Medications (mainly for Knee Osteoarthritis)

It is usually safe to take Tylenol with most prescription medications but taking Tylenol with alcohol can cause liver damage. Exceeding the recommended daily limit also can damage your liver.

Codeine Preparations

When Tylenol is not enough, more potent medications such as Tylenol with Codeine may be prescribed. Codeine is a narcotic that helps reduce pain. It is rarely addictive when used for pain relief. However, when codeine is used regularly for a long time, you develop a tolerance to it - you need larger amounts of the medication to relieve the pain. Since knee osteoarthritis is a chronic condition, save codeine preparations for your really bad days.

Tylenol 1 contains a low dose of codeine - 8 mg . Tylenol 2 contains 15 mg of codeine & Tylenol 3 contains 30 mg of codeine.
Acetylsalicylic acid (Aspirin), and Ibuprofen with codeine are also available

Side effects of codeine are constipation, which can be counteracted with fiber, stool softeners, prune juice, lots of fluids

NSAIDS

NSAIDS (Non-steroidal anti-inflammatory drugs) are medications used to treat pain and inflammation.

Non-prescription NSAIDs:
- Acetylsalicylic acid (ASA), Brand names: Aspirin, Anacin
- Ibuprofen, Brand names: Advil, Motrin, Nuprin
- Naproxen, Brand names: Aleve

Prescription NSAIDs:
Diclofenac (Voltaren, Arthrotec), Celebrex, (Vioxx and Bextra have been recalled)

Side effects of NSAIDs:
Side effects are dose related:
Short term use may cause upset stomach, nausea, heartburn.
Long term use can cause erosion of the stomach lining and potentially life-threatening bleeding ulcers in some people. Medications to reduce the risk of ulceration can be prescribed. NSAIDs should be taken with a meal to reduce the risk of stomach upset.

Slow release NSAIDs dissolve mostly in the small intestine, past the stomach, decreasing the chance of stomach upset - however, the gastrointestinal effects of these medications are not eliminated. NSAIDs decrease inflammation by decreasing prostaglandins (natural substances involved in inflammation) and certain prostaglandins are required to protect the stomach lining from stomach acid. Some NSAIDs have less severe gastrointestinal side effects than others because they have less effect on the stomach prostaglandins (e.g. Cox-II Selective Inhibitors)

COX-2 Inhibitors:

COX-2 inhibitors are a subset of NSAIDs. The COX-2 inhibitors are commonly prescribed for osteoarthritis because they are less likely to cause stomach ulcers with long-term use than the other NSAIDs.

Vioxx and Bextra, two COX-2 inhibitors, are no longer on the market in the United States. Celebrex is still on the market.

Vioxx was recalled Sept 30, 2004 after a study showed an increased risk for heart attack and stroke, beginning after 18 months of taking Vioxx. Vioxx had been on the market since 1999. Questions were raised as to the safety of Bextra and Celebrex, both of which are in the same class of medications.

Bextra was the next to go. The Food and Drug Administration requested Pfizer to voluntarily suspend sales of Bextra in the United States in April, 2005. The risks appeared to outweigh the benefits. Bextra has a higher risk of rare but serious, life-threatening skin reactions than other NSAIDs and offers no benefits over other NSAIDs.

Celebrex remains on the market to date (summer 2006). In response to the request of the Food and Drug Administration April 7/2005, Celebrex has expanded its risk information to include a boxed warning highlighting the potential for increased risk of cardiovascular (CV) events and gastrointestinal (GI) bleeding. The FDA concluded "The benefits of Celebrex outweigh the potential risks in properly selected and informed patients."

Based on currently available data FDA has concluded that the potential for increased risk of serious cardiovascular adverse events may be a class effect of NSAIDs (excluding aspirin). Click here to read FDA alert.

THE FDA requires boxed warnings of potential cardiovascular risk for all prescription NSAIDs both COX-2 pain relievers and non-selective NSAIDs), including older non-specific drugs such as ibuprofen and naproxen. Some drugs are available in both prescription and non-prescription form.

The FDA has asked manufacturers of non-prescription NSAIDs to revise their labeling to include more specific information about potential cardiovascular and gastrointestinal risks and a warning about potential skin reactions. The new labeling is expected to be in place by the end of 2006.

Note: While not risk-free, non-prescription NSAIDs (including of ibuprofen and naproxen) are of a lower dose and do not appear to significantly increase the risk of serious cardiovascular events. Taking aspirin does not increase chance of heart attack but has the other risks associated with NSAIDs).

See FDA's Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

Topical Medications

Some prescription topical creams contain an NSAID that is absorbed through your skin directly to the area where it is needed. The amount of drug absorbed by the bloodstream is minimal, eliminating or significantly reducing the side effects associated with oral NSAIDs. Because some medication still gets into the bloodstream, if you are taking oral NSAIDs for knee osteoarthritis you may have to reduce the dosage of your medication.

Corticosteroids

In severe cases of knee osteoarthritis, where mobility is severely restricted, corticosteroids (steroids) can be injected into the knee joint for quick relief that can last from weeks to months to years. Steroid medications have powerful anti-inflammatory properties but also can have serious side effects. Used too frequently, they can actually lead to more cartilage degradation. In knee osteoarthritis, corticosteroids are not given orally because the side effects outweigh the benefits.

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