Pain Management: Neuropathic PainIntroduction
Neuropathic pain is a complex, chronic pain state that usually
is accompanied by tissue injury. With neuropathic pain, the nerve
fibers themselves may be damaged, dysfunctional or injured. These
damaged nerve fibers send incorrect signals to other pain centers.
The impact of nerve fiber injury includes a change in nerve
function both at the site of injury and areas around the
injury.
One example of neuropathic pain is called phantom limb syndrome.
This occurs when an arm or a leg has been removed because of
illness or injury, but the brain still gets pain messages from the
nerves that originally carried impulses from the missing limb.
These nerves now misfire and cause pain.
What causes neuropathic pain?
Neuropathic pain often seems to have no obvious cause; but, some
common causes of neuropathic pain include:
Alcoholism
Amputation
Back, leg, and hip problems
Chemotherapy
Diabetes
Facial nerve problems
HIV infection or AIDS
Multiple sclerosis
Shingles
Spine surgery
What are the symptoms of neuropathic pain?
Symptoms may include:
Shooting and burning pain
Tingling and numbness
How is neuropathic pain diagnosed?
A doctor will conduct an interview and physical exam. He or she
may ask questions about how you would describe your pain, when the
pain occurs, or whether anything specific triggers the pain.
How is neuropathic pain treated?
Some neuropathic pain studies suggest the use of non-steroidal
anti-inflammatory drugs, such as Aleve or Motrin, may ease pain.
Some people may require a stronger painkiller, such as those
containing morphine. Anticonvulsant and antidepressant drugs seem
to work in some cases.
If another condition, such as diabetes, is involved, better
management of that disorder may alleviate the pain.
In cases that are difficult to treat, a pain specialist may use
invasive or implantable device therapies to effectively manage the
pain. Electrical stimulation of the nerves involved in neuropathic
pain generation may significantly control the pain symptoms.
Unfortunately, neuropathic pain often responds poorly to
standard pain treatments and occasionally may get worse instead of
better over time. For some people, it can lead to serious
disability.
Patient Discussions - Viewers share their commentsNeuropathic
PainThe MedicineNet physician editors ask:
What was the cause of your neuropathic pain?
I have had 3 back operations. The 1st was due to a bulging disc
and I had to have it removed. I take 120mg of morphine per day and
40ml of oramorph medicine. I`ve been diagnosed as having Chronic
Neuropathic pain and the specialists have said there is no more
they can do for me. I`m unable to walk and spend most of my days in
bed unable to move due to tremendous pain. Is there any advice that
anyone can give me as I am very depressed and don't know what to
do.
Related Reading: Neuropathic pain
Comment from: VikiMason, 55-64 Female (Patient) Published: April
12
I'm two years out from chemotherapy for breast cancer. I'm
enjoying a fine remission, however I've been told my sundry
symptoms indicate neuropathic pain. My fingers and toes buzz and
tingle. I also frequently have what behaves like gouty arthritis in
my feet and hands. My uric acid levels are generally good when this
happens. I get more and more confused about the nature of this
condition. I'm also pretty discouraged.
Related Reading: chemotherapy | breast cancer | arthritis
Comment from: Fate, 35-44 Female (Patient) Published: April
08
I was caught in a crossfire and got shot 7 times, 2 to the
torso, 2 to the left arm and 3 to the right thigh. I was also
injured in the grenade blast, multiple fragments to my entire body.
I was inside a car then that crashed on a 30 feet cement wall
causing concussion and abrasions. I've been diagnosed with
Neuropathic & Nociceptive Chronic Pain Syndrome. This was 23+
years ago.
Related Reading: concussion | Chronic Pain
Comment from: Tewey, 45-54 Male (Patient) Published: February
17
Diabetes (Type 1) was the cause of my neuropathic pain. For a
few years the pain in my calves (left more than right) was more of
an irritation than a disability, but about three years ago, after a
serious hypo which I over-treated (too much orange juice) I found I
could not walk at all. For almost a year I was unable to walk more
than a few yards without crippling pain, but after a few months I
was able to ride a bicycle, and now I can walk a couple of miles
(though not very fast) and I can ride my bicycle for an hour or
more. The pain is still there, and it is worse when I walk, but it
is never as severe as three years ago. I think the daily yoga is
helping.
How Nerve Pain Feels
People with nerve pain feel it different ways. For some, it's a
stabbing pain in the middle of the night. For others, it's a
chronic tingling or burning they feel all day.
Uncontrolled nerve pain can be hard to bear. But with treatment,
it can often be controlled.
Understanding Nerve Pain
Pain is supposed to be a warning. When your hand gets too close
to a stove, the nerves send a pain signal to the brain -- and you
pull back before you burn yourself. But if you have nerve pain,
that system isn't working. Damaged nerves may send false signals --
and you feel real pain without another cause. Or damaged nerves may
stop you from feeling pain when you have an injury.
Nerve Pain Triggers
Some find that certain body positions or activities -- like
standing in line or walking -- may become painful. Nerve damage may
also make your body overly sensitive. Even a gentle breeze on your
face may become excruciating.
Loss of Feeling
Nerve damage may cause loss of sensation, making it harder to do
things with your hands. Knitting, typing, and tying your shoes may
become difficult. Many people with nerve damage say that their
sense of touch feels dulled, as if they are always wearing
gloves.
Nerve Pain and Sleep
Nerve pain is often worst at night. The touch of sheets or the
pressure of lying down may be terribly uncomfortable. If you can't
sleep because of your nerve pain, make sure to mention it to your
doctor. Changing some habits or taking medicine could help
Losing Balance
In addition to dulling your sense of touch, nerve damage may
decrease muscle strength. These two effects may make it harder to
keep your balance -- and that could lead to falls. Assistive
devices -- like braces, canes, or walkers -- may help.
Unseen Injuries
Nerve damage doesn't just cause pain. It may also cause numbness
that may prevent you from feeling pain when it matters. People with
nerve damage sometimes hurt themselves without realizing it. Your
doctor may recommend that you check yourself for injuries regularly
-- especially your feet.
Nerve Pain Progression
Left untreated, nerve damage may worsen over time. It usually
starts in the nerves farthest from the brain and spinal cord --
like those in the feet and hands. Then it may move up into the legs
and arms.
However, if you get control of your nerve pain promptly, you may
be able to stop the damage -- and even reverse it.
OTC Treatments for Nerve Pain
Over-the-counter painkillers may be the first treatment your
doctor recommends. These may include nonsteroidal anti-inflammatory
drugs (NSAIDs) -- such as ibuprofen -- or analgesics, such as
acetaminophen. Other options include painkilling creams, ointments,
oils, gels, or sprays that are used on the skin.
Nerve Pain: Prescription Treatments
There are many prescription medicines that may help with nerve
pain. Some are powerful painkillers. Other drug types might help
too. Studies have found that some medicines originally used for
depression and epilepsy may also help relieve nerve pain.
Natural Treatments for Nerve Pain
Complementary or alternative treatments may help. For instance,
studies have found that acupuncture may ease nerve pain. In some
cases, nerve pain is caused or aggravated by a deficiency of
vitamin B12. Taking supplements -- under your doctor's care --
could help.
Taking Control of Your Health
In addition to working with your doctor to find treatment that
works, you can take other steps to fight chronic pain. Getting
regular exercise, keeping a healthy weight, and improving your diet
may help.
GENERIC NAME: naproxen BRAND NAME: Anaprox, Naprelan, Naprosyn,
Aleve
DRUG CLASS AND MECHANISM: Naproxen belongs to a class of drugs
called nonsteroidal antiinflammatory drugs (NSAIDs). Other members
of this class include ibuprofen (Motrin), indomethacin (Indocin),
nabumetone (Relafen) and several others. These drugs are used for
the management of mild to moderate pain, fever, and inflammation.
They work by reducing the levels of prostaglandins, chemicals that
are responsible for pain, fever, and inflammation. Naproxen blocks
the enzyme that makes prostaglandins (cyclooxygenase), resulting in
lower concentrations of prostaglandins. As a consequence,
inflammation, pain and fever are reduced. Naproxen was approved by
the FDA in December 1991.
PRESCRIPTION: Yes; (Aleve, no)
GENERIC AVAILABLE: Yes
PREPARATIONS:
Anaprox (tablets): 275 and 550 mg;
Naprosyn (tablets): 250, 375, and 500 mg;
Naprosyn suspension: 125 mg/5ml;
EC-Naprosyn: 375 mg,
Aleve: 220 mg;
Naprelan (controlled-release tablets): 375 and 500mg.
STORAGE: Naproxen should be stored at room temperature: 15-30 C
(59-86 F).
PRESCRIBED FOR: Naproxen is used for the treatment of mild to
moderate pain, inflammation, and fever.
DOSING: The usual adult dose is 250-500 mg twice daily using
regular naproxen tablets. The usual dose for Naprelan controlled
release tablets is 750 to 1000 mg given once daily. For
EC-Naprosyn, the usual dose is 375-500 mg twice daily. Naproxen
should be given with food to reduce upset stomach.
DRUG INTERACTIONS: Naproxen is associated with several suspected
or probable interactions that affect the action of other drugs. The
following examples are the most common suspected interactions.
Naproxen may increase the blood levels of lithium (Eskalith) by
reducing the excretion of lithium by the kidneys. Increased levels
of lithium may lead to lithium toxicity.
Naproxen may reduce the blood pressure lowering effects of blood
pressure medications. This may occur because prostaglandins play a
role in the regulation of blood pressure.
When naproxen is used in combination with methotrexate or
aminoglycosides (for example, gentamicin) the blood levels of the
methotrexate or aminoglycoside may increase, presumably because the
eliminationfrom the body is reduced. This may lead to more
methotrexate or aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants [for
example, warfarin, (Coumadin)] should avoid naproxen because
naproxen also thins the blood, and excessive blood thinning may
lead to bleeding.
PREGNANCY: There are no adequate studies of naproxen in pregnant
women. Therefore, naproxen is not recommended during pregnancy.
NURSING MOTHERS: A small amount of naproxen is excreted in
breast milk. Because the concentration in breast milk is low,
breastfeeding while taking naproxen probably is not harmful to the
infant.
SIDE EFFECTS: The most common side effects from naproxen are
rash, ringing in the ears, headaches, dizziness, drowsiness,
abdominal pain, nausea, diarrhea, constipation, heartburn, fluid
retention and shortness of breath.
NSAIDs reduce the ability of blood to clot and therefore
increase bleeding after an injury. Naproxen also may cause stomach
and intestinal bleeding and ulcers. Sometimes, stomach ulceration
and intestinal bleeding can occur without any abdominal pain. Black
tarry stools, weakness, and dizziness upon standing may be the only
signs of the bleeding.
People who are allergic to other NSAIDs should not use naproxen.
NSAIDs reduce the flow of blood to the kidneys and impair function
of the kidneys. The impairment is most likely to occur in patients
with preexisting impairment of kidney function or congestive heart
failure, and use of NSAIDs in these patients should be done
cautiously. Individuals with asthma are more likely to experience
allergic reactions to naproxen and other NSAIDs. Fluid retention,
blood clots, heart attacks, hypertension, and heart failure have
also been associated with the use of NSAIDs.
WARNING: This drug may infrequently cause serious (rarely fatal)
bleeding from the stomach or intestines. This side effect can occur
without warning at any time during treatment with naproxen. The
elderly are at increased risk for serious stomach/intestinal
bleeding.
Drugs related to naproxen have rarely caused blood clots to
form, resulting in serious (possibly fatal) heart attacks and
strokes. This medication might also rarely cause similar problems.
The risk of these serious side effects may increase if you have
heart disease and with longer use of this medication. Talk to your
doctor or pharmacist about the benefits and risks of treatment, as
well as other possible medication choices.
Stop taking naproxen and seek immediate medical attention if you
notice any of the following rare but very serious side effects:
black stools, persistent stomach/abdominal pain, vomit that looks
like coffee grounds, chest pain, shortness of breath, weakness on
one side of the body, sudden vision changes, slurred speech.
This medication should not be used right before or after heart
bypass surgery.
USES: Naproxen is used to relieve pain and swelling
(inflammation) from various conditions. It is used to treat
headaches, muscle aches, backaches, tendonitis, dental pain, and
menstrual cramps. It also reduces pain, swelling, and joint
stiffness caused by arthritis, bursitis, and gout attacks. Reducing
these symptoms helps you do more of your normal daily activities.
This medication is known as a nonsteroidal anti-inflammatory drug
(NSAID).
naproxen - oral, Anaprox, Naprosyn (cont.)
HOW TO USE: Read the Medication Guide provided by your
pharmacist before you start using naproxen and each time you get a
refill. If you have any questions regarding the information,
consult your doctor or pharmacist.Take this medication by mouth
with a full glass of water (8 ounces or 240 milliliters) unless
your doctor directs you otherwise. Do not lie down for at least 30
minutes after taking this drug. To prevent stomach upset, take this
medication with food, milk, or an antacid.Dosage is based on your
medical condition and response to therapy. Do not take more than
1,500 milligrams of naproxen (equal to 1,650 milligrams of naproxen
sodium) per day. To minimize side effect risks (e.g., stomach
bleeding), use this medication at the lowest effective dose for the
shortest possible length of time. Do not increase your dose or take
it more often than prescribed. For ongoing conditions such as
arthritis, continue taking it as directed by your doctor. Discuss
the risks and benefits with your doctor or pharmacist.In certain
conditions (e.g., arthritis), it may take up to 2 weeks of regular
use before the full benefits of this drug take effect.If you are
taking this drug on an "as needed" basis (not on a regular
schedule), remember that pain medications work best if they are
used as the first signs of pain occur. If you wait until the pain
has significantly worsened, the medicine may not work as well.If
you use this medication for migraine headache, and the pain is not
relieved or worsens after the first dose, tell your doctor
immediately.Inform your doctor if your condition worsens.
SIDE EFFECTS: See also Warning section.Upset stomach, nausea,
heartburn, diarrhea, constipation, headache, tiredness, drowsiness,
and dizziness may occur. If any of these effects persist or worsen,
notify your doctor or pharmacist promptly.Remember that your doctor
has prescribed this medication because he or she has judged that
the benefit to you is greater than the risk of side effects. Many
people using this medication do not have serious side effects.Tell
your doctor immediately if any of these unlikely but serious side
effects occur: stomach pain, difficult/painful swallowing, swelling
of the hands/feet, sudden/unexplained weight gain, vision changes,
hearing changes (e.g., ringing in the ears), mental/mood changes
(e.g., depression), fast/pounding heartbeat, persistent/severe
headache, fainting.Tell your doctor immediately if any of these
rare but very serious side effects occur: change in the amount of
urine, easy bruising/bleeding, signs of infection (e.g., fever,
persistent sore throat), unexplained stiff neck.This drug may
rarely cause serious (possibly fatal) liver disease. If you notice
any of the following rare but very serious side effects, stop
taking naproxen and tell your doctor immediately: yellowing
eyes/skin, dark urine, unusual/extreme tiredness, severe
stomach/abdominal pain, persistent nausea/vomiting.A very serious
allergic reaction to this drug is unlikely, but seek immediate
medical attention if it occurs. Symptoms of a serious allergic
reaction may include: rash, itching/swelling (especially of the
face/tongue/throat), severe dizziness, trouble breathing.This is
not a complete list of possible side effects. If you notice other
effects not listed above, contact your doctor or pharmacist.In the
US -Call your doctor for medical advice about side effects. You may
report side effects to FDA at 1-800-FDA-1088.In Canada - Call your
doctor for medical advice about side effects. You may report side
effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking naproxen, tell your doctor or
pharmacist if you are allergic to it; or to aspirin or other NSAIDs
(e.g., ibuprofen, celecoxib); or if you have any other
allergies.This medication should not be used if you have certain
medical conditions. Before using this medicine, consult your doctor
or pharmacist if you have: aspirin-sensitive asthma (a history of
worsening breathing with runny/stuffy nose after taking aspirin or
other NSAIDs), severe kidney disease, recent heart bypass surgery
(CABG).Before using this medication, tell your doctor or pharmacist
your medical history, especially of: kidney disease, liver disease,
poorly controlled diabetes, stomach/intestine/esophagus problems
(e.g., bleeding, ulcers), heart disease (e.g., congestive heart
failure, history of heart attack), high blood pressure, stroke,
swelling (edema, fluid retention), a severe loss of body water
(dehydration), blood disorders (e.g., anemia), bleeding or clotting
problems, asthma, growths in the nose (nasal polyps).Some naproxen
products contain salt (sodium). Tell your doctor if you are on a
salt-restricted diet.Before having surgery, tell your doctor or
dentist that you are using this medication.This drug may make you
dizzy or drowsy. Do not drive, use machinery, or do any activity
that requires alertness until you are sure you can perform such
activities safely.This medicine may cause stomach bleeding. Daily
use of alcohol and tobacco may increase your risk for stomach
bleeding, especially when combined with this medicine. Limit
alcohol and stop smoking. Consult your doctor or pharmacist for
more information.This medication may make you more sensitive to the
sun. Avoid prolonged sun exposure, tanning booths, and sunlamps.
Use a sunscreen and wear protective clothing when outdoors.The
elderly may be more sensitive to the side effects of this drug,
especially stomach/intestinal bleeding and kidney effects.This
medication should be used only when clearly needed during the first
6 months of pregnancy. It is not recommended for use during the
last 3 months of pregnancy due to possible harm to the unborn baby
and interference with normal labor/delivery. Discuss the risks and
benefits with your doctor.This drug passes into breast milk. While
there have been no reports of harm to nursing infants, consult your
doctor before breast-feeding.
DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor
or pharmacist) may already be aware of any possible drug
interactions and may be monitoring you for it. Do not start, stop
or change the dosage of any medicine before checking with them
first.This drug should not be used with the following medications
because very serious interactions may occur: high doses of aspirin
and related drugs (salicylates), cidofovir, other NSAIDs (e.g.,
ketorolac).If you are currently using any of these medications
listed above, tell your doctor or pharmacist before starting
naproxen.Before using this medication, tell your doctor or
pharmacist of all prescription and nonprescription/herbal products
you may use, especially of: anti-platelet drugs (e.g., cilostazol,
clopidogrel), oral bisphosphonates (e.g., alendronate), "blood
thinners" (e.g., enoxaparin, heparin, warfarin), corticosteroids
(e.g., prednisone), cyclosporine, desmopressin, digoxin, high blood
pressure drugs (including ACE inhibitors such as captopril,
angiotensin receptor blockers such as losartan, and beta-blockers
such as metoprolol), lithium, methotrexate, pemetrexed, probenecid,
SSRI antidepressants (e.g., fluoxetine, sertraline), "water pills"
(diuretics such as furosemide, hydrochlorothiazide,
triamterene).Check all prescription and nonprescription medicine
labels carefully for other pain/fever drugs (NSAIDs such as
aspirin, celecoxib, ibuprofen). These drugs are similar to this
medication, so taking one of these drugs while also taking this
medication may increase your risk of side effects. However, if your
doctor has prescribed low doses of aspirin to prevent heart attack
or stroke (usually at dosages of 81-325 milligrams a day), you
should continue to take the aspirin. Daily use of NSAIDs (e.g.,
ibuprofen) may decrease aspirin's ability to prevent heart
attack/stroke. Consult your doctor or pharmacist for more details
and to discuss other possible treatments (e.g., acetaminophen) for
your pain/fever.This medication can affect the results of certain
lab tests. Make sure laboratory personnel and your doctors know you
use this drug.This document does not contain all possible
interactions. Therefore, before using this product, tell your
doctor or pharmacist of all the products you use. Keep a list of
all your medications with you, and share the list with your doctor
and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison
control center or emergency room immediately. US residents can call
the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly.
Symptoms of overdose may include: severe stomach pain, vomit that
looks like coffee grounds, extreme drowsiness, slow or shallow
breathing, seizures.
NOTES: Do not share this medication with others.Laboratory
and/or medical tests (e.g., complete blood count, liver and kidney
function tests) may be performed periodically to monitor your
progress or check for side effects. Consult your doctor for more
details.Non-drug treatment for arthritis that is approved by your
doctor (e.g., weight loss if needed, strengthening and conditioning
exercises) may help improve your flexibility, range of motion, and
joint function. Consult your doctor for specific instructions.
MISSED DOSE: If you are prescribed this drug on a regular
schedule (not just "as needed") and you miss a dose, take it as
soon as you remember. If it is near the time of the next dose, skip
the missed dose and resume your usual dosing schedule. Do not
double the dose to catch up.
STORAGE: Store at room temperature between 59-86 degrees F
(15-30 degrees C) away from light and moisture. Do not store in the
bathroom. Keep all medicines away from children and pets.Do not
flush medications down the toilet or pour them into a drain unless
instructed to do so. Properly discard this product when it is
expired or no longer needed. Consult your pharmacist or local waste
disposal company for more details about how to safely discard your
product.
GENERIC NAME: ibuprofenBRAND NAME: Advil, Children's
Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.
DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs
called non-steroidal anti-inflammatory drugs (NSAIDs). Other
members of this class include aspirin, naproxen (Aleve),
indomethacin (Indocin), nabumetone (Relafen) and several others.
These drugs are used for the management of mild to moderate pain,
fever, and inflammation. Pain, fever, and inflammation are promoted
by the release in the body of chemicals called prostaglandins.
Ibuprofen blocks the enzyme that makes prostaglandins
(cyclooxygenase), resulting in lower levels of prostaglandins. As a
consequence, inflammation, pain and fever are reduced. The FDA
approved ibuprofen in 1974.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets of 200, 400, 600, and 800 mg; Chewable
tablets of 50 and 100 mg; Capsules of 200 mg; Suspension of 100
mg/2.5 ml and 100 mg/5 ml; Oral drops of 40 mg/ml.
STORAGE: Ibuprofen should be stored at room temperature, between
15-30C (59-86F).
PRESCRIBED FOR: Ibuprofen is used for the treatment of mild to
moderate pain, inflammation and fever caused by many and diverse
diseases.
DOSING: For minor aches, mild to moderate pain, menstrual
cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to
6 hours.
Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
When under the care of a physician, the maximum dose of
ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g
daily. Individuals should not use ibuprofen for more than 10 days
for the treatment of pain or more than 3 days for the treatment of
a fever unless directed by a physician.
Children 6 months to 12 years of age usually are given 5-10
mg/kg of ibuprofen every 6-8 hours for the treatment of fever and
pain. The maximum dose is 40 mg/kg daily.
Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4
divided doses.
Ibuprofen should be taken with meals to prevent stomach
upset.
DRUG INTERACTIONS: Ibuprofen is associated with several
suspected or probable interactions that can affect the action of
other drugs. Ibuprofen may increase the blood levels of lithium
(Eskalith) by reducing the excretion of lithium by the kidneys.
Increased levels of lithium may lead to lithium toxicity. Ibuprofen
may reduce the blood pressure-lowering effects of drugs that are
given to reduce blood pressure. This may occur because
prostaglandins play a role in the regulation of blood pressure.
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.
PREGNANCY: There are no adequate studies of ibuprofen in
pregnant women. Therefore, ibuprofen is not recommended during
pregnancy. Ibuprofen should be avoided in late pregnancy due to the
risk of premature closure of the ductus arteriosus in the fetal
heart..
NURSING MOTHERS: Ibuprofen is not excreted in breast milk. Use
of ibuprofen while breastfeeding, poses little risk to the
infant.
SIDE EFFECTS: The most common side effects from ibuprofen are
rash, ringing in the ears, headaches, dizziness, drowsiness,
abdominal pain, nausea, diarrhea, constipation and heartburn.
NSAIDs reduce the ability of blood to clot and therefore increase
bleeding after an injury. Ibuprofen may cause ulceration of the
stomach or intestine, and the ulcers may bleed. Sometimes,
ulceration can occur without abdominal pain, and black, tarry
stools, weakness, and dizziness upon standing (orthostatic
hypotension) due to bleeding may be the only signs of an ulcer.
NSAIDs reduce the flow of blood to the kidneys and impair function
of the kidneys. The impairment is most likely to occur in patients
who already have impaired function of the kidney or congestive
heart failure, and use of NSAIDs in these patients should be
cautious. People who are allergic to other NSAIDs, including
aspirin, should not use ibuprofen. Individuals with asthma are more
likely to experience allergic reactions to ibuprofen and other
NSAIDs. Fluid retention (edema), blood clots, heart attacks,
hypertension and heart failure have also been associated with the
use of NSAIDs.
WARNING: This drug may infrequently cause serious (rarely fatal)
bleeding from the stomach or intestines. Also, related drugs rarely
have caused blood clots to form, resulting in heart attacks and
strokes. This medication might also rarely cause similar problems.
Talk to your doctor or pharmacist about the benefits and risks of
treatment, as well as other possible medication choices.
If you notice any of the following rare but very serious side
effects, stop taking ibuprofen and seek immediate medical
attention: black stools, persistent stomach/abdominal pain, vomit
that looks like coffee grounds, chest pain, weakness on one side of
the body, sudden vision changes, slurred speech.
USES: Ibuprofen is a nonsteroidal anti-inflammatory drug
(NSAID), which relieves pain and swelling (inflammation). It is
used to treat headaches, muscle aches, backaches, dental pain,
menstrual cramps, arthritis, or athletic injuries. This medication
is also used to reduce fever and to relieve minor aches and pains
due to the common cold or flu.This drug works by blocking the
enzyme in your body that makes prostaglandins. Decreasing
prostaglandins helps to reduce pain, swelling, and fever.
HOW TO USE: Read the Medication Guide provided by your
pharmacist before you start using ibuprofen and each time you get a
refill. If you have any questions regarding the information,
consult your doctor or pharmacist.Take this medication by mouth
with a full glass (8 ounces or 240 milliliters) of water unless
your doctor directs you otherwise. Do not lie down for at least 30
minutes after taking this drug.If stomach upset occurs while taking
this medication, take it with food, milk, or an antacid. The dosage
is based on your medical condition and response to therapy. If
repeat doses are needed, they are usually given 6 or 8 hours apart;
or as directed by your doctor.When ibuprofen is used in children,
the dose is based on your child's weight. Read the product
instructions to find the appropriate dose for your child's weight.
Consult the pharmacist or doctor if you have questions or if you
need help in choosing the appropriate dosage form.In certain
conditions (e.g., arthritis), it may take up to two weeks, taken
regularly, before the full benefits of this drug take effect.If you
are taking this drug on an "as needed" basis (not on a regular
schedule), remember that pain medications work best if they are
used as the first signs of pain occur. If you wait until the pain
has significantly worsened, the medicine may not work as well.If
you use this medication for migraine headache, and the pain is not
relieved or worsens after the first dose, tell your doctor
immediately.For nonprescription ibuprofen products: If you are
treating yourself or giving this medication to a child for
undiagnosed fever or pain, consult the doctor immediately if
symptoms do not improve within 24 hours, worsen or last for more
than 3 days, or if new symptoms appear.To reduce your risk of
stomach bleeding and other side effects, take this medication at
the lowest effective dose for the shortest possible time. Do not
increase your dose, take it more frequently, or take it for a
longer time than prescribed. Do not take the over-the-counter
product for more than 10 days unless otherwise directed.
SIDE EFFECTS: Upset stomach, nausea, vomiting, heartburn,
headache, diarrhea, constipation, drowsiness, and dizziness may
occur. If any of these effects persist or worsen, notify your
doctor or pharmacist promptly.If your doctor has directed you to
use this medication, remember that he or she has judged that the
benefit to you is greater than the risk of side effects. Many
people using this medication do not have serious side effects.Tell
your doctor immediately if any of these serious side effects occur:
stomach pain, swelling of the hands or feet, sudden or unexplained
weight gain, ringing in the ears (tinnitus).Tell your doctor
immediately if any of these unlikely but serious side effects
occur: vision changes, rapid or pounding heartbeat, easy bruising
or bleeding, difficult/painful swallowing.Tell your doctor
immediately if any of these highly unlikely but very serious side
effects occur: change in amount of urine, severe headache, very
stiff neck, mental/mood changes, persistent sore throat or
fever.This drug may rarely cause serious (possibly fatal) liver
disease. If you notice any of the following highly unlikely but
very serious side effects, stop taking ibuprofen and consult your
doctor or pharmacist immediately: yellowing eyes and skin, dark
urine, unusual/extreme tiredness.An allergic reaction to this drug
is unlikely, but seek immediate medical attention if it occurs.
Symptoms of an allergic reaction include: rash, itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble
breathing.This is not a complete list of possible side effects. If
you notice other effects not listed above, contact your doctor or
pharmacist.In the US -Call your doctor for medical advice about
side effects. You may report side effects to FDA at
1-800-FDA-1088.In Canada - Call your doctor for medical advice
about side effects. You may report side effects to Health Canada at
1-866-234-2345.
PRECAUTIONS: Before taking ibuprofen, tell your doctor or
pharmacist if you are allergic to it; or to aspirin or other NSAIDs
(e.g., naproxen, celecoxib); or if you have any other
allergies.This medication should not be used if you have certain
medical conditions. Before using this medicine, consult your doctor
or pharmacist if you have: severe kidney disease, aspirin-sensitive
asthma (a history of worsening breathing with runny/stuffy nose
after taking aspirin or other NSAIDs), recent heart bypass surgery
(CABG).Before using this medication, tell your doctor or pharmacist
your medical history, especially of: kidney disease, liver disease,
poorly controlled diabetes, stomach/intestine/esophagus problems
(e.g., bleeding, ulcers, recurring heartburn), heart disease (e.g.,
congestive heart failure, history of heart attack), high blood
pressure, stroke, swelling (edema, fluid retention), dehydration,
blood disorders (e.g., anemia), bleeding or clotting problems,
asthma, growths in the nose (nasal polyps), history of an allergic
reaction with symptoms of lip/tongue/throat swelling (angioedema),
any allergies in addition to those listed above.This drug may make
you dizzy or drowsy. Do not drive, use machinery, or do any
activity that requires alertness until you are sure you can perform
such activities safely. Limit alcoholic beverages.This medicine may
cause stomach bleeding. Daily use of alcohol and tobacco,
especially when combined with this medicine, may increase your risk
for stomach bleeding. Limit alcohol and stop smoking. Consult your
doctor or pharmacist for more information.This medication may make
you more sensitive to the sun. Avoid prolonged sun exposure,
tanning booths or sunlamps. Use a sunscreen and wear protective
clothing when outdoors.Caution is advised when using this drug in
the elderly because they may be more sensitive to the side effects
of the drug, especially stomach bleeding and kidney effects.This
medication should be used only when clearly needed during the first
6 months of pregnancy. It is not recommended for use during the
last 3 months of pregnancy due to the potential for harm to an
unborn baby and interference with normal labor/delivery. Discuss
the risks and benefits with your doctor.This medication passes into
breast milk. While there have been no reports of harm to nursing
infants, consult your doctor before breast-feeding.
DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor
or pharmacist) may already be aware of any possible drug
interactions and may be monitoring you for it. Do not start, stop
or change the dosage of any medicine before checking with them
first.This drug should not be used with the following medications
because very serious interactions may occur: cidofovir,
ketorolac.If you are currently using any of these medications
listed above, tell your doctor or pharmacist before starting
ibuprofen.Before using this medication, tell your doctor or
pharmacist of all prescription and nonprescription/herbal products
you may use, especially of: anti-platelet drugs (e.g., cilostazol,
clopidogrel), oral bisphosphonates (e.g., alendronate), other
medications for arthritis (e.g., aspirin, methotrexate), "blood
thinners" (e.g., enoxaparin, heparin, warfarin), corticosteroids
(e.g., prednisone), cyclosporine, desmopressin, high blood pressure
drugs (including ACE inhibitors such as captopril, angiotensin II
receptor antagonists such as losartan, and beta-blockers such as
metoprolol), lithium, pemetrexed, "water pills" (diuretics such as
furosemide, hydrochlorothiazide, triamterene).Check all
prescription and nonprescription medicine labels carefully for
other pain/fever drugs (NSAIDs such as aspirin, celecoxib,
naproxen). These drugs are similar to ibuprofen, so taking one of
these drugs while also taking ibuprofen may increase your risk of
side effects. Consult your doctor or pharmacist for more
details.However, if your doctor has prescribed low doses of aspirin
to prevent heart attack or stroke (usually at dosages of 81-325
milligrams a day), you should continue to take the aspirin. Daily
use of ibuprofen may decrease aspirin's ability to prevent heart
attack/stroke. Talk to your doctor about using a different
medication (e.g., acetaminophen) to treat pain/fever. If you must
take ibuprofen, talk to your doctor about possibly taking
immediate-release aspirin (not enteric-coated) while also taking
the ibuprofen dose apart from your aspirin dose. Do not increase
your daily dose of aspirin or change the way you take aspirin/other
medications without your doctor's approval.This document does not
contain all possible interactions. Therefore, before using this
product, tell your doctor or pharmacist of all the products you
use. Keep a list of all your medications with you, and share the
list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison
control center or emergency room immediately. US residents can call
the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly.
Symptoms of overdose may include: severe stomach pain, coffee
ground-like vomit, unusually fast or slow heartbeat, trouble
breathing, extreme drowsiness, loss of consciousness, or
seizures.
NOTES: Do not share this medication with others.Laboratory
and/or medical tests may be performed periodically to monitor your
progress or check for side effects. Consult your doctor for more
details.
MISSED DOSE: If you are prescribed this drug on a regular
schedule (not just "as needed") and you miss a dose, use it as soon
as you remember. If it is near the time of the next dose, skip the
missed dose and resume your usual dosing schedule. Do not double
the dose to catch up.
STORAGE: Store at room temperature between 59 and 86 degrees F
(15-30 degrees C) away from light and moisture. Do not store in the
bathroom. Keep all medicines away from children and pets.Do not
flush medications down the toilet or pour them into a drain unless
instructed to do so. Properly discard this product when it is
expired or no longer needed. Consult your pharmacist or local waste
disposal company for more details about how to safely discard your
product.
GENERIC NAME: gabapentin BRAND NAME: Neurontin, Gabarone
DRUG CLASS AND MECHANISM: Gabapentin is an anticonvulsant that
is used for preventing seizures and for treating postherpetic
neuralgia. The mechanism of action of gabapentin is not known.
Gabapentin structurally resembles the neurotransmitter gamma
aminobutyric acid (GABA). It is possible that this similarity is
related to gabapentin's mechanism of action. In animal models used
for testing the anticonvulsant and analgesic activity of drugs,
gabapentin prevents seizures and reduces pain-related responses.
The FDA approved gabapentin in December 1993.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
Capsules: 100, 300, and 400 mg.
Tablets: 100, 300, 400, 600, and 800 mg.
Solution: 250 mg/5 ml
STORAGE: Tablets and capsules should be stored between 15-30 C
(59-86 F). Gabapentin solution should be refrigerated between 2-8 C
(36-46 F).
PRESCRIBED FOR: Gabapentin is approved for treating seizure
disorders and nerve damage from herpes zoster (shingles,
postherpetic neuralgia). There are many non-approved uses for
gabapentin. These include alcohol withdrawal, cocaine withdrawal,
hiccups, restless leg syndrome, hyperhidrosis, headaches, diabetic
neuropathy, hot flashes, and fibromyalgia.
DOSING: Gabapentin may be taken with or without food. The
recommended dose for postherpetic neuralgia is 1800 mg daily in 3
divided doses. The initial dose of 300 mg daily is increased over
several days to the recommended daily dose. Seizures are treated
with 900-1800 mg/daily in 3 divided doses. Withdrawal of treatment
should occur slowly over a week.
DRUG INTERACTIONS: Antacids reduce the concentration of
gabapentin in blood. Therefore, gabapentin should be administered 2
hours or more after taking antacids. Morphine significantly
increases blood concentrations of gabapentin and may increase
central nervous system-related adverse events associated with
gabapentin.
PREGNANCY: Safety in pregnancy has not been established.
NURSING MOTHERS: Gabapentin is secreted in human breast milk.
Nursing mothers should only use gabapentin if the benefits outweigh
the unknown risk to the fetus.
SIDE EFFECTS: Common side effects of gabapentin are dizziness,
somnolence, ataxia, fatigue, fluid retention, hostility, nausea and
vomiting. Other adverse events associated with gabapentin include
hypertension, anorexia, bruising, joint pain, motion sickness, and
pneumonia.
Antiepileptic medications have been associated with increased
risk of suicidal thinking and behavior. Anyone considering the use
of antiepileptic drugs must balance this risk of suicide with the
clinical need. Patients who are started on therapy should be
closely observed for clinical worsening, suicidal thoughts, or
unusual changes in behavior.
USES: Gabapentin is used with other medications to help control
seizures in adults and children (3 years of age and older). It is
also used to relieve nerve pain associated with shingles (herpes
zoster) infection in adults.OTHER This section contains uses of
this drug that are not listed in the approved professional labeling
for the drug but that may be prescribed by your health care
professional. Use this drug for a condition that is listed in this
section only if it has been so prescribed by your health care
professional.Gabapentin may also be used to treat other nerve pain
conditions (e.g., diabetic neuropathy, peripheral neuropathy,
trigeminal neuralgia).
HOW TO USE: Take this medication by mouth, with or without food,
as directed by your doctor. The dosage is based on your medical
condition and response to therapy. During the first few days, your
doctor may gradually increase your dose so your body can adjust to
the medication. To minimize side effects, take the very first dose
at bedtime.Use this medication regularly in order to get the most
benefit from it. This drug works best when the amount of medicine
in your body is kept at a constant level. Therefore it is best to
take gabapentin at evenly spaced intervals throughout the day and
night.Do not take this medication more often or increase your dose
without consulting your doctor. Your condition will not improve any
faster and the risk of serious side effects may be increased.Do not
stop taking this medication without consulting your doctor. Some
conditions such as seizures may become worse when the drug is
abruptly stopped. Your dose may need to be gradually
decreased.Antacids containing aluminum or magnesium may interfere
with the absorption of this medication. Therefore it is best to
take gabapentin at least 2 hours after taking an antacid.Inform
your doctor if your condition does not improve or worsens.
SIDE EFFECTS: Drowsiness, dizziness, unsteadiness, fatigue,
vision changes, weight gain, nausea, dry mouth, or constipation may
occur. If any of these effects persist or worsen, notify your
doctor or pharmacist promptly.Remember that your doctor has
prescribed this medication because he or she has judged that the
benefit to you is greater than the risk of side effects. Many
people using this medication do not have serious side effects.Tell
your doctor immediately if any of these serious side effects occur:
tremor or shaking, swollen arms/legs.Tell your doctor immediately
if any of these unlikely but serious side effects occur: loss of
coordination.A small number of people who take anticonvulsants for
any condition (such as seizure, bipolar disorder, pain) may
experience depression, suicidal thoughts/attempts, or other
mental/mood problems. Tell your doctor immediately if you or your
family/caregiver notice any unusual/sudden changes in your mood,
thoughts, or behavior including signs of depression, suicidal
thoughts/attempts, thoughts about harming yourself.Tell your doctor
immediately if any of these highly unlikely but very serious side
effects occur: persistent sore throat/fever/cough, unusual
bleeding/bruising, pain/redness of arms or legs, trouble breathing,
fast/slow/irregular heartbeat, hearing loss, stomach/abdominal
pain.A very serious allergic reaction to this drug is unlikely, but
seek immediate medical attention if it occurs. Symptoms of a
serious allergic reaction may include: rash, itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble
breathing.This is not a complete list of possible side effects. If
you notice other effects not listed above, contact your doctor or
pharmacist.In the US -Call your doctor for medical advice about
side effects. You may report side effects to FDA at
1-800-FDA-1088.In Canada - Call your doctor for medical advice
about side effects. You may report side effects to Health Canada at
1-866-234-2345.
PRECAUTIONS: Before taking gabapentin, tell your doctor or
pharmacist if you are allergic to it; or if you have any other
allergies.Before using this medication, tell your doctor or
pharmacist your medical history, especially of: kidney disease.This
drug may make you dizzy or drowsy. Do not drive, use machinery, or
do any activity that requires alertness until you are sure you can
perform such activities safely. Limit alcoholic beverages.Caution
is advised when using this drug in the elderly because they may be
more sensitive to its effects, especially swollen arms/legs or loss
of coordination.Caution is advised when using this drug in children
because they may be more sensitive to its effects, especially the
mental/mood changes (e.g., hostility).This medication should be
used only when clearly needed during pregnancy. Discuss the risks
and benefits with your doctor.Gabapentin passes into breast milk.
Because the effects of this drug on the nursing infant are unknown,
consult your doctor before breast-feeding.
DRUG INTERACTIONS: Your doctor or pharmacist may already be
aware of any possible drug interactions and may be monitoring you
for them. Do not start, stop, or change the dosage of any medicine
before checking with them first.See also How to Use section.Before
using this medication, tell your doctor or pharmacist of all
prescription and nonprescription/herbal products you may use,
especially of: antacids containing aluminum or magnesium,
morphine.This product can affect the results of certain lab tests
for urine protein. Make sure laboratory personnel and your doctors
know you use this drug.This document does not contain all possible
interactions. Therefore, before using this product, tell your
doctor or pharmacist of all the products you use. Keep a list of
all your medications with you, and share the list with your doctor
and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison
control center or emergency room immediately. US residents can call
the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly.
Symptoms of overdose may include: severe drowsiness, slurred
speech, or extreme lethargy.
NOTES: Do not share this medication with others.
MISSED DOSE: If you miss a dose, use it as soon as you remember.
If it is near the time of the next dose, skip the missed dose and
resume your usual dosing schedule. Do not double the dose to catch
up.
STORAGE: Store at room temperature (77 degrees F or 25 degrees
C) away from light and moisture. Brief storage between 59-86
degrees F (15-30 degrees C) is permitted. Do not store in the
bathroom. Keep all medicines away from children and pets.Do not
flush medications down the toilet or pour them into a drain unless
instructed to do so. Properly discard this product when it is
expired or no longer needed. Consult your pharmacist or local waste
disposal company for more details about how to safely discard your
product.MEDICAL ALERT: Your condition can cause complications in a
medical emergency. For enrollment information call MedicAlert at
1-800-854-1166 (USA), or 1-800-668-1507 (Canada).
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