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Paracetamol versus ibuprofen – which works best and when?

<p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>In most cases, pain and fever relief is as simple as a trip to your local supermarket for some paracetamol or ibuprofen.</p> <p>While both are effective at reducing pain, they work in different ways. So deciding which one you should choose is dependent on the type of pain you are experiencing. Sometimes it might be appropriate to take a medication that contains both drugs.</p> <p>In Australia, <a href="https://www.tga.gov.au/paracetamol-practitioner-fact-sheet#:%7E:text=It%20is%20available%20in%20many,Panamax%2C%20Chemist%20Own%20and%20Dymadon.">paracetamol</a> is branded as Panadol, Herron Paracetamol, Panamax, Chemist Own or Dymadon, plus there are generic chemist brands. Nurofen is the common brand name for <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&amp;t=&amp;q=ibuprofen">ibuprofen</a>, which is also sold under generic brand names.</p> <p>So how do you know which one to choose and when?</p> <h2>Different blocking actions</h2> <p>While ibuprofen and paracetamol can be taken for similar reasons (pain relief) each works in a slightly different way.</p> <p>Ibuprofen is a <a href="https://www.healthdirect.gov.au/anti-inflammatory-medicines">non-steroidal anti-inflammatory drug</a>, which means it acts by blocking the enzymes that produce a group of chemicals called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/">prostaglandins</a>. These chemicals are important for normal body functions such as relaxing blood vessels, preventing blood clotting, secreting protective mucus in the gut and helping the uterus contract. They are also involved in inflammation, pain and fever.</p> <p>It is still not completely understood how paracetamol works. Like ibuprofen, it is thought to act by blocking the enzymes that produce prostaglandins, although through a different mechanism to ibuprofen. There is also good evidence paracetamol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590544/">interacts</a> with the brain’s <a href="https://www.healthline.com/health/endocannabinoid-system">endocannabinoid system</a> and the “<a href="https://www.physio-pedia.com/Pain_Descending_Pathways">descending pain pathway</a>”, which inhibits the perception of pain.</p> <h2>Is one drug better than the other?</h2> <p>Because they each provide pain relief in different ways, paracetamol can be better at treating some types of pain, while ibuprofen is better at treating other types. But be wary of packaging that claims a medication is useful for targeting pain associated with a specific condition as these claims are <a href="https://www.abc.net.au/news/2017-08-03/nurofen-offers-3.5-million-compensation-to-customers/8770910">not true</a>.</p> <p>Because it reduces inflammation, the <a href="https://www.tg.org.au/">Australian Therapeutic Guidelines</a> state ibuprofen is the better choice for pain associated with osteo- and rheumatoid arthritis, period pain, some types of headache, and for pain that comes from having an operation. Paracetamol does not reduce inflammation but it is a better choice when fever is associated with the pain, like when you have a cold or flu.</p> <p>The Australian government recommends either paracetamol or ibuprofen if you have <a href="https://www.healthdirect.gov.au/covid-19/treating-symptoms-at-home">pain associated with COVID</a>.</p> <h2>What about taking both or ‘piggybacking’ them at intervals?</h2> <p>We can sometimes get better relief when we take both types of medicine at the same time, since each targets a different cause or pathway of the pain. If one pathway does not completely control the pain then it can be useful to target the other one. The effects of each drug <a href="https://www.frontiersin.org/articles/10.3389/fphar.2017.00158/full">can add</a> together for a bigger effect.</p> <p>Combination products that contain both paracetamol and ibuprofen in a single tablet include <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&amp;id=CP-2022-CMI-02442-1&amp;d=20230620172310101">Nuromol</a> and <a href="https://maxigesic.com.au/wp-content/uploads/2021/05/cmi-approved.pdf">Maxigesic</a>.</p> <p>Using a combination product means you can take fewer tablets. However, the doses in these combined products are sometimes less than the maximum recommended dose, meaning they might not work as well when compared with taking the tablets individually.</p> <p>Other times, you can get the best effect by alternating doses of ibuprofen and paracetamol. This keeps the levels of the medication in the body more constant and helps to provide more steady pain relief. This may be particularly useful when treating <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Pain_relief_for_children_-_Paracetamol_and_Ibuprofen/#:%7E:text=So%20that%20your%20child%27s%20pain,too%20much%20of%20either%20medicine.">pain</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009572.pub2/full?highlightAbstract=therapy%7Cfor%7Cibuprofen%7Calternating%7Cchildren%7Creview%7Cfour%7Ctherapi%7Caltern%7Ccombin%7Cfebril%7Ccombined%7Cparacetamol%7Cfebrile%7Cchild">fever</a> in children. To do this, one drug is given, then a dose of the other drug is given a few hours later, with you continuing to alternate between the two throughout the day.</p> <p>If you are alternating between different pain medicines, make sure you leave <a href="https://www.nhs.uk/medicines/paracetamol-for-children/taking-paracetamol-for-children-with-other-medicines-and-herbal-supplements/#:%7E:text=If%20you%27ve%20given%20your%20child%20paracetamol%20and%20they%27re,1%20medicine%20at%20a%20time">time (at least one hour)</a> between the dosing of each product to get more effective and consistent relief. Only give the recommended dose of each medicine as outlined on the pack. And do not administer more than the maximum recommended number of doses for each medicine per day.</p> <h2>How do the side effects compare?</h2> <p>Side effects from either drug are rare and generally mild.</p> <p><a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">Ibuprofen</a> does have a <a href="https://www.webmd.com/rheumatoid-arthritis/features/anti-inflammatory-drugs-rheumatoid-arthritis">reputation</a> for causing stomach problems. These can manifest as nausea, indigestion, bleeding in the stomach, and diarrhoea. For this reason, people with a history of bleeding or ulcers in the gut should not take ibuprofen. Ibuprofen is also known to sometimes cause headaches, dizziness, and higher blood pressure.</p> <p>Because ibuprofen thins the blood, it should also not be taken by people who are taking other medicines to thin the blood; like aspirin, warfarin, and clopidogrel. Ibuprofen should also be <a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">avoided</a> by pregnant women and people with asthma. In these cases, paracetamol is the better choice.</p> <p>However, you need to be careful when using these medicines to make sure you don’t use more than is recommended. This is particularly important for <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50296">paracetamol</a>.</p> <p>Paracetamol at the recommended doses is not toxic but too much can lead to liver failure.</p> <p>Because paracetamol is found in lots of different products, it can be hard to keep track of exactly how much paracetamol you have taken and this increases the risk of taking too much.</p> <h2>Both work, both need to be used safely</h2> <p>Paracetamol and ibuprofen are effective medications for the relief of both pain and fever; however, care must be taken to use them safely.</p> <p>Always read the label so you know exactly what products you are using and how much. Only take the recommended dose, and if you need to, write down the time you take each dose. Your pharmacist or doctor can also advise on the best medicine for your pain and fever and how to use the selected medicine safely.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207921/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/paracetamol-versus-ibuprofen-which-works-best-and-when-207921">original article</a>.</em></p>

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Ibuprofen and COVID-19 symptoms: Here’s what you need to know

<p>There’s been some <a href="https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms">confusion recently</a> on whether we should or shouldn’t take ibuprofen to treat symptoms of COVID-19 – especially after the World Health Organisation (WHO) changed its stance. After initially recommending people avoid taking ibuprofen to treat symptoms of the new coronavirus disease, <a href="https://twitter.com/WHO/status/1240409217997189128">as of March 19</a> the WHO now does not recommend avoiding ibuprofen to treat COVID-19 symptoms.</p> <p>The confusion began after France’s Minister of Solidarity and Health <a href="https://twitter.com/olivierveran">Oliver Véran</a> <a href="https://twitter.com/olivierveran/status/1238776545398923264">announced on Twitter</a> that taking anti-inflammatory drugs (such as <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ibuprofen">ibuprofen</a> or <a href="https://www.sciencedirect.com/topics/nursing-and-health-professions/cortisone">cortisone</a>) could be a factor in worsening a COVID-19 infection. He recommended that paracetamol should be taken instead to treat the associated fever.</p> <p>At the moment, the NHS only recommends <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/">taking paracetamol for COVID-19 symptoms</a>, even though it admits there is no strong evidence showing ibuprofen worsens symptoms. The BMJ also states that <a href="https://www.bmj.com/content/368/bmj.m1086">ibuprofen should be avoided</a> when managing COVID-19 symptoms.</p> <p><a href="https://bnf.nice.org.uk/drug/ibuprofen.html">Ibuprofen</a> is a non-steroidal anti-inflammatory drug (<a href="https://bnf.nice.org.uk/treatment-summary/non-steroidal-anti-inflammatory-drugs.html">NSAID</a>). <a href="https://www.nhs.uk/conditions/nsaids/">NSAIDs</a>, including ibuprofen, normally have three main uses: they help with inflammation, pain, and <a href="https://www.nhs.uk/conditions/fever-in-children/">fever</a>. People might also take them for inflammatory conditions such as <a href="https://www.nhs.uk/conditions/rheumatoid-arthritis/">arthritis</a> and for <a href="https://www.nhs.uk/live-well/healthy-body/ways-to-manage-chronic-pain/">pain</a>. However, <a href="https://www.nhs.uk/medicines/paracetamol-for-adults/">paracetamol</a> can also help treat pain and fever.</p> <p>Fever is a <a href="https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-do-i-take-someones-temperature/">higher than normal body temperature</a>, and is <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/">one of the signs</a> of COVID-19, along with a persistent cough and shortness of breath. The body develops a fever as a defence mechanism, where the immune system produces a chain of molecules that tell the brain to make and keep more heat inside to fight the infection.</p> <p>While <a href="https://www.britannica.com/science/fever">getting fever</a> during an infection is part of the body’s defence mechanism, a serious rise in body temperature can be fatal and should be treated. Having fever is also uncomfortable because it often comes with shivering, headaches, nausea and stomach upsets. Taking an anti-inflammatory like ibuprofen or paracetamol will bring down a high temperature by lowering some of the fever molecules. However, doctors who <a href="https://www.bmj.com/content/347/bmj.f6041">compared the two</a> in 2013 suggested taking paracetamol over ibuprofen for normal chest infections because they found a small number of people’s illness got worse with ibuprofen.</p> <p><strong>Cause for concern?</strong></p> <p>Some of the reasons that there’s a concern taking ibuprofen will make COVID-19 symptoms worse comes from <a href="https://www.ncbi.nlm.nih.gov/pubmed/20724739">previous studies</a> that <a href="https://www.ncbi.nlm.nih.gov/pubmed/24997726?dopt=Abstract">have shown</a> people with <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.23041">other serious chest infections</a> (such as pneumonia) experienced worse symptoms and <a href="https://www.resmedjournal.com/article/S0954-6111(16)30326-2/fulltext">prolonged illness</a> after taking an NSAID, including ibuprofen.</p> <p>But it’s difficult to say if taking ibuprofen in these instances directly causes worse symptoms and prolonged illness, or if it’s because taking ibuprofen or other anti-inflammatories help manage pain, which may hide how serious the illness is and could stop people from asking for help earlier – delaying treatment. Or, it might be to do with ibuprofen’s anti-inflammatory effects. One <a href="https://www.sciencedirect.com/science/article/pii/S0166354217307362?via%3Dihub">theory</a> is that anti-inflammatory medicines can interfere with some of the body’s immune response, although this is not proven for ibuprofen.</p> <p>However, two French studies <a href="https://www.ncbi.nlm.nih.gov/pubmed/28005149">warn doctors and pharmacists</a> not to give NSAIDs when they see signs of chest infections, and that NSAIDs shouldn’t be given when <a href="https://www.jpeds.com/article/S0022-3476(16)30233-5/fulltext">children are infected</a> with viruses. There’s no agreement on why ibuprofen could make chest infections worse, but both studies reported worse outcomes in patients who had taken a NSAID to treat their condition.</p> <p>A recent letter to The Lancet suggested that ibuprofen’s harm in COVID-19 is to do with its <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext">effect on an enzyme</a> in the body called angiotensin-converting enzyme 2 (ACE2) – though this has yet to be proven. This caused additional worries for patients taking angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for existing heart conditions. <a href="https://www.britishcardiovascularsociety.org/news/ACEi-or-ARB-and-COVID-19">Several</a> <a href="https://pccsuk.org/2020/en/page/home">leading</a> <a href="https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang">organisations</a> have rightly warned patients not to stop taking their regular medicines in light of unconfirmed theories.</p> <p>Because novel coronavirus is a new type of virus, there is currently no evidence proving that taking ibuprofen will be harmful or make COVID-19 symptoms worse. Research in this area is developing fast, but with so much <a href="https://www.bbc.co.uk/news/51929628">misinformation about COVID-19 and ibuprofen use</a>, the cautious approach is to avoid ibuprofen with COVID-19 if at all possible – especially for those with pre-existing health conditions. Anyone who thinks they might have COVID-19 can consider <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/">using paracetamol instead</a> of ibuprofen for managing their fever, unless they’re told otherwise by their doctor or pharmacist.</p> <p>In the meantime, the UK’s Committee of Human Medicines and the National Institute for Health and Care Excellence (NICE) have been <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103001">asked to review</a> all the evidence to understand ibuprofen’s impact on COVID-19 symptoms. Naturally, people already prescribed an anti-inflammatory drug for a health condition should ask their doctor’s opinion and not just stop their medication.</p> <p>It’s worth noting, however, that <a href="https://www.nhs.uk/medicines/ibuprofen-for-adults/">ibuprofen</a> and <a href="https://bnf.nice.org.uk/treatment-summary/non-steroidal-anti-inflammatory-drugs.html">NSAIDs</a> can trigger stomach ulcers and indigestion and might not be suitable for some people with heart disease, kidney and liver problems, and asthma, as well as people over 65, and those who drink more alcohol. These drugs should not be used in people with very high blood pressure, and women trying to get <a href="https://www.nhs.uk/common-health-questions/pregnancy/can-i-take-ibuprofen-when-i-am-pregnant/">pregnant or already pregnant</a>.</p> <p><a href="https://www.nhs.uk/medicines/paracetamol-for-adults/">Paracetamol</a>, which can also treat pain and fever, may be preferred. Though it takes up to an hour to work, it’s safe to use for women who are pregnant or breastfeeding, and can be taken with or without food. Some people need to take extra care with paracetamol and should speak with their doctor or pharmacist first, for example if they have liver or kidney problems.</p> <p>The usual dose of paracetamol for adults is one or two 500 milligram tablets up to four times in 24 hours, with at least four hours in between doses. Most people use a syrup to give paracetamol to <a href="https://www.nhs.uk/medicines/paracetamol-for-children/">children</a>. How much to give depends on your child’s age, but again paracetamol should only be given up to four times in 24 hours, with at least four hours between doses.</p> <p>Pharmacies have been running short of paracetamol and some shops have been <a href="https://www.pharmaceutical-journal.com/news-and-analysis/news/unprecedented-demand-for-otc-painkillers-as-covid-19-outbreak-spreads/20207830.article">rationing</a> sales. For those exhibiting symptoms, a box of 32 tablets should last for at least four days. At this time of crisis, it’s important people make sure they’re not stockpiling medicines unnecessarily and depriving others who are equally in need of paracetamol and other vital drugs.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/134064/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/parastou-donyai-126907">Parastou Donyai</a>, Professor and Director of Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-reading-902">University of Reading</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ibuprofen-and-covid-19-symptoms-heres-what-you-need-to-know-134064">original article</a>.</em></p>

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WHO sounds new warning against use of ibuprofen for coronavirus symptoms

<div class="post_body_wrapper"> <div class="post_body"> <div class="body_text "> <p>The World Health Organisation has recommended that people suffering from COVID-19 symptoms to avoid taking ibuprofen after French officials warned that anti-inflammatory drugs could worsen the effects of the virus.</p> <p>The warning came after French Health Minister Olivier Veran followed a recent study in The Lancet medical journal that hypothesised that an enzyme boosted by anti-inflammatory drugs such as ibuprofen could worsen COVID-19 infections.</p> <p>When asked about the study, WHO spokesman Christian Lindmeier told reporters in Geneva that the UN health agency’s experts were “looking into this to give further guidance”.</p> <p>"In the meantime, we recommend using rather paracetamol, and do not use ibuprofen as a self-medication. That's important," he said.</p> <p>He added that if ibuprofen had been "prescribed by the healthcare professionals, then, of course, that's up to them."</p> <p>Mr Lindmeier’s comments came after Veran made a tweet cautioning the use of ibuprofen and other anti-inflammatory drugs.</p> <p>"In the case of fever, take paracetamol," he wrote.</p> <p>A spokesperson for British pharmaceutical company Reckitt Benckiser, which makes Nurofen, said in an email statement that the company is aware of concerns about the use of steroids for the alleviation of COVID-19 symptoms.</p> <p>“Consumer safety is our number one priority," the spokesperson said, stressing that "Ibuprofen is a well-established medicine that has been used safely as a self-care fever and pain reducer, including in viral illnesses, for more than 30 years."</p> <p>"We do not currently believe there is any proven scientific evidence linking over-the-counter use of ibuprofen to the aggravation of COVID-19," the statement said.</p> <p>The COVID-19 pandemic has currently infected 190,000 people worldwide and killed more than 7,800. It causes mild symptoms in most people, but can result in pneumonia and in some cases, severe illness that can lead to multiple organ failure.</p> </div> </div> </div>

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9 times ibuprofen won’t work – and could be dangerous

<p><strong>When ibuprofen should be avoided</strong></p> <p>Athletes call it “Vitamin I.” Women with menstrual cramps depend upon it. But scientists are beginning to realise that ibuprofen may not be as benign as we thought. Here’s when you should just say no.</p> <p><strong>If you have heart disease</strong></p> <p>While low-dose aspirin can help prevent heart attack, other painkillers in the nonsteroidal anti-inflammatory drug family (NSAIDs) – which include ibuprofen – have been associated with an increase in the chance for heart attack or stroke. A 2017 <em>British Medical Journal</em> study reported a 20 to 50 percent elevated risk of heart attack among people who used NSAIDs daily for a week or more. The increased risk associated with ibuprofen could be as high as 75 percent. The greatest danger occurred within the first month of NSAID use and at high doses.</p> <p>Those with heart disease or at risk for heart disease should be especially mindful of these findings, though the elevated risk affects everyone, says Catherine Sherwin, PhD, chair of the clinical pharmacology track at the American Association of Pharmaceutical Scientists PharmSci 360 Meeting. If you’re taking blood-pressure medication, be especially cautious – NSAIDs could make them less effective. Talk to your doctor about alternative medications to treat your pain, whether it’s, say, paracetemol for a headache or physical therapy for back pain.</p> <p><strong>If you’re on anti-clotting meds</strong></p> <p>Anticoagulants and antiplatelets prevent blood from clotting easily. Anticoagulants are typically prescribed for people at high risk for stroke (such as those with atrial fibrillation or artificial heart valves), or those who’ve suffered from a pulmonary embolism; antiplatelets are usually advised for those who’ve already suffered a heart attack or stroke, as a way to prevent it from happening again. The problem? “The combination of these drugs with ibuprofen could significantly increase the risk for bleeding complications,” says David Craig, PharmD, pharmacist lead at the Moffitt Cancer Centre. So instead, discuss other options with your doctor.</p> <p><strong>If you have gastrointestinal issues</strong></p> <p>NSAIDs not only irritate the lining of the stomach and intestines, but they can also reduce blood flow in the area and impair its ability to fix itself. So if you already have digestive issues, such as inflammatory bowel disease, you probably wouldn’t want to pop any NSAID. They’re not effective for pain associated with IBD and, in the cases where you’re suffering from other achy issues, you’re better off talking to your doctor about alternative treatments. According to Venkata Yellepeddi, PhD, adjunct assistant professor in pharmaceutical chemistry, if you have trouble with menstrual cramping, birth control pills could help.</p> <p><strong>If you’re pregnant</strong></p> <p>NSAIDs have been found to harm the foetus, raising the risk of miscarriage in early pregnancy and heart defects in the third trimester. What’s more, a recent Human Reproduction study on foetal tissue suggests an association between women who have taken ibuprofen during their first trimester with a subsequent reduction in egg development in the foetal ovaries – which could compromise a daughter’s future fertility. Ibuprofen is also not a good idea during laboor and delivery since it could lead to prolonged bleeding. If you’re in need of pain relief at some point over the course of your pregnancy, check with your doctor.</p> <p><strong>If you have a UTI</strong></p> <p>A few years ago, researchers reported that NSAIDs may be useful for treating urinary tract infections. Besides possibly soothing pain, they may reduce recurrence, as well as help curb the use of antibiotics – a good thing, given the threat of antibiotic resistance. The hitch? NSAIDs might actually not do any of that: “There’s conflicting evidence in the literature on the effectiveness of ibuprofen, and it’s dependent on the antibiotic with which it’s compared,” says Sherwin. In addition, a PLOS Medicine study reports that women who took ibuprofen only to treat a UTI took an average of three days longer to heal than those on antibiotics, and they had a slightly higher risk of complications.</p> <p><strong>If you have arthritis</strong></p> <p>Arthritis sufferers have long taken ibuprofen and other NSAIDs for arthritis pain. But because of its negative effects on the gastrointestinal and cardiovascular system, certain patients – particularly if they had a history of stomach or heart issues – should probably think twice before popping an ibuprofen. A 2017 <em>European Heart Journal</em> paper compared the blood pressure effects of different types of NSAIDs (ibuprofen, naproxen, and celecoxib) on osteoarthritis and rheumatoid arthritis patients. The verdict? All the drugs were associated with an increased risk of hypertension – and ibuprofen had the worst impact, with 23.2 percent of patients on the drug going from normal to hypertensive, compared to 19 percent for naproxen and 10.3 percent for celecoxib.</p> <p>What’s more, for those with rheumatoid arthritis, NSAIDs are not able to control the inflammation enough to prevent further joint damage. What can? Disease-modifying anti-rheumatic drugs (DMARDs) as well as biologic-response modifiers (or simply, biologics). Non-drug options – like exercise, physical therapy, and warm baths – can also offer some pain relief.</p> <p><strong>If you enjoy wine or cocktails</strong></p> <p>We’ve been there. You’ve got plans to meet a friend for drinks, and you’ve got an awful headache. But think twice before popping an Advil just before running out for that cocktail. Alcohol can irritate the stomach and so can NSAIDs. Put the two together, and you just compounded your chances damaging your tummy. “Alcohol should be avoided due to increased risk of stomach ulcers,” says Sherwin. Making matters worse, the one-two punch can also up your risk of liver damage.</p> <p><strong>If you’re about to tackle a really tough workout</strong></p> <p>Die-hard athletes sometimes take an Advil before, say, a long run. But that may be, at best, a waste of time and potentially harmful at worst. “Painkillers are a chemical Band-Aid,” says Lillie Rosenthal, DO, a medical advisory board member at MedShadow Foundation, a nonprofit group that educates patients on long-term drug safety and efficacy. “You have to listen to the body and figure out the cause,” says Dr. Rosenthal, who specialises in physical medicine and rehabilitation. With ibuprofen muting the pain, you may not know if you’re overexerting yourself or it may prevent you from slowing down or getting help when it’s needed.</p> <p>Plus, if you’re working out extremely hard – as in ultramarathon hard – taking ibuprofen can exacerbate the kidney damage that’s sparked by rigorous exercise. In a 2017 <em>BMJ Emergency Medicine </em>paper, ultramarathoners who took ibuprofen over the course of 80 kilometres (for a total of 1200 mg) were about 18 percent more likely to experience acute kidney injury than those who took a placebo. Extreme workouts tax the kidneys by drawing blood to the muscles for a prolonged period of time; taking ibuprofen – which reduces prostaglandins, which then, in turn, diverts blood flow from the kidney – exerts a double whammy on the kidneys.</p> <p>Furthermore, an ibuprofen may not even be that helpful. In a small 2015 study published in the <em>Journal of Athletic Training</em>, researchers rounded up experienced runners, had them do a baseline workout, and then induced muscle pain in their legs through strenuous exercise (ouch!). Later, the subjects were either given ibuprofen or placebo and then told to do a follow-up workout. The difference? Essentially, none. One possible reason, say the researchers, may be that the drug’s effect on the heart may compromise oxygen uptake and negate any gains in pain reduction.</p> <p><strong>If you have asthma</strong></p> <p>Ibuprofen and other NSAIDs quell inflammation by inhibiting an enzyme that reduces the production of substances called prostaglandins, which help with healing. The issue is that interfering with prostaglandins could exacerbate asthma. That’s why the insert in your ibuprofen packages warns asthma sufferers to exercise caution, says Marilyn E. Morris, PhD, SUNY Buffalo distinguished professor and chair of the department of pharmaceutical sciences. “Asthmatics who have a demonstrated sensitivity to NSAIDs, like ibuprofen, could have a life-threatening bronchospasm event,” explains Craig. “These patients should talk to their doctors about alternative options to manage pain.”</p> <p><em>Written by Joanne Chen. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/tips/drugs-medicine/9-times-ibuprofen-wont-work-and-could-be-dangerous?slide=all">Reader’s Digest.</a> For more of what you love from the world’s best-loved magazine,</em><em><u> <a href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&amp;utm_medium=articles&amp;utm_campaign=RDSUB&amp;keycode=WRN93V">here’s our best subscription offer.</a> </u></em></p> <p><img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" /></p>

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Ibuprofen linked to 30% increased risk of cardiac arrest

<p>A 10-year Danish study of almost 30,000 participants has discovered a link between the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Neurofen) and a 31 per cent increase in the risk of cardiac arrest.</p> <p>Researchers from Copenhagen University Hospital Gentofte are calling for tighter restrictions to be placed on the sale of these drugs. “Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” said lead author and professor of cardiology Gunnar Gislason.</p> <p>Among other NSAIDs studied were diclofenac (the second-most commonly used NSAID, associated with a whopping 51 per cent increased risk), rofecoxib and celecoxib. It’s believed these drugs may cause arteries to constrict, restricting blood flow to the heart, blood blots and a rise in blood pressure.</p> <p>Professor Garry Jennings, Chief Medical Officer at the Australian Heart Foundation told AAP the findings are concerning, but consumers should not panic. “In absolute terms this is a relatively small risk but it seems to be fairly real,” he said. “There is really no information which suggests that they can cause either a cardiac arrest or heart attack out of the blue. I think that is very unlikely.”</p> <p>Professor Jennings says those who are most at risk are people who have not yet discovered they are suffering from a heart condition. The call for ibuprofen restrictions comes just months after the Therapeutic Goods Administration ruled that, from 2018, painkillers containing codeine would require a prescription.</p> <p>“There is an assumption that if you can buy something anywhere, then they must be safe and we know these drugs are not safe, this is not the only problem associated with them,” he added, explaining overuse of NSAIDs is also known to cause stomach ulcers and liver and kidney issues.</p>

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Scientists create breakthrough pain relief patch

<p>If you’ve ever experienced chronic pain, arthritis or even nursed a hangover, this news is for you. British scientists have just released a breakthrough in pain relief that might revolutionise the way we medicate: a wearable patch.</p> <p>Researchers from the University of Warwick in the United Kingdom have created a wearable device that takes a lot of the guess work and risk out of self-administered pain relief. The device is similar to a nicotine patch. It’s clear and adhesive so it can be discretely worn by users.</p> <p>The real benefit of the patch is its ability to deliver slow release ibuprofen. “[It is] a transparent adhesive patch that can consistently deliver a prolonged high dose of the painkiller ibuprofen directly through the skin," researchers said in a statement. It releases a steady dose over the course of 12 hours, combatting the danger of overdoses associated with pain relief pills.</p> <p>The patch can hold a large amount of the drug, roughly five to ten times that of other medical patches. It’s flexible and easy to remove.</p> <p>So, is this the end of the common pain relief pill? Not yet, but it might be in a few years, say researchers. "Our first products will be over-the-counter pain relief patches and through partnering we would expect to have the first of those products on the market in around two years," says Nigel Davis, CEO of Medherant, the university's commercial arm.</p> <p>Here’s to a pain-free future. </p> <p><strong>Related links:</strong></p> <p><strong><em><a href="http://www.oversixty.co.nz/health/hearing/2015/12/gene-therapy-breakthrough-hearing-loss/">Gene therapy breakthrough for treatment of hearing loss</a></em></strong></p> <p><strong><em><a href="http://www.oversixty.co.nz/health/hearing/2015/11/what-to-tell-loves-ones-about-hearing-loss/">What you should tell loved ones about your hearing loss</a></em></strong></p> <p><strong><em><a href="http://www.oversixty.co.nz/health/hearing/2015/11/history-of-hearing-aids/">What people did before hearing aids</a></em></strong></p>

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