Painkillers

What painkillers can you take when you've got asthma?

Each time I ask over the counter I get different answers ranging from none to ohh err umm, not overly helpful when I'm sitting here with a splitting headache... doh.

Cheers

Suz

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Hi purple-ferrets,

I know how you feel - I have had pharmacists in the pharmacy where they know me (and what medication I'm on, and thus how bad my asthma is) refuse to sell me any painkillers at all, which is infuriating. I now get all my painkillers on prescription, so they're doctor-approved, which also saves me money, as I have a prepayment certificate.

Basically:- (although if in doubt do please check with your doctor)

Paracetamol at the standard dose should be alright for just about anyone (unless you have an actual paracetamol allergy - very rare). You do have to be careful not to exceed the recommended dose, so be especially careful if you are also taking cold remedies etc which contain paracetamol.

Non-Steroidal Anti Inflammatory Drugs (NSAIDs) such as ibuprofen (Brufen), diclofenac (Volterol) and mefanamic acid (Ponstan) provoke asthma symptoms in approximately 10% of asthmatics. The reaction can range from incredibly mild to life-threatening. If you don't know how you react to these drugs they are probably best avoided unless you discuss it with your GP first.

Codeine and tramadol, which are weak opiates (morphine-like drugs, but not as strong as morphine) are usually safe in asthma at low doses. They can provoke histamine release, which can be a trigger for some people (they make me itch, for this reason, but not wheeze). Also, these drugs at higher doses can have the effect of depressing the central mechanism in your brain that triggers breathing - in other words, they can make you breath more shallowly and slowly. This usually won't in itself trigger bronchospasm or an asthma attack, but obviously if your oxygen levels and so on are a bit borderline at the best of times, then taking high doses of these can make that worse.

The only way you can get codeine over the counter is in the form of weak cocodamol - a standard dose of two tablets contains 1g of paracetamol and 16mg of codeine. This is a small dose and most people should be absolutely fine with it, although again check with your doctor if you have severe asthma or are prone to low sats. People with sleep apnoea should also be cautious about taking it at night.

Stronger versions of codeine are available on prescription from your doctor, as well as even stronger opiates like morphine and fentanyl (I know you are asking with reference to headaches and things, so I shouldn't imagine morphine is appropriate! - I include it for completeness and in case it's helpful to someone else). How you react to these painkillers in terms of asthma is very variable - I know some severe asthmatics who can't touch codeine without their breathing going off, and others who seem to tolerate fairly large doses without too much effect on the breathing. If you have severe asthma, most doctors would probably want to start these under medical supervision, for example whilst in hospital, so that you can be monitored closely.

There are also alternative medications for specific types of pain, which aren't painkillers as such but have some pain relieving action - for example, sumatriptan for migraine, antidepressants and antiepileptics for nerve pain, and steroids for bone pain. Again, these are usually prescription only and your doctor would assess their suitability.

Lastly, there is an atypical prescription only painkiller called nefopam which I have found quite useful in the past. It doesn't fall into any of the classes above but does have moderate to strong painkilling action. It seems to be most often used (at least where I used to work) for recovering drug addicts who don't wish to expose themselves to opiates (which are similar to heroin). It is useful, though, in any patients who can't take conventional painkillers for whatever reason. The side effects are sympathomimetic (salbutamol-like) and anticholinergic (ipratropium-like) in effect so if anything it should perhaps marginally improve breathing rather than the other way round; the only down side to this is that it can interact with some asthma drugs to worsen the side effects that we are all familiar with such as fast heart rate and tremor.

Finally, it's worth reminding folks to consider non-pill-based methods of relieving pain. Personally, I wouldn't be without my TENS machine, and I also find hot wheat bags very useful for stomach cramps or muscular aches and pains. Creams like Deep Heat (available over the counter) and capsaicin cream (prescription only) can also be useful for muscle and nerve pain, as can NSAID creams (although be careful if you are NSAID sensitive - although there is very little absorption into the body, some does occur). I believe the menthol sticks that you rub over your head can also help with headache, although I've not tried them myself. Menthol and eucalyptus can certainly help with headache associated with blocked sinuses. And then there is the option of persuading your friend or Significant Other to give you a nice shoulder, neck and scalp massage to help with tension headache - not so useful if you wake at 5am with a headache like I have this morning!

Anyway, hope this helps a bit, and you find something that suits you

Take care

Em H

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paraceptomol is ok, but ive been told to stay away from ibuprofen and aspirin by multiple doctors.

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Yes, it's true that a lot of doctors will be cautious and recommend that all asthmatics stay well away from NSAIDs like ibuprofen, especially if you have severe asthma. There is even a misconception amongst some junior doctors that all asthmatics will react to NSAIDs. In fact, only approx 10% are actually NSAID sensitive. You are more likely to be NSAID and aspirin sensitive if you have nasal polyps as well as asthma (this is called Samter's triad and often responds well to leukotriene antagonists such as montelukast (Singulair) and zafirlukast (Accolate)).

I would still suggest that you discuss it with your doctor before taking NSAIDs (including NSAID gels) if you don't know if you are sensitive or not - especially if you have severe asthma. I have never been allowed to take NSAIDs by any of my consultants, despite having no history of NSAID sensitivity (and no nasal polyps) as it's felt that it is too much of a risk given how brittle my asthma is. Some doctors are more cautious than others, though, and if you have problems with pain and would find NSAIDs useful it is often possible to test for sensitivity in a safe environment.

Incidentally, in my last post I mentioned Deep Heat cream - I should point out that it does contain methyl salicylate, a compound that is related to aspirin, and there is a small amount of absorption as there is with NSAID gels. Therefore, if you are sensitive to aspirin and NSAIDs, it is theorectically possible that you will get bronchospasm from using Deep Heat - although I have never heard of it happening. It does recommend on the packet that you should consult your doctor before use if you are asthmatic or NSAID sensitive.

Anyway, hope this has not confused the issue even more!

Take care all

Em H

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Thank you for the replies, there are some potential painkiller names to try now.

When I was badly lergied the doctor prescribed strong painkillers and although they worked they had an all be it small affect on the asthma and in the instructions did say you shouldn''t take with Asthma.

I have always taken Paramol for bad headaches and still do, but now they expressly say not for Asthmatics, and I tend to hae adverse reactions to things with codine in. Not helped by normal paracetamol doesn't seem to work on the pain at all when I have tried in the past.

Cheers

Suzanne

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Hi everyone! My boyfriend is asthmatic and doesn't take NSAIDs (he doesn't know how he'll react to them) but he want's to get his tongue pierced, and they recommend either aspirin or ibuprofen to reduce the swelling as well as relieving the pain. Does anyone know anything that he can safely take to reduce the swelling (the pain doesn't matter - he's fine with paracetamol)? Or any asthma related reason for tongue piercing being a really bad plan? Thanks guys, Lizziebee x

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Lizziebee, my son does not take NSAIDs cos I have a proven anyphylaxis to them and as he is asthmatic we have been told to avoid them like the plague anyway he had his tongue done and just used ice lollies to cool and reduce the swelling.

Bex

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Thanks Bex. He got his tongue done yesterday and it was fine!

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bump for laurenjane - see emily's extensive and useful guide below!

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thanx for that owl!

And thank to EmilyH for the brill explanation.