Medications (mainly for Knee Osteoarthritis)

Analgesics

Analgesics are painkillers which relieve pain, but do not reduce inflammation. Tylenol falls into this category. Tylenol (acetaminophen) is usually well tolerated but like every medication, does not "agree" with everyone. It can cause nausea in some people.

Because Tylenol does not erode the stomach lining as NSAIDs can with long term use, it is commonly prescribed for the pain of knee osteoarthritis and other chronic conditions.

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

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.
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.

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 selective NSAIDs) :

Celebrex is a COX-2 inhibitor. Celebrex is commonly prescribed for osteoarthritis because it is less likely to cause severe gastrointestinal side effects with long-term use than the non-selective NSAIDs.

Though Celebrex was linked to an increase in cardiovascular events, the FDA concluded "The benefits of Celebrex outweigh the potential risks in properly selected and informed patients."

Vioxx and Bextra, two other COX-2 inhibitors, were taken off the market in the United States back in 2004 and 2005. It was concluded that the risks of Vioxx and Bextra outweighed the benefits.

THE FDA requires boxed warnings of potential cardiovascular risk for all prescription NSAIDs (both COX-2 selective 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 requires manufacturers of non-prescription NSAIDs to include information about potential cardiovascular and gastrointestinal risks and a warning about potential skin reactions in their labeling.

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 appear to increase chance of heart attack but has the other risks associated with NSAIDs.

See list of COX-2 Selective and Non-Selective 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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