We typically
believe that nonprescription (OTC; over-the-counter) drugs are quite safe and
harmless, even if taken regularly and at maximum daily dosages. But nothing is
further from the truth. The very fact that we take them frequently, even daily,
puts our health and wellness at great risk. In this article, we will discuss the
class of one of the most frequently used nonprescription drugs: the pain
relievers.
Pain relievers (analgesics), fever
reducers (antipyretics), and anti-inflammatories are of two main types;
acetaminophen (Tylenol), which is a pain reliever and fever reducer but not an anti-inflammatory, and the NSAIDs
(nonsteroidal anti-inflammatory drugs), which are pain relievers, fever
reducers, and anti-inflammatory (such as joint pain from arthritis) include the
following: aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). These are
all fine to use when necessary and as directed by the labeling for short
periods of time but should be avoided if you have a known sensitivity to them.
Trouble comes when we use them consistently or daily at the higher doses.
Acetaminophen can be found in a
multiplicity of products for pain and cold remedies and is easily overused. The
primary problem with acetaminophen is its propensity for liver toxicity as it
directly interferes with the liver’s ability to produce glutathione, which is a
powerful and necessary antioxidant and protectant. It has been estimated that
over 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths are
attributed yearly in the U.S. to acetaminophen overdose and toxicity. This has
sparked the makers of Tylenol to modify the daily dosage recommendations. The
old standard recommendation (adult dose) was a maximum of 8 tablets or capsules
(1-2 per 6 hours) @ 500mg for a total of 4000mg per day. The new standard is 6 (1-2 per 6 hours) @
500mg for a total of 3000mg per day. Please keep that in mind. If you must take
acetaminophen regularly, then you should also be taking the supplement N-acetyl
cysteine (NAC). N-acetyl cysteine is an amino acid derivative of L-cysteine, an
amino acid that your body uses to make proteins. The liver uses the amino acids
cysteine, glutamic acid, and glycine to make the antioxidant glutathione. NAC
has many medical uses and is given intravenously to spare the liver from
acetaminophen (and alcohol) toxicity.
As for the NSAIDs, aspirin (acetylsalicylic
acid) has been around the longest. It was originally derived from plant
sources, notably white willow bark, which, incidentally, when taken as an herb
is a better alternative to the common side effects of aspirin. The primary
problem with all NSAIDs is that they deplete essential nutrients (especially
vitamin C, the B vitamins, and minerals) and they all have the propensity for
severe gastrointestinal upset, ulceration, and subsequent bleeding potentially
leading to anemia. If your digestive tract is sensitive to one NSAID, it is
highly likely that you will be sensitive to them all. If you must take aspirin,
make sure it is “safety coated” (enteric coated, like Ecotrin), which keeps it
from dissolving in your stomach acid and spares stomach irritation. Do not take
the plain white powdery tablets on a regular basis as they will certainly cause
gastric upset. Please note that even if coated, any NSAID can still cause
gastrointestinal upset farther down the tract, notably the large intestine or
colon, resulting in ulceration and bleeding there. Aspirin, like acetaminophen,
can be found in a multitude of OTC products so you must read labels. Also
please note that any ingredient such as “salicylate” is in fact aspirin, and
this is found in numerous OTC products. The recommended adult dose for aspirin
is 1-2 tablets @ 325mg every 4 hours to a maximum of 12 tablets or 3900mg
daily—and that’s a lot. As a special note, aspirin is not advised for children
under 12 and caution if used in teenagers due to the risk of developing Reye’s
syndrome.
Ibuprofen and naproxen are the new
NSAIDs and can work very well but carry with them the same potential problems
as with aspirin. Due to the heavy use of these drugs, gastrointestinal upset
and bleeding are common. Just so you know, if your stools are hard, dark, and
tarry in appearance, this is a typical sign of gastrointestinal bleeding, and
you should discontinue NSAID use. The recommended adult dosage for ibuprofen is
1-2 200mg tablets every 4-6 hours to a maximum of 6 tablets or 1,200mg per day.
Many people routinely exceed that. Naproxen is a much longer acting NSAID so
the recommended dosage is much less at 1 tablet @ 220mg every 8-12 hours or no
more than three times daily to a maximum of 3 tablets or 660mg daily. For
chronic pain and inflammation sufferers, it’s easy to exceed these dosages
routinely and create unintentional problems. Remember to check your Drugs.com app
for all the potential side effects of these drugs, as there are many more than
we’ve discussed here.
So what about alternatives? For
fever and the occasional headache and pain all the above are quite acceptable
and probably desirable unless you have a known sensitivity. Just try to stay
within the limits and use the least amount to bring about the desired effect and
use it for the shortest period of time necessary. Here are some alternative
suggestions:
For Pain:
· DL-Phenylalanine (DLPA). This is an amino acid
combination of L-phenylalanine, an amino acid used to build proteins, and its
mirror isomer form, D-phenylalanine, which is not used to build proteins, but is a neuro-modulator and chemical
messenger which increases your body’s endorphin production to inhibit pain.
·
Methylsulfonylmethane (MSM), also known as
dimethylsulfone. This can help with both pain and inflammation (good for joint
pain) and it also comes in a topical cream, which is great for skin health too.
· Notable herbals: White willow bark, as we
mentioned before contains aspirin-like compounds with minimal side effects.
Feverfew is notable for migraines.
· Homeopathic: Arnica has long been used for pain
and bruising, both as sublingual pellets and topicals.
For inflammation:
· Digestive plant enzymes, especially bromelain and
papain and others, when taken between
meals, have an anti-inflammatory effect rather than as a digestive aid.
Animal-based enzymes (pancreatin) must be enteric coated or they will be denatured
and destroyed by stomach acid. Plant-based enzymes are not denatured or
destroyed by stomach acid.
·
Herbals: Turmeric (curcumin) and tart cherry are
anti-inflammatory.
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