WebMD Ask the Pharmacist

Fitness Aches and Pains: Ask the Pharmacist

July 20, 2010. Pharmacist Heather Free, PharmD, answers questions about treating aches and pains from exercise and fitness activities.

Question:

I am taking diclofenac for a sprained ligament. Can I use Nabutone for the same pain?

Answer:

Diclofenac and nabutone are both nonsteroidal anti-inflammatory drugs (NSAIDs). Diclofenac and nabutone are both used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). In addition, diclofenac is used to aid with ankylosing spondylitis (arthritis that mainly affects the spine).
These medications are very similar. However, you should consult your physician or health care provider before using another medication that wasn’t originally prescribed for the sprained ligament. Before you substitute nabutone for the diclofenac, make sure the prescriber is fine with the switch.

Question:

I just started taking Lorazepam 1 milligram, twice daily as needed. But I’m going out dancing tonight. Can I have a few alcoholic beverages, as long as I keep it to a minimum?

Answer:

Lorazepam and alcohol both cause drowsiness that can interfere with operations of normal daily tasks, including driving. It is not recommended to drink alcohol while taking this medication.
Lorazepam is an intermediate-acting benzodiazepine medication, meaning that it will last about 12 hours in the body. It has been used for short-term treatment of anxiety and insomnia issues. Because of these indications, adjunctive administration of lorazepam and alcohol would really increase your risk of an accident.

Question:

At one time, I was given Octogen cream for joint pain relief. Can you please assist me in finding where to get this cream? I don't know if it was prescription or over-the-counter.

Answer:

Octogen is a product that is not monitored or approved by the United States Food and Drug Administration. It can be ordered online. But after going to the web site and seeing how little information they give about the product, I am less confident about recommending it.
The exact ingredient list contains only four active ingredients: methyl salicylate (a.k.a. oil of wintergreen), rectified gum spirits of turpentine, camphor, and menthol, plus Octogen’s proprietary blend of five herbal essences (not listed). The quantities or percentages of each of the ingredients are not available. Without this information or FDA monitoring, it is not wise to use this product.

Question:

After working out, I sometimes get a pain in my backside. It seems similar to sciatica. What is the best way to ease this pain?

Answer:

It is important to differentiate between sore muscles from the workout and a possible injury. You typically feel sore muscles about a day later, and the feeling can last for 2 to 3 days. You can treat it with rest and nonsteroidal anti-inflammatory medicines such as aspirin, ibuprofen, or naproxen. If there is pain associated with the sciatica, you should consult your physician to make sure there isn't a more intense injury that needs to be treated.

Question:

If you are allergic to codeine can you use Bactroban topical?

Answer:

Yes, you can use Bactroban topical if you are allergic to codeine. These two medications are not related. Therefore, you will not have the same allergic reaction to the Bactroban antibiotic cream as you do with the codeine, or pain/cough suppressant medication.

Question:

Is it harmful to drink alcoholic beverages while taking prednisone?

Answer:

Currently, there are no drug-drug interactions between alcoholic beverages and prednisone. However, new drug interactions may be discovered. So it is important to check with your health care professional, especially the pharmacist, to make sure it is still OK to take this combination together.

Question:

Should I be concerned about getting a tattoo if I’m taking any certain medications?

Answer:

Any medication that can thin the blood, such as Coumadin, should be avoided. Drinking alcohol should also be avoided for this reason. Keep in mind that getting a tattoo is like having a wound that needs to heal appropriately. Proper care should be taken in consideration.
You should also consult with your health care professional about contraindications that may interfere with your immune system or healing time, such as diabetes, heart conditions, allergies, or any viral conditions. Extra precautions may need to be taken under these circumstances. Make sure you are up to date with your immunizations, especially hepatitis and tetanus.

Question:

My mother has been taking Joint MD for the last several months. With Joint MD she has no trouble with walking. I can no longer find it on the market. Are there any other products that would give her the same results?

Answer:

All the information for Joint MD is contained on the MD Products’ web site, a company that also produces a wide range of health and wellness supplements. The Joint MD page is fairly brief but the basics of the product and its formula are covered. A diagram is included, showing exactly how it works in the joint. Several customer testimonials are on the site, and there is a short FAQ section.
Be cautious. Joint MD is a doctor-developed product and it is not monitored or approved by the FDA. If the product is no longer available there may be a very good reason why the risks outweigh the benefits. Check with your mother’s doctor to make sure this product is safe to continue.

Question:

My husband is currently taking Neurotin and Percocet for a broken back and nerve damage. He has been unable to fall asleep, so his father gave him three over-the-counter sleep aids last night. Is it OK to mix these with what he is currently taking?

Answer:

Without knowing the exact medication his father gave him, it is really hard to say whether or not the combination is safe for your husband to take. Keep in mind, while over-the-counter medications are readily available, safety is still important. There are still drug-drug interactions that can occur, toxicities with taking too much, and it is important to take medications, whether prescription or over-the- counter, for the right reasons.
Most over-the-counter sleep aids contain diphenhydramine as the active ingredient. If he was given 3 pills, he could have taken too much. Another thing to keep in mind is that many sleep aids contain a pain reliever, such as acetaminophen or ibuprofen. If he is taking Percocet, which contains oxycodone and acetaminophen, he could be taking too much acetaminophen, which can be very toxic.
Mixing over-the-counter medications with prescription medications is not as simple as one would think. It is really important to check with a medical professional to make sure there is no duplication or drug-drug interactions.

Question:

I just spilled my Cephalexin on the floor. I just had foot surgery on Friday. Am I OK to take it?

Answer:

If you are referring to the capsule, yes. The capsule protects the medication. Just brush it off and pick them all up. If the capsules get wet then it could start the dissolving process. If the medication is a liquid then you may need more from the pharmacy.
Check with your insurance benefits to see if they have a damaged medication override for the pharmacist to dispense more medication to you.

Question:

I have been experiencing hand and lower arm tremors. I read about an herbal treatment called Limbarax for this problem. Is it safe and do you think it will help?

Answer:

There is not a lot of information about Limbarax. Keep in mind that herbal products are not regulated by the FDA, leaving plenty of room for consumers to believe a product works without knowing about the ingredients, warnings, side effects, and dosages. I would be cautious about using this product. I would also encourage you to seek medical attention about the lower arm tremors to make sure nothing more complicated is going on.

Question:

I have cast itch. Is there a product I can buy that has an extended aerosol spray to help with the itching?

Answer:

Do not put anything inside the cast. This could irritate the skin with small micro-cuts, which can lead to an infection. Do not use talc or creams inside a plaster cast. These become gritty when mixed with sweat, which could also irritate the skin and cause an allergy or infection.
Raise your arm or leg up above chest level for about 1 hour. This can help reduce the swelling and cool the area, which would decrease the itch. If it is too intense, talk with your pharmacist about using an oral antihistamine for the itching. Be cautious about drug-drug interactions or drowsiness. If the itching is still too intense, check with you doctor about recasting the area.

Question:

Can potassium help with leg cramps?

Answer:

Low potassium is usually a sign of muscle weakness. Leg cramps are mostly caused by dehydration, low magnesium, or low blood calcium. The best treatment for cramps is to rehydrate and replenish your electrolytes, possibly with chicken or beef broth.

Question:

How long after drinking a margarita do you have to wait before taking a Vicoden for muscle pain?

Answer:

The liver is responsible for metabolizing Vicoden and alcohol. The liver can metabolize only a certain amount of alcohol per hour, regardless of the amount that has been consumed. The rate of alcohol metabolism depends, in part, on the amount of metabolizing enzymes in the liver, which varies among individuals and appears to have genetic determinants.
In general, after the consumption of one standard drink, the amount of alcohol in a drinker's blood (blood alcohol concentration, or BAC) peaks within 30 to 45 minutes. (A standard drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof distilled spirits, all of which contain the same amount of alcohol.) Alcohol is metabolized more slowly than it is absorbed. Since the metabolism of alcohol is slow, consumption needs to be controlled to prevent accumulation in the body and intoxication.
Everyone’s metabolism by the liver can vary depending on several different factors, including age, food consumption, body weight, gender, and most importantly and most controllably, drug-drug interactions. Alcohol has a drug-drug interaction with acetaminophen (Tylenol). Many studies have shown that liver damage can occur with the combination of acetaminophen and alcohol.

Question:

Does a written prescription expire?

Answer:

Every state will differ in regards to how long a written prescription will be active. Check with your local pharmacist to learn your state’s regulations regarding the type of prescription and the expiration date.

Question:

I have a plantar wart on the heel of my foot. Is there something I can buy over-the-counter for this?

Answer:

Salicylic acid is available at drug stores for wart removal. However, if the wart is in a very callused place, you may want to have your health care professional freeze the wart off with prescription-strength medication. Sanding the skin down can flake off the wart and transfer it to another location on the body. Seek medical advice for the quickest, safest removal.

Question:

I was given a cortisone injection in my knee a few days ago. Since then, I have experienced stomach problems and my face is flush and hot to the touch. Are either of these a side effect of my injection?

Answer:

Upset stomach is not likely a side effect from the cortisone injection. But cortisone can cause flushing or swelling of the skin. Do not be alarmed. This side effect will probably subside.
However, if you itch, if redness appears, or if you have difficulty breathing, seek medical advice to make sure you are not having an allergic reaction to the injection. If any of these symptoms becomes unbearable, seek advice from your health care professional or your local pharmacist.

Question:

Is there a known reaction from mixing Skelaxin 800 mg, Geodon 40 mg, and Unisom?

Answer:

There is a moderate interaction between Skelaxin and Geodon. The drugs can depress the central nervous system and respiratory system, especially in elderly or debilitated patients.
If your health care professional/prescriber feels that it is all right to take this combination, you should be monitored carefully. You should avoid hazardous activities requiring mental alertness and coordination until you know how these drugs will affect you.
The same interaction can be seen between Skelaxin and Unisom. It is not advisable to take this combination. If you are experiencing issues with sleep, consult your health care professional to determine the root cause.

Question:

My wife slid down eight steps and has bruising on her buttocks. She is sore all over her body. What rub-on pain relief can she use? We used a rub on call Glacier previously but cannot find it now.

Answer:

To relieve the soreness, your wife should try the RICE method: 
Rest
Ice the sore areas
Compress the sore areas with an Ace bandage
Elevate the sore parts of her body
She may also try taking over-the-counter pain relievers (particularly NSAIDs), and doing some light stretching exercises. There are many different over-the-counter pain relievers to select. Ask your local pharmacist to aid in the selection that best fits your wife’s age and health.

Question:

I have a sprained neck and have been seen by two different doctors. One prescribed Vicodin, and the other prescribed Nabumetone 750 mg. Can I take both together as directed on each bottle?

Answer:

I do not recommend taking both without consulting one of the prescribers. These medications both treat pain, but in different ways. They will not interact or increase toxicity levels from the ingredients. However, it is important to check with your health care professional and keep them all in the loop about all the medications you are taking or have been prescribed.

Question:

I have a prescription for a compression stocking. Can I go to a drugstore for this item?

Answer:

A medical supply store or specialty pharmacy is your best bet if you are going to run the prescription through your insurance company. Call your medical and pharmacy benefits to see if this medial supply is covered. If it is not covered, you can look online to compare the cheapest prices.
Make sure you get the specifics from your doctor as to thickness or compression type; full leg or partial leg. This will help you search for the actual stocking that your health care professional is recommending

Question:

Where can I find quinine pills for my husband’s leg cramps?

Answer:

Don’t use quinine for your husband’s leg cramps. Quinine is a malaria drug that can cause serious side effects such as severe bleeding, abnormal heart rhythms, and even death. The FDA issued a drug safety warning on July 8, 2010, and will soon require the drugmaker to warn doctors of its potentially life-threatening side effects. Talk to the doctor about other safe ways to ease leg cramps.

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