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Old 08-03-2005, 05:46 AM   #1
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Any problem taking Ibuprofen and Celebrex on the same day?

Hi, I'm trying to move away from taking opiate pain killers and curently I'm down to Ultram 100 x 8 a day and Celebrex 200mg a day. I can't even take acetamin because my liver enzimes are high. But sometimes the pain is just too much and so my only option is to take 500/30 acetamin/codeine or take 400mg Ibruprofen (my favoured choice.) I'm not sure which would be better though.

Does anyone have an opinion on this please?

 
Old 08-03-2005, 03:33 PM   #2
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Re: Any problem taking Ibuprofen and Celebrex on the same day?

Hey Blaster, Your taking twice the recomended dosage of Ultram, It's not a benign med. It has both opiate and SSRI properties and the withdrawal is a nasty combination of both. If your liver is impaired the normal dose should be reduced.

Combining NSAIDS is another risky thing to do, Your putting yourself at risk for a gastric bleed, a stroke or a heart attack. Anti inflamatories work by drawing fluids out of your body into your circulatory system. This puts added strain on your circulatory system which can cause heart attack or stroke. These are just risks, but should be weighed very heavily. Not everyone that took Bextra had a stroke or heart attack, but the mechanism of action is the same, increasing the load on your cardio vascular system by drawaing excess fluids into your blood stream raising your BP. Thinning your blood make bleeds harder to stop and more likely to occur. You may have decreased your opiate intake but your putting your overall health at a much greater risk than any pure opiate would.
I would see a doc and rethink the entire cocktail.

Published info.
........................................ .............
Seizures have been reported in patients receiving ULTRAM within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of ULTRAM above the recommended range. Concomitant use of ULTRAM increases the seizure risk in patients taking:

•Selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics),

•Tricyclic antidepressants (TCAs), and other tricyclic compounds (e.g., cyclobenzaprine, promethazine, etc.),or

• Other opioids.

Administration of ULTRAM may enhance the seizure risk in patients taking:

•MAO inhibitors

Risk of convulsions may also increase in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections). In ULTRAM overdose, naloxone administration may increase the risk of seizure

DOSAGE AND ADMINISTRATION
Adults (17 years of age and over)

For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of ULTRAM can be improved by initiating therapy with the following titration regimen: ULTRAM should be started at 25 mg/day qAM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg q.i.d.).Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.).After titration, ULTRAM 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, ULTRAM 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day.
• The recommended dose for adult patients with cirrhosis is 50 mg every 12 hours.

Last edited by Shoreline; 08-03-2005 at 03:40 PM.

 
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Old 08-04-2005, 03:06 AM   #3
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Re: Any problem taking Ibuprofen and Celebrex on the same day?

Thanks for taking the time to respond to my post Shoreline. I made a mistake noting my Ultram intake it's actually up to 8 x 50mgs a day as allowed. I have never taken more than that, although I was mixing it with up to 8 x 500/30 Codeine phos and acetamin'. I'm trying to keep the Ultram to 6 pills a day recently, as I had a good pain day last week and went into withdrawals and it was absolutely awful, I was so surprised, I had no idea I was due that when coming off these pills!!! I'm keen to keep opiate dose down to a minimum as best possible, in the hope that withdrawal will be easier when pain allows it (I'll taper next time, any advice on that please Shoreline?) Also my doctors wants me off the acetamin' because of my ALT been high and so he's replaced that and the codeine with the Celebrix up to 200mg's a day (he wont let me have more as I just had surgery for GERD.) I'm real happy to try this drug and 3 days in I think it's quite effective, I know there's these risks but it seems the lesser of all risks for me. I wonder though will Celebrix's effect build up over time???

I also take up to 75mg a day of Amitriptline and I'm finding that helpful in reducing the sensitivity of the area around the problem spot. Before that it would be almost funny, my partner would touch me in the general area and I would yell and recoil like she's just axed me, lol!!! I felt silly at 1st thinking I was over reacting and then I read that this is a problem associated with Nerve type pain.

The problem I'm facing now is that when the pain is especially acute, I need something more then the Ultram and Celebrex and that's why I'm considering a 400mg dose of Ibuprofen is such emergency. I would rather that than the acemtamin and codeine; given the greater detail I've listed what's your opinion on all this please Shoreline?

Thanks

 
Old 08-04-2005, 06:45 AM   #4
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Re: Any problem taking Ibuprofen and Celebrex on the same day?

Hey Blaster, with the history of gerds and recent surgery, I still think mixng NSAIDS is a bad idea. YOu would be more prone to a bleed especalilly if the surgery was recent and you haven't entirely healed.

Whn en Ultram first came out it was touted a a miracle drug without the risk of narcotics. IT turns out it's not quit e so benign. You felt the initial withdrawal and that's because tit has both SRI properties, which should never be stopped abruptly and it does bind to the Mu opiate receptor just like ther pure opiates. It's not as postent but people do become on less postent opaites like codeine and drugs that also have opiate propeties like darvecet.

Celebrex dos build up its effectiveness over the course of a couple weeeks, so you should get better relief by the end of the month fromit.

As far as a specific taper, Decrse 50 mgs every 3 days, if 50 is too much break a tablet in half and decrease by 25mgs evry few dsays. That would normaly take care of minor physical dependnece to opiates but the discontinuing SSRI's or drugs that do the same thing is more complicated. Unfortunately many docs are still unaware of the dependence problem with ultram although the DEA has wanted to reschedule ultram for several years, but the power of pharna lobbyists sis almost as great as the Autonomy of the DEA who can make and enforce their own policies withot any law to back it. If they want something done, the mere threat of investigation and closure while the investigation is ongoing gives them ultimate control ove docs who treat pain with controlled meds.

I am glad to hear your max dose is 50 mgs per day. Because your really not freeing yourself from physical dependecy,by using Ultram and T-3 "codeine is extremely week" you may find a mild opiate such as Lortab 2.5 may provide better relief, minimize physical dependence and asnd be just s easy to taper off as Ultram. Elevil is a wonder drug for certain types of nerve pain. It was the only thing that amanaged the nerve pain as the nerves died after my mothers mastecectomy, however it only has an 8 hour duration. It' not an SSRI and is easier to discontinue but needs to be dose 3 times a day to provice relief all day. There are other meds in th anticonvulsant class "seizure meds" like Neurontin , Toppamax,and Lamyctyl that are now being used
as first line treatment for nerve pain although it's an off label use of this class of meds. Lamyctyl is believed to enhance the speed of nerve regeneration moreso than the others that simply iterupt or disrupt pain signals. You may also find that alternative modalities like Bio feedback, acupuncture, Tens , relaxation techniques can also provide some adde relief.

Most CP patents try or learn these methods before opiates can be considered the only treatment option. Methyl B vitamins are growing in popularity, the B vits have always been known to support a healthy nervous system and even if it only adds another 10% relief, many would gladly use it to get that extra bit of relief. It's unlikely other modalities will have absolutely no effect on your pain, the ability to relax does have an effect on pain perception. When your streessd and tense, things tend to hurt more, so it's not a waste of time to learn some of the relaxtion techniques.

Lidocaine infusion is another method to manage nerve pain, Lidoderm patches placed directly over the affected area may help, but you need a pain management doc that uses a multi faceted aproach on all his patents to manege pain and improve quality of life. Can you tell us the cause of nerve pain, Is it post op, from an inury or a compressed nerve? Nerves pass through muscle and when a muscle is in spasm, that clenches down on nerves and increases pain so even muscle relaxers can benefit without the higher risk of dependence of opiates and drugs with opiate qualities like ultram. If you haven't ried Darvecet becaue of the tylenol, you could use Darvon which is just Darvecet without tylenol. It has some unique properties that may be more effective, due to its' relationship to methadone. Same class of drugs only 1/100th the strength.

With any med that can cause abstinenece syndrome if discontinued abruptly, tapering down the dose and increasing the interval between doses is the most effective way to deminish withdrawal symptoms. IMO a low dose of hydrocodne like breaking a 5/325 norco in half so your recieving 2.5mg of hydrocodone and 167 mgs of tyelenol would still be easier to discontinue than Ultram. I've done ultram withdrawal and it lasts longer and screws up your brain chemisty more due to it's SSRI propeties.

Anti depressants in he SSRI class can be a bear to discontinue and even take 6 months to come off a moderate dose of a med like Paxil. Opiate withdrawal is pretty much over in 10 days and if the dose is limited and used short term, it would be even easier to discontinue.

People don't have seizures from opiates, other than Demerol. But the risk of siezure, the dependnece issue, really doesn't make Ultram a better choce than low dose opiates. Mixing NSAIDS is still a bad idea IMO

Good luck, Dave

 
Old 08-04-2005, 07:52 AM   #5
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Re: Any problem taking Ibuprofen and Celebrex on the same day?

Thanks for that extra info Dave! It's very interesting to see how many options I really have to try and find effect relief from this nerve pain. The pain started after a Laprospopic Fundplication of my stomach to relieft GERD. The was pretty much there from the start I think, but as I was so dosed on meds it's hard to be very sure. It definatly starting getting worse after 3 weeks and so I guess it a good possibility that an Adhesion is weighing onto a nerve in some manner. This also causes unplesent referred pain to my left shoulder!

My surgeon want refer me to a pain management centre until early December as he still thinks it could calm down (I'l try to keep positive on that point,) it doesn't seem to be at all though. The mentioned that the clinic would do things like nerve blocks; I will definatly make notes and research all these options you've mentioned, I'm very interested to hear the importance of meditation and relaxation, not suprised, but encourged. These are tools I already have and so I will make an effort to turn to them. Also the Acupunture, I keep meaning to do that and so no excuse for not been there already.

The problem is in the UK it's to easy for the General Doctors in the 10 minutes allocated to each patient appointent to dish out the opiates for the relief and a patient. And so from that source I haven't benefited anything like the advice I have found on these friendly boards.

One important thing that I'm very happy about is that I feel mentally I've turned a corner, I guess there are always up and down periods with ongoing pain issues, nice to be on an UP!!!!

Thanks again for your help so far, any further advice would be appreacaite and I wish you a peace filled day.

Blaster

Last edited by Blasterboy; 09-17-2005 at 03:21 AM.

 
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