WebMD Ask the Pharmacist

Pain Relief: Ask the Pharmacist

Oct. 27, 2009. Pharmacist Kristen Binaso, RPh, answers your questions about pain relief and pain medications.

Question:

I am suffering from chronic back pain. I am taking 500 mg of naproxen once daily for pain and inflammation. Is this dosage sufficient, or should I take it more than once daily? Also, I have been prescribed Robaxin to relax the muscle spasms. Should I take both of these drugs together?

Answer:

I would really like to ask how you feel and if this is taking care of the pain? If you are still is pain, have you spoken to your doctor or health care provider to let them know? You should not take more than what was prescribed. What we are finding out is that pain therapy has to be individualized and that is why it's important to let your doctor or health care provider know if you are still experiencing pain -- they may need to adjust your medications. It is fine to take the naproxen and Robaxin together because they work differently to treat pain.

Question:

Is it normal to take Vicodin while pregnant?

Answer:

Vicodin is a pain medication that should really not be used in pregnant women unless the doctor or health care provider feels that the benefits outweigh the risks.

Question:

I'm taking amoxicillin 500 mg. Can I take acetaminophen for the pain and how much?

Answer:

Good question. I would need to ask some additional questions around why they are on an antibiotic and what kind of pain are they having and for how long. I would then ask if they have a personal medication record so I can see what other prescription and over-the-counter medications they are taking. If acetaminophen seems like a proper choice, I would advise taking it as directed on the package and make sure that you do not exceed the daily dose of 4,000 mg.

Question:

What are the symptoms of swine flu vs. regular seasonal flu?

Answer:

This is a good question and I want to let everyone know that they can go to www.flu.gov for up-to-the-minute information and resources. The H1N1 flu varies from seasonal flu in a few ways. One of the symptoms is diarrhea and vomiting, which is not typical of seasonal flu. The other important factor that is not typical of seasonal influenza is the age group that it affects. The H1N1 virus has been affecting healthy young adults (in their 20s and 30s).

Question:

I am allergic to aspirin, ibuprofen, and codeine. What other pain medicines could I take that would not cause an allergic reaction? I am having my gallbladder out and am concerned with pain.

Answer:

Because you are allergic to most of the medications used to treat pain, the only option that would be left is acetaminophen or Tylenol. Thanks for submitting a question today.

Question:

What is the maximum dose of ibuprofen that should be taken in 24 hours?

Answer:

The maximum daily dose of ibuprofen is 3,200 mg. However, if you are taking that much ibuprofen, I would be asking you a lot of questions as to why and if you have been to the doctor or health care provider for further evaluation. You want to also make sure that you are not taking products related to ibuprofen like aspirin, naproxen, and meloxicam and avoid alcohol while taking any of these products.

Question:

I take hydrocodone 10/660 for pain and I don't understand the 10 mg. Is that the pain medicine or the acetaminophen or is the 660 the dosage of pain medicine?

Answer:

This is a common question. Believe it or not, the medication that you are on is a combination product that uses two medications to combat pain on two different levels. Acetaminophen (660 mg) is an effective pain reliever and is used in combination with the hydrocodone (10 mg). You want to take the medication exactly as prescribed by your doctor or health care provider.

Question:

I have a shooting pain from the top of my jaw all the way up to my eye, and from the side of my nose all the way to my ear. I already tried ibuprofen, it didn’t work, and I tried a cold rag on the side of my face, what should I try to get the pain to go away?

Answer:

Due to the fact that you have tried ibuprofen and that did not seem to help, I am concerned with the level of pain that you are having and the area that you are having it in and strongly suggest that you see a health care provider for further evaluation. It could be a sign of an infection and it is very important that you have this looked at. Thanks for submitting a question today.

Question:

I take Excedrin for aches and pains. Each tablet contains 250 mg acetaminophen, 250 mg aspirin plus 65 mg caffeine. I average three tablets a day (24 hrs). Is that a safe amount to be taking or could that amount cause liver damage?

Answer:

This caught my attention because I would like to ask what types of aches and pains have you been experiencing that you need to take this medication as frequently as you do? Have you spoken to a doctor or health care provider about your pain and has it been evaluated? There may be better options for you once you are evaluated.

Question:

I fell on cement stairs 6 months ago and I am still in pain and I don’t like taking drugs to only cover the pain symptoms. What should I do?

Answer:

I would like to know if you went to see a doctor or health care provider when you fell and if you are still seeing them. It is very important that you advise them that you are still in pain so they can re-evaluate your condition and possibly prescribe treatment. At the end of the day, your quality of life is the most important and if you are on the right medications, it will actually help. When pain is not treated properly, it can cause other issues like insomnia and depression, not to mention the fact that you may call out sick from work or not be able to focus on work -- something that is called "presenteeism."

Question:

Do you recommend the swine flu (H1N1) vaccine?

Answer:

I absolutely recommend people getting the H1N1 vaccine. People do not realize that they will put themselves at more risk by not getting the vaccine. The H1N1 strain has been infecting healthy young adults, which is typically not the case for seasonal influenza. I know that there are questions about the safety, but the vaccine has been manufactured through the same process as the seasonal one. What people forget is the fact that the H1N1 vaccine was able to be manufactured more quickly because it contains only one strain whereas the seasonal influenza vaccine takes longer because it has three. It was not included in the seasonal vaccines this year because they had already started the manufacturing process.

Most likely next year, the seasonal influenza vaccine will contain the H1N1 already for the 2010-11 season. So just think of a simple cooking process, things with one ingredient take a lot less time than those with three. Be smart, get vaccinated!

Question:

What does the abbreviation “BID” on a prescription stand for?

Answer:

Great question, and something that you can always ask your pharmacist when you pick up your medication. The term "BID" means twice a day or every 12 hours. I recommend to patients that if they take their medication at 8 a.m., then they should take their next dose at 8 p.m. If you are ever unsure about how or when to take your medication, talk to your pharmacist.

Question:

Can I take Relpax 40 mg for migraine when I take my Norco for back pain? Is there a side effect if I do mix these two?

Answer:

This is a good question that you can always ask your pharmacist. You can be on both of these medications at the same time. I would recommend staying home if possible when you take your Relpax with the Norco so you can see how they make you feel (it may be hard to distinguish between the possible side effects and a migraine). Make sure that you carry a personal medication list that has all of your medications, including over-the-counter medications, and make sure you show that list to your pharmacist, doctor, and other health care providers.

Question:

Can Tamiflu be taken with ibuprofen?

Answer:

This is a good question that you can always ask your pharmacist. Yes, you can take ibuprofen while taking Tamiflu.

Question:

My mother has been prescribed numerous medications for several different things, and I’m questioning if it’s safe to be on all the meds she's on all at once.

Answer:

This is a great reason to go and talk to your pharmacist. This is why I went to pharmacy school and one of the reasons why I became a pharmacist -- to help people and make sure they are on the right medications and taking them correctly so they get the benefits of the medication. Your mother may be eligible for medication therapy management services. This is where a pharmacist will review all of her medications and look for possible problems and also make sure she is on the right medications. You can contact her insurance company to see if they cover this service, if not, some pharmacists offer these services as part of their practice for a fee.

Question:

What’s the difference between Percocet oral and Endocet oral?

Answer:

Endocet is a generic version of Percocet. It is manufactured by Endo Pharmaceuticals, and it is an FDA approved generic so there is no difference between the two. If you have any questions about generics, ask your pharmacist, we are happy to help.

Question:

Are there any OTC creams that will help relieve the pain and sting of shingles?

Answer:

Shingles is tough because it typically requires evaluation by a doctor or health care provider and prescription medications to help speed the recovery and for the pain. There are no over-the-counter creams that can be used for the pain and stinging.

Question:

My daughter has Crohn's disease. Can she take ibuprofen?

Answer:

Great question! You can take acetaminophen (Tylenol, others) for pain. You will want to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). These are likely to make your symptoms worse for Crohn's disease.

Question:

I had a nodule on my thyroid removed 13 years ago. I have been on Synthroid since then. Due to the economy I cannot afford my medication and have been off for three weeks. What is the worst thing that can happen if I don't take my medicine?

Answer:

This is very risky, and I have to ask if you talked to your pharmacist or doctor about the fact that you cannot afford your medication? If you are taking Synthroid (Brand) there may be other options for you to take that may not be as expensive. You should not go without taking your medication, and I also advise you to call your doctor or health care provider as soon as possible and let them know that you have not taken your medication for that long. Many people do not realize that this may cause more harm than good ... you may end up in the hospital, which ends up being a much bigger health care bill. You also want to check out the web site for Synthroid at www.synthroid.com and also the partnership for prescription assistance at www.pparx.org or by calling 888-477-2669.

Question:

I was using Sandoz brand Fentanyl patches and they worked well. My pharmacy switched me to Mylan brand and they appear to be totally different looking -- you cannot see the liquid medication inside as you could with the Sandoz. When I put the Sandoz brand on I could immediately feel a rush and a funny taste in my mouth, they began to work in about 45 minutes and the Mylan don't seem to work as fast. Is there a difference in brands? Both were 75 mcg/h. I have been using the patches for about eight weeks. Is there a preferred brand?

Answer:

This is a very good question because it shows that in pain management, the therapy has to be patient-specific. Both Sandoz and Mylan make generic versions of the Duragesic patch. They both contain the same active ingredient, but the way the medication is released through the patch may be different, and it also depends upon your skin and how it absorbs medications. In cases like this, I always talk to my patients to see what brand works better for them. I would suggest talking to your pharmacist and let them know that you have better results with the Sandoz brand and would prefer to receive that brand in the future. This is a great example of something that you can talk to you pharmacist about. It is important that your pain is managed properly, and if this helps in that cause, it is an easy fix.

Question:

If you have a cold can you still receive flu shot?

Answer:

This is a question I just got asked the other day. If you are sick with a fever, you should wait and get your flu shot at a later date. If it is just a cold or other type of mild illness, you can receive the flu shot.

Question:

What is Oxy IR?

Answer:

This is a good question that you can ask your pharmacist. Oxy IR is a medication that contains oxycodone that is used to treat moderate to severe pain. The IR stands for "immediate release."

Question:

I was prescribed Macrobid for a bladder infection, and I have a question about this medicine. Can I take it for a bad toothache?

Answer:

I always find out from my patients when they don’t finish their antibiotics when they are supposed to and try to save them for a rainy day. You should always finish your medications when you have an infection, even if you feel better. What many people do not know is that you can actually get a more severe infection because your body didn't benefit from the "trial phase" you decided to give it with a few days of pills rather than the full course. Macrobid is an antibiotic that is very specific for bladder infections and nothing else, so you cannot take this for your toothache. I would advise calling your dentist as soon as possible and get it checked out!

Question:

Are naproxen and Darvocet similar?

Answer:

Great question. Both of these medications can be used to treat pain. They are not similar in how they work though. Naproxen is an anti-inflammatory drug, so it tries to decrease inflammation that could be causing the pain. Darvocet is actually a combination product that uses a codeine-like ingredient along with an acetaminophen component. If you ever have any questions about medications, talk to your pharmacist.

Question:

I am taking 75 mg diclofenac. Can I also take Advil for cramps?

Answer:

No, you cannot take Advil if you are diclofenac. They are actually related to each other and are in the same class of what we call an NSAID -- nonsteroidal anti-inflammatory drug, so think of them as sisters in a family. You can try acetaminophen to see if that helps with the cramps, and I recommend talking to your doctor or health care provider about other options.

Question:

I am taking Lortab 7.5 twice a day, and when I do it makes my stomach hurt and makes me itch. When I've taken something called Percocet it doesn't cause the same problems as the Lortab. Why and what’s the difference in the two meds?

Answer:

Great question. Lorcet contains a different pain medication than Percocet, so there could be a possibility that you are allergic to the Lorcet. Stomach upset is common in pain medications, so you can also try taking the medication with some food (more of a meal rather than some crackers). I would suggest that you talk to your health care provider about your reaction to Lorcet and also let your pharmacist know. They can put a note in your profile about this reaction.

Question:

Can Mobic be taken with Diovan?

Answer:

This is a great question you can ask your pharmacist when you pick up your prescription. It is also the reason why it is very important to use one pharmacy for your medications so we can check for possible drug interactions. If you need to use more than one pharmacy, it is important that you carry a personal medication list, which is a list of all of your prescription medications, over the counters, vitamins and herbals and show that list to your pharmacist and doctors/health care providers. In this particular case, you can take Mobic and Diovan at the same time.

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