Aspirin and Tylenol with prednisone?

[1Purplecrow]

Any problem with using enteric coated aspirin and/or Tylenol for pain while on 5mg. prednisone?

I have hydrocodone but prefer non- narcotic pain relief if possible.

[PMRpro Ambassador]

You should never mix aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, celebrex) with pred as both they and pred can irritate the stomach and some experts think it is as much due to the presence of the drug in the tissues as much as it being in the stomach and irritating the stomach lining. Aspirin and pred also change how your blood clots (pred can cause bruising) and using both may lead to that being even worse.

If by Tylenol you mean the substance paracetamol that is OK but you need to stick to the recommended doses as it is very easy to overdose on it and don't mix it with alcohol (that can cause liver damage). The odd single dose of aspirin or ibuprofen for a headache or something is probably OK - though one lady with PMR was told by her GP to take ibuprofen for the pain and ended up after only 3 days as an emergency admission to the ED with a gastric bleed!

Why do you need it? If the PMR pain is returning you don't need painkillers, you need a slightly higher dose of pred - it is the painkiller in PMR.

[hwigston in reply to PMRpro]

Hi PMRPro. I was very interested in your comments re Aspirin and Pred. My Rheumy told me last week that it was essential that I take Aspirin in order to safeguard the sight of my remaining eye. I stopped it some months ago after reading similar comments as yours so I am now confused and unsure whose advice to take.

[PMRpro Ambassador in reply to hwigston]

Ah - that's different. Using low dose aspirin (75mg) is to make the blood cells "slipperier" and helps prevent heart attacks and strokes or other things caused by clots forming in the blood vessels. One of the recommendations is that all GCA patients should be told to take a single low dose aspirin tablet a day for that - like heart and stroke patients. It seems to help recurrence.

Taking aspirin as a pain killer means a much larger dose - each tablet has 300mg and you can take up up to 3 at a time, 13 tablets (or 4g) in 24 hours. In the larger doses the risk is far higher - even the low dose can be a problem for very sensitive patients and isn't suggested for patients with asthma.

If your doctor tells you to take low dose aspirin while on pred that means the benefits of taking it outweigh the risks. In the case of using it as a painkiller there are other options so using an NSAID (as I explained above) is not necessary. Even though some companies have developed "new" versions of drugs that are said to be less of a problem for the stomach the jury is still out - so paracetamol, codeine and stuff are safer for stomachs, but have their own downsides. Always check with a pharmacist (not the counter staff, the pharmacist!) before taking ANYTHING - even herbal remedies, because even foodstuffs can interact with medications.

[bowler in reply to PMRpro]

Hi PMRpro

I was interested in what you said about low dose aspirin. I have never been told to take it [ I have GCA/PMR ], and wondering if I should ? I do have irritable bowel and some diverticula, so perhaps I will ask my Rheumy when I next see him. Do you know if a low dose of 75mgs has any pain killing effect ? if so, perhaps it would help with tapering on the Pred.

[PMRpro Ambassador in reply to bowler]

At that low dose it doesn't have any pain-killing effect in adults - they simply weigh too much! The general experience with any NSAIDs in PMR is that they really don't do much for the pain despite their anti-inflammatory action and some of the guidelines suggesting they can be used for "mild PMR". What I had for the first 5 years was what I personally might describe as "mild" - certainly in comparison with the last 5 years! Ibuprofen and co never did more than round off the edges of the pain but even 10mgs of pred left me pain-free. At least until the rheumy took me off pred altogether after 6 weeks. The pain was back, worse than before, and I have only recently got below 9mg again. Don't forget - NSAIDs have their own side-effects, some of them can be really serious.