Saw Rheumy at HSS - New York - Question for You?

[schmuppy]

Hi Folks,

Saw really good rheumy and she had some good info and advice (as well as taking 8 vials of blood out of me. Talk about thorough...)

She said as I taper that she was not in love with the idea of me hitting extra pain here and there with Advil (ibuprofen), and prefers that I use Tylenol (paracetemol). So I tried it, and - not so effective. Could it just be that I have to stick it out with the T? Have any of you done a pred plus Advil combo? She doesn't want me to wreck my digestive system, nor do I, but it seems to be the better way to get through a day.

[HeronNS]

The reason you don't use nsaids with prednisone is because prednisone is already hard enough on the stomach so adding nsaids to that can cause bleeding, worse case scenario a perforated gut. On a personal level I have used aspirin for headaches (which don't respond to acetaminophen) but never take it at the same time or even within a few hours of my pred and always take it with food, and do not lie down afterwards. I did in pre-pred days have a serious stomach bleed caused, I think, by naproxen, so I've never taken a stronger msaid than aspirin since, although I have used acetaminophen with small dose codeine occasionally. In general I find Tylenol alone ineffective for a really bad headache, but alternated with aspirin it does seem helpful and means I don't take as much aspirin. I only use aspirin because I feel I really understand it, I think any doctor would tell me not to! But when you are incapacitated by a bad headache there doesn't seem much choice. I would likely not use it for any other kind of pain should the situation arise but would rely on something like prescription Tylenol 3.

[PMRpro Ambassador]

Maybe adding a mg or so to your pred dose might be a better option if the pain you have is due to PMR. Pred plus ibuprofen on a regular basis is not a good idea. And for other pain - headache for example, a single dose of ibuprofen taken with food and not at the same time as pred probably won't be the end of the world. I fond oral paracetamol is useless too. Though I do have to admit that i.v. paracetamol is pretty impressive!

[journey2019]

I use cocodamol on top of the pred and it definitely works for me so may be worth a try

[schmuppy]

We can only get cocodomol (Tylenol+Codeine) here in the states with a prescription, but I do actually have some leftover from an old dental surgery. Of course I can't take it on the way to work but if I really need it at night it's def an option - thank you!

[Sollymo]

I was advised by my GP and my Rheumatologist to take regular long acting plain paracetamol (called Panadol Osteo here in Australia ) . If taken regularly -2 tablets three times a day it’s meant to help -and I think it does ! Because if I forget a dose my sore back reminds me !

[Cross-stitcher]

I think it's important to distinguish different types of pain and their causes. PMR pain, either withdrawal symptoms or a flare, probably require an extra mg or two of Pred and won't respond to much else. Pain from OA or a physical injury or normal headaches (or even overdoing the gardening) won't respond to extra Pred. For these, I would always recommend Paracetamol. My GP also allows me a small supply of plain Codeine phosphate 30mg, on prescription, which I sometimes combine with the Paracetamol, but not too often due to Codeine's awful effects on my gut. I would absolutely never take aspirin, ibuprofen or Naproxen (or any other NDAID) while taking Pred.