Painkillers while on Hydroxycarbamide for treatment of Polycythaemia Vera

[Edinburgh1953]

Has anyone with PV and taking Hydroxycarbamide been advised not to take Ibroprfen or any similar painkillers ending in fen?

[Jane-r]

Hi yes I’m on Hydroxy wit ET and told not to take ibuprofen or use ointment for joint that contain it.

[Edinburgh1953 in reply to Jane-r]

Thank for replying Jane-r

[MPort]

I have been told not to use Ibuprofen too, a long time ago. I thought gel was ok but could be wrong. I have PV since 05 and on Interferon. Paracetamol seems to work fine.

[Edinburgh1953 in reply to MPort]

Thank you for replying MPort

[Daisey123]

Hi yes I am on hydrox and got ET. They told me not to take ibuprofen but I am also on Apixaban and can't take it with that as well .

[Edinburgh1953 in reply to Daisey123]

Thank you for replying Daisy123

[Cakeface]

Hi, I have PV and was also told this. I'm sure my haemotologist said it was something to do with taking aspirin?

[Edinburgh1953 in reply to Cakeface]

Thank you for replying Cakeface

[Mazcd Partner MPNVoice]

hi Edinburgh1953, you cannot take Ibuprofen, Diclofenac or other NSAIDS if you are taking aspirin. The pharmacist in your local pharmacy/chemists will be able to advise you on what you can and can't take with your Hydroxycarbamide and indeed any other medications you are taking, and they will also be able to advise you on suitable pain relief. Best wishes, Maz

[Edinburgh1953 in reply to Mazcd]

Thank you for replying Mazcd

[finlay2106 in reply to Mazcd]

Hi Maz,

Thanks for this.

Being the pedantic person I am I checked the information leaflet with my Hydroxycarbamide and there's no warning I could see about ibuprofen but there is on the 75mg Aspirin leaflet. What is rather concerning is that when I was discharged after recent inguinal hernia surgery, I was given a bundle of painkillers (which luckily I didn't need) including a box of 400mg Ibuprofen even though they knew I was taking low dosage Aspirin. Even more concerning and confusing is that the info leaflet with the 400mg Ibuprofen indicates not to take it if taking daily Aspirin greater than 75mg, implying that it's ok if it is only 75mg Aspirin which contradicts the info leaflet with the Aspirin!

I have never been warned about this type of issue by my haematology team and sadly it reinforces my view that we have to double check everything and can't rely on others being diligent. And thanks Edinburgh1953 for initially raising this.

Paul

[CLONDARA in reply to finlay2106]

Dear Paul,Thank you for sharing all this information. I have learnt a lot.

Valerie

[Borage in reply to Mazcd]

Can I take a standard aspirin, in addition to the daily 75mg, for a headache? The paramedics give me two aspirin when I get angina badly.

I try not to take any painkillers. Often a hot or cold pack, a drink of water, a cup of tea or herbal tea, a bit of lavender oil, or a lie down works well enough. It does seem that the fewer pain killers you take the fewer you need to take.

Pilates worked wonders for chronic back pain.

[hunter5582 in reply to Borage]

"Can I" is a different answer than "Should I." The issue is with the increased risk of hemorrhage with a higher dose of aspirin. It is a matter of risk-benefit analysis. When you have angina, the need to treat the angina outweighs the increased risk of hemorrhage.

Note that the risk of hemorrhage is relative to your own history of hemorrhage. You may well tolerate the occasional higher dose of aspirin just fine. Also note that the higher your platelet levels, the more likely you are to hemorrhage.

Generally when you are on an aspirin regimen, it is recommended that you use acetaminophen (paracetamol) for pain control. Acetaminophen does not increase the risk of hemorrhage.

As always be sure to check with your care team on any question about your meds.

[Borage in reply to hunter5582]

Every time I am tempted to resort to a paracetamol tablet I consider how long I want my liver to last.

[hunter5582 in reply to Borage]

The hepatotoxicity issue is with long-term use of acetaminophen. Note that aspirin is also potentially hepatotoxic. It all goes back to the risk -benefit analysis.

[hunter5582]

It has to do with the aspirin not the HU. Ibuprofen potentiates aspirin (or other blood thinners).

Avoid/Use Alternative

ibuprofen + aspirin

avoid aspirin >325 mg/day; otherwise, monitor bleeding s/sx, renal fxn; give ibuprofen dose >400 mg 8h before or at least 2-4h after low-dose aspirin ER: combo may incr. risk of GI ulceration, perforation, bleeding (incl. life-threatening), renal impairment, other adverse effects; ibuprofen may inhibit cardioprotective effect of low-dose aspirin (additive effects; possible competition for platelet binding sites)

online.epocrates.com/intera...

Not a good idea to take NSAIDs simultaneously. It is OK to take acetaminophen (paracetamol) for short periods of time. Caution with long-term use though.

Monitor/Modify Tx

acetaminophen + aspirin

monitor renal fxn, especially w/ long-term concomitant tx: combo may incr. risk of nephrotoxicity (additive effects)

[Janis12]

I take a blood thinner Clopidogrel and was advised not to take any anti inflammatories which is a pity because I suffer from osteoarthritis. So I thought 'go natural' and try Turmeric, but that's out of bounds as it also thins your blood. Thinking about CBD oil next unless that turns out to be a no go area as well, we will see.

[Murdoch01]

I feel the same, in pain daily but can only take paracetamol which really doesn’t help me. I am on apizaban too