I’m in miserable levels of pain after a hip replacement 6 weeks ago. Before I had my surgery the pain was well managed by meloxicam and amitriptyline but then I had my first episode of AFib and they thought it may have been triggered by those drugs. So I was started on the holy grail of Bisoprolol, Edoxaban and Lipitor and told I’d need to mange on paracetamol. So for the last three months before my surgery and the two since, that’s what I’ve tried to do. This morning the pain was so bad (nothing wrong with my new hip, it just turned out to be a more complicated surgery than expected, with a lot of soft tissue damage), that I phoned GP and was given a prescription for diclofenic gel. I queried but was told it wasn’t ‘absorbed by any organs’ - um - well what about the skin for a start. Anyway, asked pharmacist and he made a cats bum face and said it wasn’t ideal with edoxaban but some doctors risked it. I’m not asking you to tell me what to do, but just wondered if this was quite a common prescription combo and I’m just being over cautious. At the moment, the tube hasn’t been opened and I’m still white-knuckling it with a bag of frozen peas.
edoxaban and topical diclofenic gel? - Atrial Fibrillati...
edoxaban and topical diclofenic gel?
Why have they put you on statins for hip pain? That sounds like they managed to shove their holy grail statin pill in while you were down and not concentrating.
It's a pain in the ass not being able to have Ibuprofen and similar drugs when on anticoagulants. I have migraine from time to time and Ibuprofen is the only drug that will touch it for me. Trying to manage on paracetamol just means I have to go to bed and suffer until it's over.
I spoke to the pharmacist at the hospital and explained that situation to her and she said provided I didn't take many of them in a row or for an extended period of time, I'd be OK to use them to stop the migraines and that I should take them with some food. That's what I do. It only usually needs the 2 tablets to kill the migraine pain, then I can use paracetamol until the evil thing has worked it's way out of my body. That is, of course, what I have chosen to do.
I was also told I could not have decongestant meds if I had a cold when on a Beta blocker. When you read up about it it actually says you should avoid decongestant (can't remember the drug name) if you have high blood pressure. So the GP and another pharmacist saw the Beta blocker, which can be used to control high blood pressure, and told me I can't use the Suddafed. My Beta blocker is for rate control of my Afib and my blood pressure is mostly reasonably good. So I ignore that one too.
thanks fancypants (love the name btw!). The Lipitor isn’t for hip pain, they put me on it when my AFib was diagnosed.
They will give statins to anyone and everyone if they can. There is little evidence they help many at all. Only specific groups of people have known benefits. Mainly middle aged men who have had a first heart attack. I would do a lot of reading up on that subject if I were you. Cholesterol is a vital component of our bodies. Our brains need it, and we can't convert the sun's rays to Vitamin D without it.
it’s always useful to hear others’ thoughts, but I did think very carefully about statins and I was convinced that a trial on them had an appropriate risk/benefit ratio for me. I’ve had no noticeable ill effects at all. My hip otoh - argh!
I think it's ironic that you trash statins, yet ignore the excellent and correct advice from your GP and pharmacist about "Suddafed". Sounds like a case of listening to advice when it's what you want to hear. Just sayin'.
Sudafed and statins are not comparable. We all have to live the best way we can. Sudafed I take for 2 or perhaps 3 days, and as few as possible in that time. Statins you take for the rest of your life if you start them. Nothing remotely ironic about it.
Good morning, very sorry to hear you are struggling after your hip replacement. For your interest only I have had both hips replaced, one was a replacement and the other a re-surface. The first took 6 weeks before I was able to return to normal, and the other took the full 12 weeks.
Be patient it does take time, and like you I was in considerable pain each time, however the walking is imperative even through the pain barrier
Best of luck
Dave
I use the gel but I am not just post operative. I feel for you - I have had three hip ops, can’t take anti inflammatories. Had GP got a pharmacist? Ours has and more informed than the community ones. I took dihydrocodeine, maybe ask?
I have this to use on my scalp and was told it is entirely safe to use, so I suspect that your doctor is acting entirely correctly. For pain relief, I think there are other options such as codeine but they come with their own risks.
I imagine your doctor is hoping that the tissue injury will heal quite quickly and that the pain will naturally lessen as that happens. This happened to my next-door neighbour with his recent knee replacement, which took longer than expected to recover, perhaps not least because of his large size, but he is now fully recovered and as pleased as punch with his new knee.
Steve
My understanding is that topical creams are safe in small doses. I have never noticed it affecting my INR (I'm on warfarin).
thanks everyone, I haven’t used it yet, but I may have to at some point. I’d feel more confident if it hadn’t possibly been drugs that got me into this situation in the first place, or if you could actually ever have a conversation with a doctor. I’ve seen no one but the A&E doctor for my AFib, and he was obviously more concerned re my heart than my pain. And yesterday I didn’t get to speak to anyone at the GP, just got a ‘triage’ email from the nurse to use the gel and when I replied saying I was worried about it, just got another reply to say it should be fine. Health care is just so difficult these days.
Hi. I can’t comment on the drugs, but would suggest you find a ScarWork therapist. That’s a long time post-op to still be in significant pain. They may be able to help the wound to heal more effectively and reduce some of the pain.
I have had both hips replaced and had a much longer recovery after the second op as that hip had had much more extensive soft tissue damage pre op. Also due to fissuring commencing as the prosthesis was being hammered in I had to have a cerclage cable to stabilise it and was confined to a walker or 2 sticks for 6 weeks . My surgeon prescribed Tramadol which worked well for the pain but gave me digestive problems so I used it as little as possible. Is it possible that the statin might be contributing to the pain? You could try ditching it for a few days and see if that made a difference. I would not worry about using the gel. The stress of being in pain might well be worse for your body than using the gel. I have used Arnica gel for soft tissue pain with success.
I recently checked with my GP about topical ibuprofen/voltarol and he suggested it was not a risk to use with my blood thinner (apixiban). So I have been using it fairly regularly on my knee osteoarthritis. Good luck with the recovery.
I have used diclofenac gel for over 2 years for back pain no problems. I'm on Apixaban, another of the NOAC family if anti coagulation.
I don't have A F but I have severe spinal pain for which I take opiates and use an anti inflammatory gel; feldene. After my heart attack I took a "blood thinner" for a year and used the gel the whole time and still do. I was only told not to use it directly over my heart area like for costochondritis.
Diclofenic (generic Voltarin) has an interesting history. It was originally an oral anti inflammatory, but proved to be too powerful and was taken off the market due to the side effects. It was subsequently reformulated into the gell that is now on the market. It was allowed on the market after it was demonstrated that <1% of the active ingredient entered into the bloodstream.
The informational insert with this carries many warnings, as folks frequently overuse this product. For example, it is NOT to be used on your back, as that implies that too much of the stuff would be gooped on, and for some reason application to the back leads to increased blood levels. They also include a "mini" ruler in the package, to the correct amount of the gel can be measured out, and also instructions on how often and for how long to use the product. I do have a hunch that for a hip issue, overuse might be a problem.
My cardo guy said with proper and controlled use, it would be acceptable to use, WITHIN THE GUIDELINES! I have used it, and have had no obvious problems with my concurrent use of apixiban. It was pretty much a "lifesaver" when I had several broken fingers after an auto crash.
You seem to have the replies you requested re the experience of using diclofenac with a DOAC.
I can only give a link to the interactions drugs.com reports ...
yes, thanks, that’s what I’d seen and had frightened myself with. But the nurse who prescribed it didn’t seem at all bothered.
sometimes it is the lesser of the two evils. Normally I’m not supposed to take aleve however with chronic back pain I am on a pain medication but it is not anti-inflammatory so it was suggested I take naproxen or Tylenol. It does make a difference. Good luck with the hip. My cousin had his done a few months back. Was back to work in a week. Now he hast to get the other one done that’s what hockey playing does to you. I just like a fib. Everything is different with each one of us and I find soft tissue injuries are worse than any other kind. Feel better.
Hi Dawn
I was reading about NSAIDS and our anticoagulants.
You can take tytenol? but not napr..... which I found hopeless for pain.
cheri JOY
my EP has allowed me to take it from the beginning because Tylenol really does nothing. I need a stronger anti-inflammatory to work with the pain med. I don’t take it every day with my pain med but there are times I just hurt so badly from the time I wake up. usually it’s weather related. Yeah once I have my surgery on my back I am hoping I won’t need anything again for a very long time if I ever.
Hi Dawn
Napro... did not do anything but 100mg IFUPROFEN works like a song. But like Napro.. I can't have it.
In 1970s I was at the Gynaecologist for bad period pain. Specialist said try INDOCID which is BRUFEN. Into the blood stream 24 hours before period came NO PAIN. I always had pain and couldn't sleep within first 24 hours only. I was told that my uterus moved forwards and back.
He said it would stop pain for 10% of patients. Indocid is in the same family as ifuprofen. (BRUFEN). It helps others with arthritis.
cheri JOY
right, no ibuprofen allowed for me. I actually took Aleve when it was the prescription in my early 20s for period pain. It was so bad it is still one of the few things that works for me.
Hi
But Naproxen? and Ifuprofen are as bad as each other. Both NSAIDS.
So if he is allowing you Naproxen? them Ifuprofen is as available.
A friend with double rogue electrical responses hurt his back and his specialist - heart said he could have ifuprofen.
100mg that's all I would need.
cheri JOY
I prefer the naproxen as it works and lasts longer with fewer pills. I only take every 12 hours. Also, things may be different now with my pacemaker.
Hi
After my last operation and I take PRAXA 110mg x twice day I was given
OXY-NORM 3 times day
and Paracetamol 4 times daily 500mg x 2.
As I knew OXY-Norm was addictive that was the first that I gave up. Then reduced paracetamol. You can have codeine or paracetamol/codeine.
I was pain free.
Had TVT Johnson & Johnson Ugly Jagged Mesh removed but leaving arms as surgeon could not reach. It would need to be another op.
cheri JOY 74. (NZ)
l have skimmed through the responses re diclofenac gel and guess that my experience may be of interest or add to your confusion!
I have taken D tabs for around ten years for chronic back and hand joint pain. For about the same length of time l have had AF and solved the syncope blackouts with a pacemaker in 2016. Tried managing without D and failed and tried every other pain med /anti-inflammatory but went back to D with Cardio’s blessing and take 50mg twice a day. Result -great QOL and going strong. Small TI A three years ago and on apixaban ever since. Was told to stop the D again but did not and result - Great QOL and still going strong.
Phrases about horses for courses spring to mind… we are all different and no two medics seem to agree anyway so l just carry on aiming for another 20 years and a telegram from the King!
What are D tabs?
DICLOFENAC TABLETS
Edoxaban switch 
Creatine Clearance while on Edoxaban 
Edoxaban digestive issues?
Edoxaban and surgery
Edoxaban or Apixaban
