Had a “procedure” yesterday and the instructions included No NSAIDs for 6 days prior. Ok, but since I have chronic aches and pains that respond just fine to the occasional aspirin, Tylenol, or Advil, without that stuff I was plenty sore for those few days. But are there any non-NSAIDs available over the counter? Of course, I mean aside from opioids, which, of course, are not available over the counter.
Acetaminophen is not an NSAID. So Tylenol would be fine.
Medical marijuana. That is also not recommended before a lot of procedures but doctors already understand it’s happening anyway. If the procedure involves anesthesia you should tell them if you ingest THC products regularly.
I don’t have a cite to hand, but I recall reading that the margin between therapeutic and toxic dose for acetaminophen is a bit too close for comfort, and it might not have been approved by current standards?
Potentially causing liver damage? But I am not a pharmacist…
Assuming you have a properly functioning liver e.g. no liver disease and not a chronic alcoholic, Tylenol is safe up to 4g per day. The problems stem from people that take multiple medications that contain Tylenol at the same time and blow through the max quickly. For example, if you have a bad back and take Tylenol and Robaxacet at the same time you would end up taking 8g a day.
…and add in Nyquil or other cold medicine, which may also contain Tylenol.
Anyway, yeah, Tylenol isn’t an NSAID and is OTC.
Are you a heavy drinker? If not, then just be careful- remembering that many OTC cold medicines already contain a significant dose of acetaminophen.
IANARD
I had a biopsy done a couple months ago and my instructions sounded the same as the OPs prior to the surgery. They told me no NSAIDs but Tylenol was okay, as it is not in this class of drugs.
Acetaminophen is a hell of a lot safer than NSAIDs, even for chronic alcoholics. Just take as directed and if you stay 3 grams or less a day (for an adult), you’ll really be safe. Acetaminophen causes far fewer deaths every year than NSAIDs do. Every year in the United States, NSAID use is linked to 17,000 deaths. Acetaminophen use is linked to ~500.
Do you want to speak a little more about the dangers of NSAIDs (other than pre-surgery)? Am I not OK popping a couple of aspirin or Advil every so often – would it be wise to switch to Tylenol for general use?
I believe the serious risks of NSAIDs are mainly related to prolonged use, as they are often treatment for chronic pain. If you have no history of GI issues from NSAIDs you should be fine for occasional use.
But I’m not a medical professional, I’m sure some one else can provide real citations.
My limited understanding of the precautions surrounding NSAIDs and medical procedures is that most NSAIDs have an anti-coagulation effect on top of the risk of gastric irritation.
It’s the basis of the idea of 81 mg “baby” asprin as an anti-clotting heart attack risk reduction regime.
Most folks tolerate occasional NSAIDs just fine. Most common side effect with occasional use is some mild stomach upset or esophageal reflux, which can often be minimized by taking it with some food. If taking more regularly (more than 2 x a week for extended periods) it can cause gastric and esophageal erosions and even ulcerations in a small but not insignificant number of folks.
If one has kidney disease or heart disease or bleeding disorders or chronic GI issues, one should consult their practitioner about whether NSAIDs should be avoided completely.
One should not generally take two different NSAIDs chronically either (chief exception: folks on 81 mg ‘baby’ aspirin daily may be ok taking other NSAIDs for pain relief).
Most otherwise healthy folks tolerate an occasional ibuprofen or naproxen for the headache/muscle strain etc. without problems. Most debility/death cases arise from chronic daily use or intentional massive overdose.
But taking NSAIDs chronically, at the direction and under the supervision of a physician, can still be a relatively safe plan for many patients with various conditions. Chronic managed NSAID use (6+ weeks or more) can significantly reduce inflammation and keep it reduced, especially in a lot of rheumatologic conditions.
But yeah, the occasional acetaminophen is probably a tiny bit more safe than the occasional NSAID. However, if you have found that acetaminophen doesn’t do much for your headache but ibuprofen does provide relief, I’d not hesitate to take the ibuprofen (well, personally I wouldn’t as my own docs tell me to stay away due to cardiac and renal issues, so I do avoid it).
You may have read something here:
Specifically, that’s aspirin. Aspirin has a permanent effect on platelets. Platelets have an effective life of about 6 days, (and are replaced after about two weeks).
The other NSAIDS have an effect of around 6 hours: that’s why you have to take another every 4-6 hours.
NSAIDs are C0X1 inhibitors or COX2 inhibitors or non-specific. COX1 inhibitors make you more likely to blead, COX2 inhibitors make you more likely to clot, dunno what non-specific effects are.
Acetaminophen has its effect on the cannabinoid system in the brain (see also thread about Acetaminophen hallucinations). It is also, as it turns out, a COX2 inhibitor.
So:
it doesn’t matter that you took acetaminophen 5 days ago.
Even if took it just before the procedure, it’s cleared out of your system by the time the procedure if finished.
But clotting is not as much of an issue as bleeding.
And if they are worried about clotting, they pre-treating you with anti-clotting agents.
But in any case, though acetaminophen is a COX2 inhibitor, and anti-inflammatory, and non-steroidal, it’s not one that’s been shown to have dangerous levels of thrombotic effect, like some of those now not used at all in the US medical system.
So the important, significant meaning of “acetaminophen is not a NSAID” is “acetaminophen is not Aspirin”, and the secondary meaning is “acetaminophen is not known to cause significant bleeding or thrombosis”.
Acetaminophen is both known to have a mild anti-inflammatory effect, and to be “not an anti-inflammatory drug”, It’s a non-steroidal anti-inflammatory and not a NSAID. Naming is important, but not always consistent.
Hello, Doctor! I’ve admired your humane and erudite posts for some time.
A quick question of clarification, for, really, anyone who knows. Don’t wish to abuse your gift of knowledge, after all.
But, when you say:
I’m taking it to mean that causes of debility up to and including death are primarily the following:
Is this a fair reading?
The source of my curiosity is that, under my long-time physician’s care, I’ve been taking ibuprofen regularly for about four years or so. Not more than five. And never exceeding 2400 mg quod diem, i.e., the maximum “recommended” daily dose. Most days during that period, which continues.
However, I have not experienced any gastric discomfort, nor any other symptoms that seem to be related to the esophagus, the gut, or other digestive system components.
Not seeking free advice, but even though my physician is confident that my use of prescription ibuprofen (in 800 mg boluses, taken by me between once and twice a day, so maximum 1600 mg qd) is OK, given that I present as asymptomatic…I’ll be seeing him professionally in about a month and would like to do a bit of light reading on the topic that is a bit above what Dr. Google Karen Oz is likely to provide without tighter search parameters.
Yes, that’s a fair reading. And call me Qadgop, as I’m retired and I wasn’t your doc anyway (and thank your lucky stars for that!!) ;-D
That sort of ibuprofen regimen is certainly reasonable since it’s being regularly monitored by yourself and your physician. You might just ask for your doc’s commentary regards your cardiac, GI, and renal status on that plan. Along with any specific signs and symptoms to watch for that they’d recommend based on their medical knowledge of you in specific.
Inquire about your kidney function if you’re curious. That is a fairly routine blood test (checking creatinine and GFR) and you probably have had at least one or two such results in your chart during the previous 4-5 years.
Yes, that is my dosages- unless I take Mobic instead- and I was warned never to mix Mobic with ibuprofen but instead just take Acetaminophen for headaches, etc.
Mobic (Meloxicam) works much better than ibuprofen and it lasts longer, too. Too bad it’s also a NSAID and only available by prescription.
By now, one would think there would be better and different drugs than Tylenol that are also not NSAIDS.
You may not be a pharmacist, but I am. The highest recommended daily amount for an adult with normal liver function is 4 grams a day (eight 500-mg tablets) although 3 grams is really a better margin.
It’s not like 4g is safe and 4.5g will kill you, but it’s best not to take any chances.
(When I was newly minted, one of my friends crushed a finger in an accident at work, and was given Darvocet, which is no longer available, and she was taking 6 of those a day and then the 4g of Tylenol daily for breakthrough pain. She told me this on the phone, and I nearly blew out her eardrum with my reaction. She replied, “Oh, is that dangerous?” She only did that for a few days, and fortunately had no sequelae as a result.)