Are Your Medications Making You Sick?

If you are feeling so-so or are experiencing more serious symptoms, it's possible that your back pain medications are the cause. While the recent media attention to certain drugs has certainly raised a red flag for many patients, the sometimes misleading or contradictory headlines have also created confusion and unnecessary fear for many. In this newsletter and on Spine-health.com, we profile (based on the facts) potential side effects and risks of several commonly used drugs for back pain.

New warnings for COX-2 inhibitors (Celebrex, Bextra, Vioxx)

This class of drugs, known as COX-2 inhibitors (a type of non-steroidal anti-inflammatory drug, or NSAID), has recently been making headlines due to evidence of increased risk of heart attack and stroke in certain studies. For this reason, Vioxx was voluntarily taken off the market last September, and Pfizer has stopped advertising Celebrex and Bextra as studies on their safety continue (although these brands are still available for use). See Vioxx recall and recommendations for the facts.

In general, the risk of heart attack and stroke for patients taking COX-2 inhibitors is thought to be higher for elderly patients and for people taking these drugs for long periods of time. Bextra also potentially carries the risk of blood clots and a serious skin reaction. Bextra is not recommended for those who have recently had coronary artery bypass graft surgery or have serious coronary artery disease. Read also COX-2 inhibitors: Celebrex and Bextra information.

If you are taking Celebrex or Bextra, you need to consult with your doctor (if you haven't in the last 6 months) to ensure that they are still the best medications for you in light of the potential risks surfacing from clinical trial results.

There may be new risks with naproxen

New information also shows that the safety of naproxen (e.g., Aleve, available without a prescription, and Naprosyn, available with a prescription) has been called into question for its potential increased risk of heart attack and stroke. The FDA now recommends that naproxen not be taken for longer than 10 days or above the recommended dosage without consulting a physician. Also see Understanding COX-2 inhibitor side effects.

Tylenol (acetaminophen) even has a few little-known risks

Many physicians say that Tylenol is arguably the most effective non-prescription medication for lower back pain, and in general has very few side effects. However, few people know that Tylenol can cause serious (potentially fatal) liver damage if combined with heavy alcohol use (thought to be about 3 drinks or more per day, or if taken with binge drinking). Acetaminophen used in high doses even without alcohol can also be fatal and is the leading cause of acute liver failure in the U.S.

There are many other medications that contain acetaminophen (such as cough syrup), so always check with your doctor regarding other medications and remedies to avoid taking too much. See also Acetaminophen.

Anti-depressants can be important for treating back pain

In addition to several other classes of drugs that can be used to help manage back pain, antidepressants (e.g., Prozac, Paxil, Wellbutrin) may also be prescribed. This is because chronic back pain can cause depression or difficulty sleeping, and depression can lead to or worsen back pain. Antidepressants usually have few side effects, but do have a potentially fatal drug interaction with monoamine oxidase inhibitors (e.g., Nardil, Parnate, Marplan) and should never be taken together. Because of many potential drug interactions, it's critical to keep your doctor informed of other drugs or remedies you are taking. For example, the brand Wellbutrin (for depression) has the same active ingredients as Zyban (for quitting smoking) and taking them together would result in a dangerously high dosage. See also Depression.

Finding the right medications may take some trial and error

As with many back pain treatments, both the side effects and effectiveness of any particular drug tends to be a very personal matter. What doesn't work for you may work quite well for someone else and vice-versa. Also, different approaches to taking many medications, such as injections, patches, time-release pills, etc., may work better for you than others. Read more in Medications for back pain and neck pain and Pain management for back pain.

Final thoughts

There are lots of medications available that can help manage back pain--the key is finding the best medication(s) for you, given your treatment needs, individual risk factors and experience with specific medications. Although most side effects are rare, you should be on the alert for anything you are experiencing that you suspect may be caused by a drug. Your best bet is to stay informed with unbiased, factual information, such as the information on Spine-health.com, and the FDA's site (www.fda.gov). Sites of particular drug manufacturers may also be helpful.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com.The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.