia and antipyretic activity by action similar to that of ASA but limited to the central nervous system. APAP is given as a pain medication to people with mild to moderate pain that cannot tolerate the GI effects of an NSAID (including aspirin). APAP is extensively metabolized by the liver and can be hard on the liver if used chronically. APAP has a metabolite that is quite toxic, but in humans it is produced in such small amounts as to be a non-issue. This toxic metabolite happens to be a major product in feline metabolism making a single tablet toxic enough to be fatal in cats.

The etiology of migraine headaches is VERY different from that alleviated by the drugs mentioned above. It is recommended that migraine sufferers seek prescription medication to alleviate the symptoms of migraine headaches. There are many ASA and APAP products available over the counter (OTC) for migraines, but these are (in my opinion) misleading. The majority of people claiming to suffer "a migraine" are actually just having a bad headache. This is why these medications work for them. A migraine is (in physiological terms) a lot more than just a bad headache and should be treated accordingly.

Anyway, I've thrown this together in like 10 mins and I'm certain I forgot things. I'll willingly open this to discussion if there's interest.

Quote from: Nebu on October 13, 2006, 03:11:15 PM

Centrally acting agents: Acetominophen - Tylenol (also called APAP).

APAP is not an anti-inflammatory and will do nothing to releive pain associated with inflamation. It maintains analgesia and antipyretic activity by action similar to that of ASA but limited to the central nervous system. APAP is given as a pain medication to people with mild to moderate pain that cannot tolerate the GI effects of an NSAID (including aspirin). APAP is extensively metabolized by the liver and can be hard on the liver if used chronically. APAP has a metabolite that is quite toxic, but in humans it is produced in such small amounts as to be a non-issue. This toxic metabolite happens to be a major product in feline metabolism making a single tablet toxic enough to be fatal in cats.

Kinda glad aspirin works for me.

As a sometimes sufferer of migrane headaches I have a vested interest in OTC pain medication (and otherwise).

Alleve pwns them all. Period.

edit: just re-read where you covered migrane vs. ordinary headaches... I'll concede that my condition may just be that I semi-regularly suffer excruciating (but mundane variety) headaches. And I've compared notes with other (actual?) migrane sufferers and I've seen doctors and the general concensus seemed to be that they were indeed migranes but in the grand scheme of things mine are better than most in that they seldom last more than half a day or so. But in terms of OTC vs. specialized forms of migrane medicine; Alleve works where others simply didn't and I'm sticking by it.

It is the ONLY thing that I have ever taken at what I felt to be certain onset of a migrane situation that got me over it w/o knocking me the fuck out. Works great for run-of-the mill stuff, hangovers, etc. too. ;) My wife takes it for general aches and pains, I only take it for headachey stuff, and it really does last.

I was nervous at first because of all the warnings on the bottle; esp. the alcohol/liver stuff. Turns out, after further review, that Alleve is no more (potentially) harmful than other pain meds in this regard and more harmless than some.

Quote from: Mr_PeaCH on October 14, 2006, 08:15:27 AM

Alleve pwns them all. Period.

Seconded. Although I do have a buddy of mine who is a hypochondriac and whose mother is a nurse, and this guy's medicine cabinet is a thing to behold. I don't know what elephant-tranquilizer version of Tylenol he has, or even if it's legal in some states, but it's just shy of morphine in the pain killing department.

It sounds like Tylenol with codine, or whatever they're calling it these days.

None of these drugs are even remotely fun to abuse. huh

Quote from: Signe on October 14, 2006, 07:04:44 PM

None of these drugs are even remotely fun to abuse. huh

QFT.

I read this topic and thought you meant medications that cause pain.

Oi vey...

I knew this would backfire. So much for trying.

I found it interesting. I didn't have any worthwhile comments to make about it though so I lurked.

Don't be shy of doing more like this.

Sorry. I'm interested, too. I take a few perscription meds and I'm also interested in finding out how otc meds and certain foods interact with what I'm already taking. I can take Advil, which works okay with me. For Alleve to work as well, I would have to take more than I should. I'm always wary about taking anything new until I'm sure it won't screw around with other meds I'm taking. Doctor's seem to be relatively useless in this regard. Internet and pharmacists are better.

Quote from: Nebu on October 15, 2006, 12:50:43 PM

I knew this would backfire. So much for trying.

It was a valiant effort though. Bravo.

Personally, over here it differs so much that it's like comparing apples to oranges.

However, I've noticed that I've been escalating in my pain meds recently. Used to be Anadin and then Anadin Extra and then Anadin Ibuprofen and shortly Anadin Ibuprofen Extra Cow Strength.

Before you know it I'll be strapping up my arm and injecting mainline.

Laptops are the devil.

I used to have 1-2 migraines, the flashing lights-nausea inducing type, every month. After several complaints from my doctor about my high BP, he put me on a calcium channel blocker. I haven't had a migraine since I started the medicine in April. I am not sure if this helps anyone, but it may be worth checking out if you suffer from high BP and migraines.

Quote from: Zephyr on October 16, 2006, 05:19:27 AM

Interesting anecdote, thanks for sharing. Most migraines are precipitated by expansion of blood vessles in the brain. SInce the skull is pretty inflexible in size, it creates pressure that generates the symptoms you describe. I've heard of a number of different methods for lowering this intercranial pressure (expensive tryptans like Imitrex or Zomig being the most common), but only a few reports of calcium channel blockers. I'm glad that it worked well for you. I'm going to see if this indication is more widespread than I had predicted.

I just think we should legalize the weed. This lab-baked crap is for the sucks.

You know... I've cornered a few policy makers to ask them why marijuana is illegal and all I ever get in response are weak references (gateway drug, blah blah) and rhetoric. The tobacco lobby is a powerful thing.

I'd assume it'd be the alcohol lobby. Big tobacc has the facilities in place to cash in big time with marijuana. But I think big alcohol wouldn't like the competition, and I'm quite sure big pharma doesn't want you growing your own medicine. I really despise big pharma, though. I've known a few old folks they are extorting.

I wish I could get the religious folks to fight for legalization.

Quote

‘Look, I have given you every seed-bearing plant on the surface of the entire earth, and every tree whose fruit contains seed. This food will be for you, for all the wildlife of the earth, for every bird of the sky, and for every creature that crawls on the earth—everything having the breath of life in it. [I have given] every green plant for food.’ And it was so” (Genesis 1:27-30).

I learned about that passage from a rastafarian. :)

Quote from: Sky on October 16, 2006, 09:52:18 AM

I learned about that passage from a rastafarian. :)

Too many people eating marijuana isn't what started the controversy.

Tea isn't illegal and we steep that into a beverage. Besides, I'd be fine with hash brownies being legal. The very idea that the growing of a non-toxic plant can land you hard time in prison fucking bothers me, especially when I've known people who have served more time than violent felons (yay mandatory minimum sentencing for tying judicial hands in what could be seen as a violation of checks and balances). In fact, one kid I went to school with is facing hard time right now for having a few plants out back.

Civil disobedience, indeed.

Thanks for the info, Nebu. Any of that knowledge you can share in ordinary medicine stuff is good with me.

What are the effects of say mild alcohol use while taking NSAID's? For instance, if I take an Aleve or an Advil, is it bad to have a beer with that (just one, not binge drinking) or should I just swear off the booze when I take the stuff?

There needs to be a real systematic assessment as to why or why not cannabis should be outlawed nowadays, instead of falling back on the idea that it should be illegal simply because it's been illegal for so long. Laws need a good reason for existing.

Some of the early campaigners for the illegalization of marijuana back in the day would actually say things like it "made black men rape white women" (among other things).

That's how outmoded these laws are. It was crazy (evil) thinking like this that aided in it's criminalization, and we really shouldn't be paying tribute to that legacy. If there are good reasons for why marijuana use should be criminalized, then so be it. But the reasons why these laws were originally formed aren't it.

On the other hand, the old propaganda films like "Reefer Madness" (formerly "Tell Your Children") are very entertaining when stoned.

Quote

The motion picture you are about to witness may startle you. It would not have been possible, otherwise, to sufficiently emphasize the frightful toll of the new drug menace which is destroying the youth of America in alarmingly increasing numbers. Marijuana is that drug - a violent narcotic - an unspeakable scourge - The Real Public Enemy Number One!

If you haven't seen it, you should. It culminates in the teenager getting the death penalty for killing his family with an axe while under the influence.

Quote from: HaemishM on October 16, 2006, 11:57:12 AM

The only thing that I'm certain about is that when combined, Nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol increases the risk for major upper gastrointestinal (GI) bleeding. There are a few studies that I could cite, but that's the bottom line. The drugs above are generally safe as long as you don't take aspirin with anticoagulants or are predisposed to GI problems while taking aspirin or any NSAID.

I only read the first part and it was interesting. I'm off to the medicine cabinet.