Tag Archives: Advil

Cocktail of simple over-the-counter drugs as effective as heavy opioids in treating pain

Americans are already taking way more opioids than they should in the first place — new study shows many are not even as effective as you’d think.

Credits: j_lai / Flickr.

Since the early 1990s, the US has gone through a dramatic opioid crisis. What started as a case of national over-prescription turned into a full-blown epidemic, with approximately 80 percent of the global pharmaceutical opioid supply being consumed in the US. For a country with only 5% of the world’s population, that’s extremely concerning.

Of course, the easiest way to avoid becoming hooked on opioids is to avoid taking them in the first place. In surprisingly many cases, even a few days of prescription can lead to an addiction. However, some patients don’t have the luxury of not taking opioids — in the case of people arriving in the emergency room or with broken limbs, opioids are required to ease the excruciating pain. Or so we thought.

A new randomized, double-blind clinical trial found that a combination of ibuprofen (Advil) and acetaminophen (Tylenol) was just as effective at dealing with acute pain as three other common opioid treatments. The authors suggest that in some cases, medics could simply skip the opioid treatment, offering instead the two very common over the counter drugs.

This change could have a significant impact in tackling the opioid crisis, as well as opening new, simpler avenues for pain management. Considering that every day, opioid overdoses kill an estimated 91 Americans, it could make a big difference.

“This change in prescribing habit,” they write, “could potentially help mitigate the ongoing opioid epidemic by reducing the number of people initially exposed to opioids and the subsequent risk of addiction.”

In the study, researchers had 416 patients (ages 21 to 64 years) with moderate to severe acute extremity pain in two urban emergency departments. The patients were randomly assigned to receive:

  • 400 mg ibuprofen and 1,000 mg acetaminophen
  • 5 mg oxycodone and 325 mg acetaminophen
  • 5 mg hydrocodone and 300 mg acetaminophen; or
  • 30 mg codeine and 300 mg acetaminophen

Oxycodone (commonly sold as OxyContin and Percocet) and hydrocodone (Vicodin) are two of the most commonly used opioids.

Two hours after each treatment, researchers assessed the pain the patients were in, finding no significant difference between the four groups. In other words, whether they took opioids or a cocktail of ibuprofen and acetaminophen, the pain still dropped significantly, with minimal differences. The reason why the two work so well together is because they act in different ways, working on the brain and nervous system respectively.

Authors point out that data from the World Health Organization suggest that opioids are much more effective at dealing with pain, but this study casts a big question mark on that data.

Of course, while they pose a much lower risk than opioids, Tylenol and Advil also shouldn’t be abused.

Journal Reference: Andrew K. Chang et al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. doi:10.1001/jama.2017.16190

 

Antidepressants Prozac

Painkillers counteract antidepressants effect, study shows

Antidepressants ProzacResearchers at the The Rockefeller University in New York City, have recently published a study which suggests painkillers such as the simple aspirin or ibuprofen could decrease the effectiveness of certain antidepressant medications.

Their research was conducted on mice, who were administrated with an anti-inflammatory drug (also called an NSAID, non-steroidal anti-inflammatory drug) and a selective serotonin reuptake inhibitor (SSRI, a type of antidepressant). After further tests, results showed that these mice scored lowered  when measuring antidepressant effectiveness than mice given only the SSRI, researchers found.

In the SSRI is the most widely spread antidepressant category, which includes the popular Prozac, which however aren’t always effective. Researchers believe this latest study might offer further insights as to why antidepressants don’t always work on certain people, for example those taking anti-inflamatory drugs.

And there’s this long therapeutic delay — you may need to take them for weeks or months, and even then some people don’t respond to them,” said the study’s lead author, Jennifer Warner-Schmidt. “What our data suggest is anti-inflammatory drugs may be one possible preventable reason for that treatment resistance.”

Scientists still don’t know how much anti-inflammatory drugs a person needs to take to counteract the antidepressants, especially since it would vary from person to person; and while it’s probably safe for a person on SSRIs to pop an Advil for a headache, more advanced use of anti-inflammatory medications like ibuprofen, aspirin and naproxen, pretty commonly seen in someone who suffers from chronic pain or arthritis, could counteract the effectiveness of the SSRI, researchers say.

Regarding the mice antidepressive tests some of you might be wondering how exactly do you screen results; I mean you can’t actually have a chat with a mouse about how he’s feeling and how his view upon life has been affected. What scientists did is they evaluated their performance on mobility tests, such as swimming, to see how their mood varied.

On the antidepressant alone, mice experience a 50 to 60 percent increase in mobility, while the anti-inflammatory drugs counteracted the antidepressants to the point where there was no longer a statistically significant improved result on the mobility tests.

“So you could basically say that there was no effect of the SSRI at all with the ibuprofen,” Warner-Schmidt said.

The data gathered in the mice experiments was correlated with past data from 1,546 people on antidepressants who participated in the 12-week STAR*D study, in which participants where asked to report their anti-inflammatory drug use, though it did not ask them to specify how frequently or how long they used those drugs.

As such, researchers have found that SSRI antidepressants were about 55 percent effective among people who did not take anti-inflammatory drugs, as opposed to only 40 percent effective among those who did.

More researchers is needed, but so far scientists have gathered enough statistical data that indeed point to the conclusion that anti-inflamatory drugs affect antidepressant use. From a reactionary point of view, it seems anti-inflammatory medications could counteract the antidepressants by inhibiting the production of a particular signaling protein, called p11.

In the next similar study, Warner-Schmidt said she hopes to do a placebo-controlled study in humans to see if the same effect observed in the mice also occurs in humans.