questions about otc medicine's

[alkemyst]

The antiplatelet effects (which is what I'm assuming yo'ure referring to when you say "thin the blood") with ibuprofen isnt nearly as noticeable as it is with aspirin, thats why people with heart disease take baby aspirin and not baby ibuprofen. The main reason you dont want to take aspirin and ibuprofen together is because of the risk of stomach ulcers, which has nothing to do w/ the "blood thinning." Unless I'm mistaking what you're saying and referring to something else why you say "thin the blood"

And I searched through the literature on pubmed and that review covered most of the literature published up until then so I'll trust its integrity.

All i'm saying is, if you have a stress fracture, rest and short term NSAIDs is perfectly fine and will not have any long term effects on healing.

nice google.

 

[Mo0o]

nice google.

??

 

[alkemyst]

I did a quick google and that looks like a rip on "ibuprofen blood thinner"

Regardless most research will list aspirin with a combination of NSAIDS as bad mojo with both clotting and ulcer conditions being side-effects.

 

[Mo0o]

I did a quick google and that looks like a rip on "ibuprofen blood thinner"

Regardless most research will list aspirin with a combination of NSAIDS as bad mojo with both clotting and ulcer conditions being side-effects.

Sure, there's some compounded effect but most of the problem is with stomach ulcers. If you dont have an active bleed or at extreme risk for hemorrhage, taking ibuprofen for short term pain control while being on a baby aspirin will not have any appreciable risk. I didnt google any of this stuff because I'm a 4th year medical student. Seems kind of silly to google something up in order to go back and tell someone else, might as well just tell them to google it if that's the case.

 

[eits]

The antiplatelet effects (which is what I'm assuming yo'ure referring to when you say "thin the blood") with ibuprofen isnt nearly as noticeable as it is with aspirin, thats why people with heart disease take baby aspirin and not baby ibuprofen. The main reason you dont want to take aspirin and ibuprofen together is because of the risk of stomach ulcers, which has nothing to do w/ the "blood thinning." Unless I'm mistaking what you're saying and referring to something else why you say "thin the blood"

And I searched through the literature on pubmed and that review covered most of the literature published up until then so I'll trust its integrity.

All i'm saying is, if you have a stress fracture, rest and short term NSAIDs is perfectly fine and will not have any long term effects on healing.

actually, it has a lot to do with the blood thinning, man. yeah, it's not a good idea to take something that will eventually cause ulcers if you're taking aspirin, but taking ibuprofen intensifies the blood thinning effects of aspirin (because it, too, is a blood thinner... just not nearly as potent).

either way, i'm not disagreeing with what you said at the end of that post. the only reason i said anything about ibuprofen and its ability to decrease healing of tissues is because i didn't read the thing about the ankle. if you look a couple posts down from where i posted that, you'll see that i only skimmed the op and the thread and wasn't aware he broke his ankle until later.

 

[eits]

Sure, there's some compounded effect but most of the problem is with stomach ulcers. If you dont have an active bleed or at extreme risk for hemorrhage, taking ibuprofen for short term pain control while being on a baby aspirin will not have any appreciable risk. I didnt google any of this stuff because I'm a 4th year medical student. Seems kind of silly to google something up in order to go back and tell someone else, might as well just tell them to google it if that's the case.

i thought you were a 3rd year

 

[Mo0o]

i thought you were a 3rd year

I dont stay a 3rd year forever =p, I'm on year 4 now.

When I was talking about nothing to do w/ blood thinning, i was talking about the formation of stomach ulcers, which has more to do w/ NSAID induced vasoconstriction and inhibiting the alkaline tide that usually protects the stomach from its own acidic secretions. NSAIDs (ibuprofen, naproxen etc) all have some antiplatelet effect (which, in layman's terms, is one method of blood thinning) but its quite mild compared to aspirin. Really though, since we're both medical people, maybe we should stop using the term 'blood thinner' since it can mean all kinds of different anticoagulative processes

 

[eits]

I dont stay a 3rd year forever =p, I'm on year 4 now.

When I was talking about nothing to do w/ blood thinning, i was talking about the formation of stomach ulcers, which has more to do w/ NSAID induced vasoconstriction and inhibiting the alkaline tide that usually protects the stomach from its own acidic secretions. NSAIDs (ibuprofen, naproxen etc) all have some antiplatelet effect (which, in layman's terms, is one method of blood thinning) but its quite mild compared to aspirin. Really though, since we're both medical people, maybe we should stop using the term 'blood thinner' since it can mean all kinds of different anticoagulative processes

lol, i know, ass. i thought you were a 2nd year last year. anyways, whatever. you excited? you know where you're headed yet?

 

[Mo0o]

lol, i know, ass. i thought you were a 2nd year last year. anyways, whatever. you excited? you know where you're headed yet?

I just started 4th year about 2 months ago so i guess you're not that far off. 4th year kicks ass, way easier hours and I know way more medicine than this time last year. I end being treated closer to an intern than a med student, which is always nice. I'm applying internal medicine, just going through the process now. Not sure where I'll end up, but hopefully somewhere on the westcoast, maybe Stanford or UCSF.

 

[eits]

I just started 4th year about 2 months ago so i guess you're not that far off. 4th year kicks ass, way easier hours and I know way more medicine than this time last year. I'm applying internal medicine, just going through the process now. Not sure where I'll end up, but hopefully somewhere on the westcoast, maybe Stanford or UCSF.

stanford's a gorgeous campus. good luck, man.

if you ever end up at washington university, let me know.

 

[Mo0o]

stanford's a gorgeous campus. good luck, man.

if you ever end up at washington university, let me know.

I applied to a lot of chicago schools but didnt apply to stL. I'm couples matching and my finacee wasn't a fan

 

[eits]

I applied to a lot of chicago schools but didnt apply to stL. I'm couples matching and my finacee wasn't a fan

yeah, i feel you... i want to move back to the east coast. my girl is tethered here because she currently shares custody of her son with her ex. we're trying to get custody, though... the guy's a total jackass and i think he's manipulating his son to not say "i love you" back to us.

 

[brainhulk]

but taking ibuprofen intensifies the blood thinning effects of aspirin (because it, too, is a blood thinner... just not nearly as potent).

I've read some studies a while back stating NSAID's actually inhibit the anti-platelet effect of aspirin. No good for peeps taking asa for clot prophylaxis

I can't find the primary articles anymore, but here are some links:
http://www.clotcare.com/ibuprofenblocksaspirinprotection.aspx
http://findarticles.com/p/articles/mi_m0CYD/is_20_38/ai_110729108/

 

[eits]

I've read some studies a while back stating NSAID's actually inhibit the anti-platelet effect of aspirin. No good for peeps taking asa for clot prophylaxis

I can't find the primary articles anymore, but here are some links:
http://www.clotcare.com/ibuprofenblocksaspirinprotection.aspx
http://findarticles.com/p/articles/mi_m0CYD/is_20_38/ai_110729108/

http://www.medicinenet.com/ibuprofen/article.htm

 

[brainhulk]

http://www.medicinenet.com/ibuprofen/article.htm

nowhere in that link discusses the interaction of NSAID's and aspirin

 

[eits]

nowhere in that link discusses the interaction of NSAID's and aspirin

"When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding."

 

[brainhulk]

"When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding."

ok...lol. no aspirin to be found. just a generic statement regarding blood thinners or anticoagulants. plus this is just a generic drug info link of ibuprofen.

the links i posted specifically discuss the mechanism of action of ibuprofen blocking aspirin from exerting it's antiplatelet effects.

did you read my links?

 

[abj13]

"When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding."

Your pharmacology and physiology is way off base. Ibuprofen (most NSAIDS) are reversible inhibitors of COX enzymes. Aspirin is a irreversible inhibitor of COX enzymes. This is probably one of the reasons why Aspirin is much more potent platelet inhibitor, since the platelet's COX enzyme is permanently out of action for the lifespan of the platelet (10 days). By taking Ibuprofen at the same time of Aspirin, its more likely that the reversible inhibitor (Ibuprofen) will sit on the COX enzyme, blocking aspirin from binding. Eventually the ibuprofen will unbind and be cleared from the body, but that is time were aspirin can be cleared from the blood, diminishing its actual activity. Nonetheless, taking them together is a double wammy for the gastric lining.

Your link goes to the action of NSAIDS blocking COX activity and therefore prostaglandin production at the afferent arteriole at the glomerulus of the kidney, and thus GFR (thus clearance of medications that are dependent on GFR). Warfarin has a completely different mechanism of action (inhibiting Vit K activity in the liver). Nonetheless many older Americans end up on BOTH aspirin and Warfarin at the same time, Aspirin for the platelet effects and cardioprotective benefit and warfarin for the anticoagulation effects (likely since they have A. Fib, or recent hx of a clot).

 

[eits]

Your pharmacology and physiology is way off base. Ibuprofen (most NSAIDS) are reversible inhibitors of COX enzymes. Aspirin is a irreversible inhibitor of COX enzymes. This is probably one of the reasons why Aspirin is much more potent platelet inhibitor, since the platelet's COX enzyme is permanently out of action for the lifespan of the platelet (10 days). By taking Ibuprofen at the same time of Aspirin, its more likely that the reversible inhibitor (Ibuprofen) will sit on the COX enzyme, blocking aspirin from binding. Eventually the ibuprofen will unbind and be cleared from the body, but that is time were aspirin can be cleared from the blood, diminishing its actual activity. Nonetheless, taking them together is a double wammy for the gastric lining.

Your link goes to the action of NSAIDS blocking COX activity and therefore prostaglandin production at the afferent arteriole at the glomerulus of the kidney, and thus GFR (thus clearance of medications that are dependent on GFR). Warfarin has a completely different mechanism of action (inhibiting Vit K activity in the liver). Nonetheless many older Americans end up on BOTH aspirin and Warfarin at the same time, Aspirin for the platelet effects and cardioprotective benefit and warfarin for the anticoagulation effects (likely since they have A. Fib, or recent hx of a clot).

you're right. thanks for better explaining the process.

 

[HybridSquirrel]

follow up questions: can i drink some brews while im on sudafed? i havent taken any since 2pm (its 1030pm now)

 

[GasX]

In a hospital, most but not all drugs are dosed on a per kilogram basis. If you are a big guy, your dose requirements are going to larger than a small kid.

Ibuprofen is typically dosed in ranges (400-600mg every 4-6 hours), it depends on what you are taking it for but you should never go above 3.2 grams per day or you'll be frying your kidneys.

 

[GasX]

also, beer and sudafed should not be an issue.

PSA: Don't mix xanax with anything especially percocets. Xanax is a contributing factor in a huge proportion of prescription drug ODs

 

[DrPizza]

Uhhh, refer to the PDR? Surprised there's a former "I used to work as a pharmacist. I was a pharmacist apprentice" in the thread who failed to mention that. 400mg Ibuprofen is the recommended dosage for mild pain & menstrual cramps. (I'm sure the latter is a bigger issue for some of you posting in the thread.) Off the top of my head, 800mg is the maximum that a physician will go. From yelling to my wife in the next room (a nurse who works in a hospital), "Do they ever give higher than 800 mg?" "No, and usually it's only 600mg." The side of an iboprofen bottle lists the dosage for adults as ONE 200mg tablet every 4 to 6 hours.

If you use it for a few days for some sort of acute pain, no big deal. But long term use (weeks) leads to stomach ulcers, and damage to either the liver or kidneys (one or the other, I can't remember which.)

One strategy for pain control would be to alternate ibuprofen & acetaminophen every couple hours.

 

[alkemyst]

not everyone has a PDR though.

In drug threads many will say they used it, but it's truly doubtful.

 

[brainhulk]

Uhhh, refer to the PDR? Surprised there's a former "I used to work as a pharmacist. I was a pharmacist apprentice" in the thread who failed to mention that. 400mg Ibuprofen is the recommended dosage for mild pain & menstrual cramps. (I'm sure the latter is a bigger issue for some of you posting in the thread.) Off the top of my head, 800mg is the maximum that a physician will go. From yelling to my wife in the next room (a nurse who works in a hospital), "Do they ever give higher than 800 mg?" "No, and usually it's only 600mg." The side of an iboprofen bottle lists the dosage for adults as ONE 200mg tablet every 4 to 6 hours.

If you use it for a few days for some sort of acute pain, no big deal. But long term use (weeks) leads to stomach ulcers, and damage to either the liver or kidneys (one or the other, I can't remember which.)

One strategy for pain control would be to alternate ibuprofen & acetaminophen every couple hours.

PDR (package inserts bound together in a book) are a solid source of FDA approved information.

Unfortunately it is not something utilized in the pharmacy too often. Simplistically it's what the drug companies have been given approval by the fda to write post initial drug studies.

you are not going to see data on studies done post approval. Or what it's being used for off-label

I utilize drug databases (that the hospital pays big bucks for that is constantly being updated) and updated periodicals for the latest in information.

with regards to ibuprofen lets put this to rest. Lower doses 200mg-400mg is used for minor pain. Higher doses, 600mg-800mg doses are needed to reduce inflammation. This is not set in stone and will be different for every individual. But that is the spectrum of action of ibuprofen in general.