Over the counter (OTC) acetaminophen, ibuprofen, and naproxen are commonly used to treat pain and fever. Because they are labeled and packaged for OTC use most people consider them safe. This is not true. In addition, many people also believe that more is better. This is also not true. In fact all three medications have the potential for serious side effects. Aging further increases the risk of serious side effects as older people, especially those over the age of 65, often have a decrease in liver and kidney function and are mildly dehydrated.
In addition to its therapeutic effects, acetaminophen is a dose-dependent liver toxin; patient who take acetaminophen with alcohol or while fasting-due to illness, anorexia, or malnutrition-are at serious risk for liver failure. Even if taken at the current OTC recommended dose (not to exceed 4 g/day), the drug can be toxic. The FDA expert panel recommends lowering the standard dose from 1,000 mg to 650 mg and the maximum dose/day to 3 g/day. Accidental overdose send roughly 80,000 people to the emergency department each year; at least 500 are fatal. Part of the problem is that acetaminophen is found in more than 600 OTC medications including cold, flu, sinus, and in Rx codeine-based medications (Vicodin® or Percocet®). Patients unaware of the potential for serious complications often mix and match drugs containing acetaminophen and easily exceed the maximum daily dose. Forewarned is forearmed. Ibuprofen and naproxen also have serious side effects. Chronic use of both, including aspirin, may cause indigestion, gastric or duodenal ulcers, and fluid retention. In addition, ibuprofen use slightly increases the risk of a heart attack or stroke. Renal damage is also possible and significantly increases if the patient is dehydrated (as is often the case in an outdoor setting). Not surprisingly the risk of adverse effects increases substantially with dose and course. Note that while many athletes take ibuprofen or naproxen for general muscle soreness, neither drug has been shown to be effective. Remember that the GI side effects of both drugs increase if the drug is not taken with food and the renal effects increase if the patient or athlete is dehydrated. Follow the following simple guidelines greatly reduces your chance of adverse effects:
Interested in learning first aid? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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Pain is a common symptom that accompanies numerous problems. It is typically rated on a subjective 1-10 scale scale with 1 being "barely noticeable" and 10 "the worst pain imaginable."
Some orthapedic pain can be significantly reduced by aligning angulated limbs, reducing dislocations, and splinting the injured area. Mild pain usually managed with Over-the-Counter (OTC) pain medications like acetaminophen, ibuprofen, or neproxin. Surprising to some, a number of studies have shown than more severe pain can also be effectively managed by ibuprofen with less side-effects than narcotics. Rx dose of ibuprofen is 600-800 mg every 6-8 hours not to exceed 2400 mg per day. Start with the OTC dose and increase an necessary to the maximum dose. Rx opioids (narcotics) should be reserved for pain that cannot be managed by other means and administered by those familiar with their use (physicians, physician assistants, nurses, paramedics, etc.). They work by binding primarily to opioid receptors in the brain and spinal cord. They reduce the sending of pain messages to the brain and the feeling of pain. Opioids are best used for short periods of time to manage pain during an evacuation and following surgery (most people develop a drug tolerance within two weeks). In a wilderness environment IV opoids and injections are impractical; Vicodin (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen) tablets are commonly carried first aid kits. The military uses fentanyl lollipops with great success. Avoid taking narcotics with alcohol, some antidepressants, antihistamines, and sleeping pills. Want more information on this and other wilderness medicine topics? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. |
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