Ibuprofen

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pellicle

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well a couple of weeks back I hurt my back and spent a lot of time playing caterpillar on the floor. Its getting better but still painful. This of course means that some of my projects (shed) are on hold.

So my physiotherapist (among others) suggested I try some iburpofen to reduce the swelling and make it less painful (and perhaps help healing). Knowing that its often suggested against I sort of shied away from it, but decided today (after some readings) that as I'm measuring INR tomorrow (its Friday night as I write this) I can examine my INR closely and of course keep an eye out for "tarry stools" (suddenly a Don McLean song some to mind) and see if I can at least confirm the INR changes.

As this is of course a bit short term I'll just follow up as I make tests, which I'll do about every 3 days.

Last INR was 2.9, previous 2.2 (dose has remainded stable at 7mg)

See ya
 
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Unicusp

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Hello. I'm still new to all of this, but I thought that once you are on Coumadin, you cannot use any NSAIDS due to increased likelihood of stomach ulcers and bleeding. Waiting for the "tarry stools" is too late. Damage has been done. Heard that you can only use acetaminophen. Sucks for me too because I find that Naproxen works the best.
 

tom in MO

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well a couple of weeks back I hurt my back and spent a lot of time playing caterpillar on the floor. Its getting better but still painful. This of course means that some of my projects (shed) are on hold.

So my physiotherapist (among others) suggested I try some iburpofen to reduce the swelling and make it less painful (and perhaps help healing). Knowing that its often suggested against I sort of shied away from it, but decided today that (after some readings) that as I'm measuring INR tomorrow (its Friday night as I write this) I can examine my INR closely and of course keep an eye out for "tarry stools" (suddenly a Don McLean song some to mind) and see if I can at least confirm the INR changes.

As this is of course a bit short term I'll just follow up as I make tests, which I'll do about every 3 days.

Last INR was 2.9, previous 2.2 (dose has remainded stable at 7mg)

See ya
Unicusp is correct, it's the stomach ulcers that I was told could happen with ibuprofen by my cardiologist. I was told I could use ibuprofen at no more than the maximum daily dose for no more than 2 months. I've pushed that envelope to 3 months, but was taking a 75% dose.
 

pellicle

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Hi

I was told I could use ibuprofen at no more than the maximum daily dose for no more than 2 months.
that's also on the box.

but you seem to assume that me using it for my back is somehow saying "I'm going to take this forever and in a way that is not directed"

I'm hoping to get away from needing it in a few more days.

The point of my post here is that people seem to take a point (as you have) and extrapolate it both ways, meaning never use it because uses in some circumstances are potentially harmful.

But (genuinely) thanks for your concern ...
 
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pellicle

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Morning

sorry this is going to be lengthy and detailed.

but I thought that once you are on Coumadin, you cannot use any NSAIDS due to increased likelihood of stomach ulcers and bleeding.
I've never seen a directive that says you can't. I have seen warnings of the possibility that you can be harmed by it.

For instance this is the guidance of Harvard:
In general, you should avoid ibuprofen—which is sold as Advil, Motrin, and generics—while taking warfarin, because taking them together may further increase your risk of bleeding

I've italicised key words. Its important to remember that while in common speech folks you meet in daily life are loose with their words, but this isn't the case with science papers, legal writing nor medical guidance. Its IMPORTANT to note that such guidance is written on their page about arthritis pain relief (suggesting chronic use not occasional).

Should is not the same as must, further increase is not the same as will cause. I believe that if there is a genuine need for a medication then you should consider (carefully) using it. But regular taking is very different to occasional.

I recommend you read this page and note the wordings and discussions about even the warnings about the possibility of liver damage from paracetamol. Note also it does not say "do not take them" it says "use caution" and "talk to your doctor"


It is a common incorrect notion that having a high INR will cause a bleed; this is a misunderstanding of a simplification because people fuzz out when you use sentences more complex than "This is Sam. Sam is a boy." ; it gets worse when uncommon words (contraindicated) are used. Having a high INR does not cause a bleed, it simply exacerbates one. Its possible many people have small bleeds often but never notice them. Warfarin use will make those minor bleeds (like minor cuts) more prominent.

I recommend you read this post by SkiGirl (who btw is an academic in the area of microbiology and unlike me is smarter and got the shits with the petty arguments and loose withthe facts bull$h1t flung around here particularly in regard to prosthesis selection and left some years back. We keep in touch yearly)


Note her words:
... I had a blood test for something totally unrelated to warfarin and just because they had a needle in me they decided to test my INR, which I said would be 3.0 +/- 0.1. Imagine my shock when it came back and was 9.0!

I immediately stopped juggling the sharp knives and took my Vit K
no panic, no screaming hysteria, but calm and a touch of humour. Why? Because she's confident ... why? Because she explores, observes, learns and then knows. That situation led to her learning another thing (about cranberry juice) and knowing to avoid it.

Myself and a few others here are prone to say Knoweledge is Power, and I often add and ignorance breeds fear.

Anyway, the primary issue surrounds gut ulcers which if you are prone to them don't take ibuprofen. The problem is not clearly studied but here's my take (and the take of my old school mate whos been a pharmacist for decades now whom I consulted with before starting this adventure)
  • many people take pills on an empty stomach without even water: this is bad for many drugs because they are then in direct contact with the lining
  • many people do not take drugs as directed
  • if I take my small dose as directed and combine that with a glass of milk I add a fatty layer on my stomach and a liquid to assist dissolving that (reducing the concentration of the compound in direct contact with my stomach)
  • if I only take for a short time (as directed) I shouldn't have any problems
  • if I monitor my INR I can check for any issues and correct for that
So this morning my stool was a nice mid to light chocolate (err not really yummy looking though) and my INR was 3.2

I took 200mg of ibuprofen today and I'm haivng 200mg every 6 hours (making no more than 4 per day and within the guidelines on the box

Lets look on the pack for guidance (crazy stuff right?):

nurofen.jpg


As reported above my INR was Last INR was 2.9, previous 2.2 (dose has remainded stable at 7mg) which shows a slow progression up 2.2 -> 2.9 -> 3.2 on a consistent dose which is nothing particularly unusual for me. I had thought to correct it down last time (because I saw a trend) but I was curious to see if uncorrected (usually a change of 0.5mg per day) it would rise (which it has).

Do I blame the Iburpofen? Not sure but its irrelevant because I'll simply take action to correct it. (which will be to take a half dose tonight instead, and to resume on 6.5mg until the next test.

I'll update mid week with a subsequent INR test.

However taking the ibuprofen has made my back much less painful and I'm clear that its not better (so no shed building yet) but at least I'm not in as much pain.

HTH
 
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Unicusp

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Well that's good to know. As with most things, "use with caution". Suggestion; try Naproxen. I find that it works much better (and longer) than Ibuprofen.
 

pellicle

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Hi
Well that's good to know. As with most things, "use with caution". Suggestion; try Naproxen. I find that it works much better (and longer) than Ibuprofen.
well given this appraisal I think I'll stick with ibuprofen as it seems to be having a profound effect.


Take this medication by mouth as directed by your doctor, usually 2 or 3 times a day with a full glass of water (8 ounces/240 milliliters). Do not lie down for at least 10 minutes after taking this drug. To prevent stomach upset, take this medication with food, milk, or an antacid.​
The dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time.​

FWIW this is the first time I've needed it in like 20 years.
 

slipkid

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This is why I hate Dr's. They make sweeping statements/generalizations/even lies and you're stuck with it for the most part.

I was told absolutely you are not allowed to ever take ibuprofen again, by multiple Drs including cardiologists. And I have suffered through pain with things like pulled muscles which used to be alleviated with ibuprofen yet now take only tylenol with no relief whatsoever.
 

pellicle

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And I have suffered through pain with things like pulled muscles which used to be alleviated with ibuprofe
Well everything is going fine here on it so far. I wish I'd started 2weeks ago.

PS: I would underscore that its important to:
  • strictly follow the guidance on the pack
  • monitor for any signs of gut ache or "tarry stools"
  • always take with something "fatty" (such as a glass of milk or some yoghurt)
  • take less than more (I've been taking 3 per day spaced at a little over 6 hours)
  • do not take with aspirin
 
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tom in MO

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This is why I hate Dr's. They make sweeping statements/generalizations/even lies and you're stuck with it for the most part.

I was told absolutely you are not allowed to ever take ibuprofen again, by multiple Drs including cardiologists. And I have suffered through pain with things like pulled muscles which used to be alleviated with ibuprofen yet now take only tylenol with no relief whatsoever.
Ibuprofen is an anti-inflammatory not a pain reliever. My orthopedic surgeon says you should take both acetaminophen for pain and ibuprofen for inflammation. Since I am on warfarin, he won't tell me unequivocally to take an NSAID, he says it's indicated, but ask your cardiologist if you can take it or not. Maybe you have some other comorbidity that makes ibuprofen a poor choice for you.
 
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