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Medical Forum / Diseases and Disorders / Hepatitis / March 2007Strongest liver-friendly OTC pain reliever
I know some OTC pain relievers (Tylenol I think) are hard on the liver. What is the strongest liver-friendly OTC pain reliever. John Mc >I know some OTC pain relievers (Tylenol I think) are hard on the liver. >What is the strongest liver-friendly OTC pain reliever. > > John Mc Perhaps a placebo? You cannot take any medication without it having an effect on your liver. You swallow the pill, drug is absorbed into your bloodstream and the liver filters the blood. Consensus here, and with much of the medical profession, is that Tylenol is the lesser of OTC evils (ibuprophen and asa are worse). Never, never ever, exceed the recommended dosage. Or, is your pain the type that could be allievated by something topical, i.e. tiger balm? If you have severe pain, and no drug abuse/addiction history, your doc may give you an opiate painkiller; more effective and hepafriendly. > If you have severe pain, and no drug abuse/addiction history, your doc may > give you an opiate painkiller; more effective and hepafriendly. Except they almost all have tylenol, aspirin or ibuprofen mixed in... >> If you have severe pain, and no drug abuse/addiction history, your doc >> may give you an opiate painkiller; more effective and hepafriendly. > > Except they almost all have tylenol, aspirin or ibuprofen mixed in... I meant, literally, an opiate painkiller, i.e. morphine sulfate, but I guess I was kinda shy about saying that here in front of everybody... well we can get codeine in Canada by asking the pharmacist while it is quite strictly controlled in the USA. Codeine. An Opiate. cactus jammies ========= >>> If you have severe pain, and no drug abuse/addiction history, your doc >>> may give you an opiate painkiller; more effective and hepafriendly. [quoted text clipped - 3 lines] > I meant, literally, an opiate painkiller, i.e. morphine sulfate, but I > guess I was kinda shy about saying that here in front of everybody... > I meant, literally, an opiate painkiller, i.e. morphine sulfate, but I guess > I was kinda shy about saying that here in front of everybody... Understood - I was thinking of opiate painkillers such as percodan, percoset and Combuprofin (sp?). Hi John. I think it depends on how much you need and for how long. For short-term moderate pain 2-4 grams of Tylenol (acetaminophen) is probably ok. My OTC choice for chronic joint pain in my spine is ibuprofen. Ibuprofen is anti-inflammatory whereas acetaminophen is not. I have been taking moderate-to-high doses of ibuprofen daily for several years, so far with no adverse gastrointestinal effects. It may catch up to me eventually. Acetaminophen is less effective and makes me nauseous. The idea of taking it on a long term basis makes me uneasy, no matter how many doctors parrot each other by saying it is the best choice. I really don't think they know. Below is the best article I can find about acetaminophen toxicity in liver patients, written by an MD. "...Studies regarding safety of acetaminophen in patients with liver disease are scarce..." Imho, narcotics that are chemically unhitched to ibuprofen or acetaminophen are the least toxic choice. Unfortunately they are quite difficult to obtain because of FDA regulatory contraints. This is a very good website. It requires registration but is hassle-free. Good luck Kathy J. www.clinicaloptions.com http://clinicaloptions.com/Hepatitis/Annual%20Updates/2006%20Annual%20Update/Mod ules/Concha-Schiff/Pages/Page%209.aspx Excerpted from "The Paradox of Treating Liver Disease With Potentially Hepatotoxic Drugs" Acetaminophen and Liver Disease Since the first report of acetaminophen-induced acute liver failure 40 years ago,[92] the drug has been recognized as the leading cause of drug-induced liver injury in western countries. Recently, the epidemiology of acute liver failure was evaluated at 22 US centers participating in the Acute Liver Failure Study.[93] Acetaminophen toxicity was by far the most common cause of acute liver failure. Despite its well-known dose-related hepatotoxic properties, the annual percentage of acetaminophen-related liver failure rose from 28% in 1998 to 51% in 2003. Acetaminophen is hepatotoxic in 2 settings: overdose as a suicide attempt and unintentionally taking high doses (eg, patients taking 2 or more preparations containing acetaminophen simultaneously to control pain). The primary cause of acetaminophen toxicity in United States appears to be unintentional overdose. Acetaminophen produces a toxic metabolite, N-acetyl-benzoquinoneimine (NAPQI). The increased production of NAPQI is promoted by preexisting high cytochrome P450 enzyme CYP2E1 and/or low glutathione levels (NAPQI is inactivated by glutathione, which is used as an antidote for toxicity). This typically occurs in alcoholic or malnourished patients.[94] Chronic ethanol ingestion can increase CYP2E1 activity, and the effect can persist for several days.[95] Conversely, following acute alcohol ingestion, CYP2E1 inhibition occurs as long as ethanol is present.[96] Chronic alcohol abuse seems to be an independent risk factor for mortality, and acute alcohol ingestion appears to be a protective factor associated with acetaminophen poisoning in alcoholics.[96] Unintentional acetaminophen poisoning can occur even with therapeutic doses. Zimmerman and colleagues[97] studied 67 patients who developed hepatic injury after ingestion of acetaminophen with therapeutic intent. All were regular users of alcohol. "Toxic" doses of acetaminophen were less than 4 grams in 40% of the patients. Schiodt and colleagues[98] evaluated patients hospitalized for excessive acetaminophen ingestion and found 21 patients having accidentally poisoned themselves while attempting to relieve pain. Fifteen percent from this group ingested 4 grams or less in a 24-hour period. This phenomenon could have been related to fasting, alcohol consumption, and genetic differences in P450 constitution. Studies regarding safety of acetaminophen in patients with liver disease are scarce. A double-blind study evaluated the safety of short-term administration of acetaminophen (4 g/day for 13 days) vs placebo to 20 patients with stable chronic liver disease. One subject from the acetaminophen-group developed symptoms and increase of liver enzymes. However, it was believed to be a result of his underlying liver disease and not related to the drug.[99] There is a reduction in the total clearance of acetaminophen and consequently a prolongation of half-life of acetaminophen in patients with liver diseases compared with healthy volunteers.[100] A therapeutic misadventure can be dangerous in patients with underlying liver disease, although this has not been proven. Therefore, long-term therapy with acetaminophen at doses of 2 grams or less per day could be the preferred analgesic regimen for cirrhotic patients who are prone to gastrointestinal bleeding or bleeding diatheses that may be exacerbated by salicylates and/or nonsteriodal antiinflammatory drugs; however, there is a paucity of data supporting this strategy so vigilance is warranted when choosing this option. I guess Aleve is ok then. John Mc > Hi John. I think it depends on how much you need and for how long. For > short-term moderate pain 2-4 grams of Tylenol (acetaminophen) is probably [quoted text clipped - 85 lines] > antiinflammatory drugs; however, there is a paucity of data supporting > this strategy so vigilance is warranted when choosing this option. >I guess Aleve is ok then. I don't know about that. Naproxen is chemically related to ibuprofen. Which is related to aspirin. It sounded like that article said there hasn't been much research on pain killers and NSAIDS with people with liver disease and if that is so than who can say with any certainty. And who knows when you are taking interferon and ribavirin and your body isn't liking it so much. I used ibuprofen occasionally on tx and didn't notice any ill effects that I could attribute to the ibuprofen. Somebody pointed out that pain reliever and NSAIDS are different and work better for different things. Since doctors often suggest the tylenol maybe that is more proven if it works for you. I remember long ago somebody posting an article in here about somebody who messed up there liver because they didn't realize they had taken such a high dose of tylenol because it was combined with several of the medications this person was taking. This might be helpful to someone. I started looking into pain relievers a few years ago when I found myself on the chronic pain path. This is how I understand them, in three or four categories, in a simplified way: First there are the opiates and their derivatives, all of which are narcotic and sometimes "addictive." In addition to relieving pain, they have the pesky side effect of making the patient feel pleasant. They range from codeine, which is relatively weak, to the big guns like morphine methadone, heroin, and opium. The class includes hydrocodone, oxycontin, morphine, fentanyl, and a whole bunch of others. They are often chemically combined with tylenol, ibuprofen or aspirin. Tylenol 3, Percocet, Darvocet and Vicoden are typical brands. They say the extra painkiller reduces the need for the narcotic. Maybe. I am starting to believe that another reason that narcotics are chemically linked to the second med is because it makes them less abusable, so the authorities think they are hunky dory. I think they are easier to mess with in home labs. They are crushable, snortable etc. It seems that ones that are pure, with no extra painreliever attached are more tightly regulated by the Fed.. For example, in my state docs need to keep multiple carbon copies of the prescription and it can't be phoned in, it must be hand written. For this reason, my rheumatologist won't prescribe Oxycontin for me because he says it is a "pain." But he does prescribe a drug called Vicoprofen, which helps. It is a mix of hydrocodone and ibuprofen. Second, there are various kinds of anti-inflammatories that control pain because they reduce inflammation. The class includes ibuprofen, aspirin, aleve, and a whole herd of prescription drugs, including Celebrex and the now defunct Vioxx. Most of these are referred to as NSAIDS: NON-steroidal antiinflammatory drugs. The rumor is that they cause intestinal bleeding after prolonged use. They are also hard on your kidneys. (By comparison, cortisone, prednisone etc are prescription STEROIDAL antiinflammatories. I have read that unless a patient is having a major meltdown the steroidals are taboo for heppers because they supress the immune system in a big way and viral load rises). Another drug in a category all its own is acetaminophen (Tylenol), which is a painkiller but not an antiinflammatory. I am fairly certain it is the most liver toxic of the lot. I don't know how it works, but it seems to have gotten itself attached just about every over-the-counter painkiller or cough or cold or toe medicine out there that isn't an antiinflammatory. Hence the frequency of unintentional overdoses. Read the labels! I say avoid the stuff altogether. There is one oddball prescription painkiller out there called Tramadol (or Ultram or Ultracet with acetaminophen). It is a "synthetic" opioid and it is effective but relatively weak. The problem with this one is that is is hooked to a seratonin-reuptake-inhibitor (SSRI) which is very common in prescription antidepressants and you can get a severe brain rattling seratonin buzz if you combine them. Been there done that. So pain control isn't a pretty picture. You and your doc must choose between liver, kidney, or intestinal toxicity, immune-suppressing steroids, or some pesky narcotic. If you have severe pain, do a little homework and present yourself to your doctor with dignity. Ramble and rant. Rattle and hum. Kokomomo out |
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