Prescribed Naproxine 250 twice a day for hip bursitis is that dangerous with Pred

[Motida]

I was prescribed Naproxine 250 twice a day yesterday for bursitis ? on right hip. Pain is so bad dr. gave a steroid injection. Suggested I take up to 4g of Paracetamol if necessary.

Just read of NHS site that Naproxine and Pred are not compatible. Is this true for short time use? If so what can I ask for instead. May be sent for an X-ray if things dont improve within 48 hrs of injection, but cant face leaving home at the moment.

Never experienced such pain in my life, so it is a big shock. Live alone but with helpful neighbours so braving up. If I press the site of the pain I can get along with a walker lent by a neighbour.

Had thought of increasing the Pred. I am on 8.5mg since 22.10.23 but reluctant if it does not zap the pain.

Any thoughts or advice on this point?

Thanks

[DorsetLady PMRGCAuk volunteer]

As you have seen comments - Naproxen increases the risk of gastrointestinal bleeding when given with Prednisolone.

Suggest you speak to pharmacist- they will have full list of your meds, and if you aren’t already on something to protect stomach, might be able to suggest something on a temporary basis. Also check the amount of paracetamol , on another thread today, it was discussed and it was advised that older patients should only take a total of 3G in a 24 hour period rather than 4g….

Hope you son feel better…🌸

[Motida in reply to DorsetLady]

Thank you so much for the advice. Dr prescribed Omeprazole 20 mg which I took with yogurt before the Naproxine and Pred. Did you mean not to take more than 3 grams of Paracetamol because I am 80 not 3 mgs? If so I will cut one dose if pain is not too bad.

If I cut the Naproxine and treated the pain as a flare going up 5 mg of Pred from 8.5mg would that cut the bursitis pain or is it a different kind of pain origin. Sorry to be so ignorant, Many thanks again.

[DorsetLady PMRGCAuk volunteer in reply to Motida]

Yes apologies… will amend. .. so used to Pred and mgs…

[PMRpro Ambassador]

I've been using ibuprofen alongside pred and blood thinners for bursitis - my rheumy just says use a PPI or other stomach protection if I need more than the odd dose.

I think I would have preferred the x-ray FIRST - I have bursitis at present but it has never been that bad. I would be concerned it isn't "just" bursitis. Did it appear suddenly?

Your maximum dose of paracetamol should be 3g in 24 hours - especially if you are frail or have a lower body weight under 150lbs/10 1/2 st.

What concerns me about this gay abandon using paracetamol is that they NEVER check liver function. One lady in her 80s with PMR was told by her GP to use paracetamol like that because he thought her pain was not PMR but OA and the paracetamol would help her reduce the pred - she was only on a low dose anyway. Luckily he also did regular blood tests every few months and one was due soon after starting the paracetamol - which did nothing anyway, He rang in a panic when he got them, her liver enzymes were raised and she was sent for an emergency ultrasound. The operator found nothing wrong - and said she had had loads of similar cases, all entirely due to this sort of use of paracetamol.

Recent studies have found that there is an increased risk of cardiac problems if you take soluble paracetamol long term.

bhf.org.uk/what-we-do/news-....

[Motida in reply to PMRpro]

Thank you both for such extra advice particularly with ibuprofen and Pred use. I rarely take the former and understood it was emergency type of pain relief. Mine was all out of date in fact. I will ask if I can take Ibuprofen and Naxproxine and drop the Panadol.

The Dr said to ring for an X ray request if his steroid injection had no effect after 48 hrs from yesterday at 9 am , but that will be the weekend so nothing doing until Monday.

Still wondering whether to quit the above and just go back to 13 mg of pred or more like a flare. Was your bursitis considered as a PMR flare.?

[Bcol in reply to Motida]

Might be worth trying Co-Codamol which is fine with Pred, 30/500 doc prescription. It doesn't agree with everyone and can give you constipation but has always worked well with my OA.

[PMRpro Ambassador in reply to Motida]

Mine is just an ongoing saga and higher pred doesn't really help. I get more targeted treatments which work well for a year or so. The pain clinic doctor pointed out it tends to reappear in autumn - didn't last year because I'd only just finished a course of extracorporeal shock wave therapy! Back this year ...

You can't take ibuprofen and Naproxen together - they are both NSAIDs, so no. You can take one of them plus cocodamol though which is stronger than paracetamol alone.