WebMD Ask the Pharmacist

Pain Relief Medications: Ask the Pharmacist

Macary Marciniak, PharmD, BCPS, answers common questions about pain relief medications, side effects, allergic reactions, and drug interactions.

Question:

I take atenolol and have hydrocodone for pain. Is it safe to take them together?

Answer:

Atenolol is a beta-blocker, a medication that is used for heart conditions like high blood pressure or irregular heart rhythms. It is safe to take atenolol with hydrocodone, a prescription opioid pain reliever.

Question:

Can I safely take Flexeril if I have been using ibuprofen for a strained back?

Answer:

Flexeril is a brand name prescription muscle relaxant and ibuprofen is a pain reliever. These two medications are often used together to help relieve a strained back -- ibuprofen will ease the pain, while Flexeril will relax the muscles. Typically, Flexeril should be used for a short period of time.

Question:

What's the difference between Vicodin and Vicodin ES?

Answer:

Vicodin and Vicodin ES are prescription pain relievers. They both contain the same active ingredients -- hydrocodone and acetaminophen -- but contain different amounts of each ingredient. Each Vicodin tablet contains 5 mg of hydrocodone and 500 mg of acetaminophen. Each Vicodin ES tablet contains 7.5 mg of hydrocodone and 750 mg of acetaminophen.

Recently, the Food and Drug Administration (FDA) has asked manufacturers to limit the amount of acetaminophen in each tablet, capsule, or other dosage form. Eventually, the amount of acetaminophen in each Vicodin and Vicodin ES tablet will be 325 mg (vs. the 500 mg or 750 mg currently). The dosing instructions will stay the same as will the maximum amount of tablets that can be taken daily. Also, the labels will now include a warning about the risk for severe liver injury and allergic reactions. An allergic reaction might be rash, itching, swelling of the face, mouth, or throat, or difficulty breathing. The FDA hopes that these changes will help to lower risks associated with acetaminophen use.

As always, while taking Vicodin, please do not take any other prescription or nonprescription medicines that also contain acetaminophen (brand name: Tylenol) or drink alcohol.

Question:

I am a diabetic and I have back pain off and on. Panitrol MSM was recommended to me. Is this safe for diabetics?

Answer:

Panitrol MSM is a dietary supplement that contains a number of ingredients, including MSM, juniper, goldenrod, dandelion, meadowsweet, and willow. I am not aware of strong data that would support the efficacy of this product (or its active ingredients) for back pain. There is also the potential for a number of interactions with this product and medications for your diabetes. As such, I would definitely not recommend this product for you.

If your back pain is infrequent, I would first try acetaminophen or a heating pad/heat wrap. If these options do not work, I would talk with your health care provider about other medications that would not be a concern with your diabetes or other medications.

Question:

What is the difference between oxycodone and hydrocodone?

Answer:

Oxycodone and hydrocodone are both opioid pain relievers. They are both extremely potent and are used for moderate to severe pain. Oxycodone is stronger than hydrocodone. Oxycodone is a C-II controlled substance, while hydrocodone is a C-III controlled substance. A C-II medication typically has more addictive potential than a C-III medication.

Question:

I am using the Fentanyl transdermal system. Are there any side effects such as headaches?

Answer:

The Fentanyl transdermal system is a very strong prescription pain medication. Headache is a common side effect of the patch. You might also notice dizziness, drowsiness, fatigue, and sedation. It can lower your heart rate, cause dry mouth, nausea, and constipation. Because Fentanyl transdermal system is a patch that is applied to the skin, some people can also have local skin reactions around the application site.

Question:

A friend recommended taking ibuprofen and an acetaminophen together for my back pain. Is it OK to mix them?

Answer:

Ibuprofen and acetaminophen are both pain relievers, but they work in different ways. Ibuprofen helps to relieve pain and inflammation, but acetaminophen only relieves pain (it doesn’t help with inflammation). It is possible to use both medications together, particularly in the short term to help relieve pain, but you may not see too much of a benefit.

There are also some potential risks with these medications. When taken in high doses and for a long period of time, ibuprofen may cause stomach or kidney problems. Acetaminophen has a risk for liver injury if too much is taken. If you find that you need both medications for a long time to relieve your pain, then you should talk with your health care provider, as you may need a stronger prescription medication to manage your pain.

Question:

If baby aspirin is used as a preventative measure and for cardiac health, should it be enteric-coated?

Answer:

Great question! I always recommend that my patients take an enteric-coated aspirin. Enteric-coating is a thin layer on the tablet that helps to protect the stomach from damage. Since you need to take the aspirin regularly, people typically notice less stomach upset or heartburn with the enteric-coated version. I also suggest taking the enteric-coated aspirin with food (a light snack or meal) to reduce the potential for stomach upset.

Question:

Can you mix ibuprofen and Excedrin for pain relief?

Answer:

There are a couple different versions of Excedrin available, but it typically contains acetaminophen, aspirin, and caffeine. Ibuprofen is a pain reliever that is very similar to aspirin. Taking both ibuprofen and Excedrin together will probably not be beneficial and may cause harm. Taken together, these medications will likely cause stomach upset and may lead to a stomach ulcer.

I would not recommend this particular combination. If one product or the other is not sufficient for your pain, talk with your local pharmacist or health care provider who could suggest other options, depending on the type of pain that you are experiencing.

Question:

Are there any problems taking acetaminophen and Cialis?

Answer:

Acetaminophen is a pain reliever, and Cialis is a prescription medication for erectile dysfunction. There are no interactions between these two medications, and they are completely safe to take together.

Question:

Are there any side effects to taking Zoloft with tramadol?

Answer:

Zoloft is a prescription medication that is often used to treat depression. Tramadol is a prescription medication used to treat moderate to severe pain. There are some potential risks with taking these two medications together. You may possibly develop serotonin syndrome, a rare condition where you would have agitation, sweating, tremors, and fever. There is also the potential for an increased risk of seizures. If you are using the tramadol infrequently, then your risk of developing these problems is probably low.

I would talk with your health care provider to ensure that these medications are the best choices for you.

Question:

Where I can get belladonna? My husband has cancer of the pancreas and this is needed for the pain in the abdomen after all his treatments.

Answer:

Belladonna is a prescription product that is used to relieve spasms and also causes mild sedation. Talk with your husband’s health care provider/oncologist about this medication. If they believe it is the right choice for his pain, then they can provide him with a prescription.

Question:

Are there any known drug interactions between amoxicillin and Vicodin?

Answer:

Amoxicillin is a prescription antibiotic and Vicodin is a prescription pain reliever. There are no interactions between these two medications and they are completely safe to take together.

Thanks so much for checking! It is so important that people do consider the potential for interactions between prescription and nonprescription medications.

Question:

Can I take acetaminophen if I am also taking Percocet?

Answer:

Percocet is a prescription pain reliever that contains oxycodone and acetaminophen. There is 325 mg of acetaminophen in each Percocet tablet. I generally recommend that my patients not take Percocet and acetaminophen together, as there is a serious risk of taking too much acetaminophen.

The maximum amount of acetaminophen someone should take is 4,000 mg daily, although some groups are recommending even less, like 3,000 mg daily. Taking too much acetaminophen can result in liver injury. You should also not consume alcohol while taking acetaminophen-containing products.

And, be sure to read the label of any other over-the-counter products to ensure that they don’t contain acetaminophen either. Thanks so much for checking on this!

Question:

I currently take Lyrica 800 mg daily along with opioid pain medication for chronic pain. Should I be concerned about the possibility of a reaction between the two drugs? I just read that Lyrica interacts with opioids at certain doses but the article was not specific.

Answer:

Lyrica and opioid pain medications can be taken together; however, you may see an increase in some side effects such as drowsiness or confusion. You will have to see how these medications work for you and if you are able to tolerate any side effects.

Question:

Is tramadol/Ultram non-narcotic?

Answer:

Yes, tramadol (brand name: Ultram) is not a narcotic. It is a very potent prescription pain reliever that is used for moderate to severe pain, but it is not a controlled substance.

Question:

I take Lunesta to help sleep (3mg). My dentist prescribed Percocet for pain relief until they can do the procedure Monday. Is it OK to take the 2 meds together?

Answer:

As Lunesta is a medication to help with insomnia, it causes drowsiness. Percocet is a prescription pain reliever that can also cause drowsiness. It is safe to take both medications together, but taking them together will definitely increase your drowsiness. It sounds like the Percocet is for short-term use. If so, then you may find that the Lunesta is not needed to help you sleep at night.

Also, while taking the Percocet, please be careful about driving as you may feel drowsy. Hope you feel better soon!

Question:

I had oral surgery and have filled both of my prescriptions. Can I take a Vicodin and an ibuprofen in the same 4 hour period?

Answer:

Vicodin is a strong prescription pain reliever that contains hydrocodone and acetaminophen. Ibuprofen is a pain reliever that is good at relieving mild pain and inflammation. You can take both medications together.

For oral surgery, the ibuprofen will definitely help with swelling and inflammation that is likely present. But, it may not be enough to completely relieve your pain. The Vicodin will provide stronger pain relief than the ibuprofen.

It is also important to note that you should not take Tylenol or other acetaminophen-containing products with your Vicodin. If you did, you might consume more than the daily limit of acetaminophen, which is 4,000 mg daily. But it is OK to take both Vicodin and ibuprofen together, particularly for short-term use like relief of pain from oral surgery.

Question:

Can I take tramadol and Coumadin together? I have been taking Coumadin for several years, and was just prescribed tramadol for leg pain/arthritis.

Answer:

Tramadol (brand name: Ultram) is a very potent prescription pain reliever that is used for moderate to severe pain. Coumadin is a “blood thinner” and taking it with tramadol can increase your risk of bleeding. There are other medications that can help with leg pain/arthritis, such as acetaminophen (brand name: Tylenol), that would be a lower risk for bleeding.

If your health care provider believes that the tramadol is the best medication to treat your leg pain/arthritis, then you can stay on both medications. But your provider will want to monitor your PT/INR regularly. And you should stay alert for signs of increased bleeding, such as bleeding gums, bruising, or blood in your urine or stool.

If you see any signs of bleeding, you should let your health care provider know as soon as possible.

Question:

My mother is taking Avelox 400 mg and prednisone. Can she still take an aspirin if needed?

Answer:

Avelox is a prescription antibiotic and prednisone is an anti-inflammatory medication. Taking aspirin and prednisone together can increase someone’s risk for bruising or bleeding. It would help to know why your mother is using the aspirin and the prednisone. If one or both is for short-term use, then your risk of bleeding would be lower. If she is taking either the aspirin or the prednisone long-term, then her risk for bleeding may be higher.

If the aspirin is only used for occasional pain relief, she should be fine. She could also try acetaminophen (brand name: Tylenol) instead. Acetaminophen would not cause any increased bleeding with her Avelox or prednisone.

Question:

Is Motrin and ibuprofen basically the same thing?

Answer:

Yes, Motrin is a brand-name product and ibuprofen is its active ingredient. Advil is another brand-name product that contains ibuprofen. You definitely should not take both Motrin and ibuprofen together.

Question:

Can I take meloxicam, acetaminophen, and Aleve at the same time?

Answer:

Meloxicam (brand name: Mobic) is a prescription nonsteroidal anti-inflammatory drug (NSAID) that helps to relieve both pain and inflammation. Aleve is a nonprescription NSAID. Both of these medications work exactly the same. Therefore, I would not take both of these medications at the same time.

If the Aleve (active ingredient: naproxen) is sufficient to relieve your pain, then I would use it and not the meloxicam. If you need more pain relief, then I would take the meloxicam and not the Aleve.

Acetaminophen (brand name: Tylenol) is a pain reliever but does not help with inflammation. Depending on your type of pain, I would use either acetaminophen or meloxicam/Aleve. I would not suggest using meloxicam, acetaminophen, and Aleve all at the same time.

Question:

I was wondering, could a person take ibuprofen and tramadol together for pain?

Answer:

Tramadol is a very potent prescription pain reliever that is used for moderate to severe pain. Ibuprofen is a nonprescription pain reliever that is good at relieving mild pain and inflammation. It shouldn’t be necessary to take both medications together.

If the ibuprofen is sufficient to relieve your pain, I would take it and not the tramadol. If you need more pain relief, then I would take the tramadol and not the ibuprofen. If in one day, you needed to use both medications, that would be OK, but I wouldn’t take both together at the same time.

Question:

Answer:

Tylenol #3 contains acetaminophen and codeine and is a strong pain reliever. Soma is a prescription muscle relaxant. It is OK to take these medications together; however, you will likely notice an increase in dizziness or drowsiness.

Also, while taking both medications, please avoid driving. Hope you feel better soon!

Question:

Can I mix my Zoloft and Flexeril? I'm assuming I can as I got them at the same pharmacy, but I’m checking because they were prescribed by two different doctors.

Answer:

Zoloft is a prescription medication that is often used for depression, and Flexeril is a prescription muscle relaxant. It is safe to take both of these medications together. It is possible that you may notice some drowsiness, so I would be cautious when driving.

Question:

Is it safe to take Benadryl and Aleve together?

Answer:

Benadryl is a nonprescription medication that is often used for allergies, and Aleve is a nonprescription pain reliever. One of the most common side effects of Benadryl is drowsiness. Depending on the quantity taken, Aleve may also cause some drowsiness. But there are no interactions between these two medications, and they are completely safe to take together.

Question:

Do they make a generic for OxyContin?

Answer:

OxyContin is a brand-name medication whose active ingredient is oxycodone. OxyContin is a controlled-release product. There is no generic for OxyContin. However, there are generic oxycodone products that are immediate-release and not controlled-release.

Question:

I am taking two 500 mg tablets of nabumetone two times daily. I also take omeprazole DR capsules once daily. Can I also take a nasal decongestant for my cold symptoms?

Answer:

Nabumetone is a pain reliever, and omeprazole is a heartburn medication. A nasal decongestant such as pseudoephedrine (brand name: Sudafed) or oxymetazoline (brand name: Afrin) would be safe to take with nabumetone.

Thanks so much for checking! It is so important that people do consider the potential for interactions between prescription and nonprescription medications.

Question:

Can you explain what’s happening with the dosing on the infant’s vs. children’s versions of acetaminophen?

Answer:

Great question! This is an area that has been changing recently. Manufacturers of generic acetaminophen as well as brand-name Tylenol products have decided to only have one formulation of acetaminophen on the shelves. They have voluntarily discontinued the more concentrated formula previously used in infant products, and will now use the same concentration for both infant’s and children’s formulations. I am excited about this change because it may help to reduce the risk of unintentional overdoses that can occur with these products.

With the liquid acetaminophen products, it is also important to use only the dosing device that comes packaged with the product (like a dosing syringe or dosing cup). If your product does not have one, please talk with your local pharmacist who can help you purchase one, and show you how to measure the correct amount for your child.

Question:

Should flexeril and naproxen be taken together?

Answer:

Flexeril is a prescription muscle relaxant, and naproxen is a nonprescription pain reliever. There are no interactions between these two medications, and it is completely safe to take these together. In fact, this is often done so that the naproxen relieves the pain, while the Flexeril relaxes the muscles. Remember to take the naproxen with some food so that it does not upset your stomach too much.

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