Re: Meds for pain

[Guest guest]

Yes, we have discussed pain meds in the past. There are a number of

concerns that have to be weighed when advising/prescribing medication

for pain.

One is the metabolic impact - Tylenol (acetaminophen) is metabolized

in the liver and large doses (more than the maximum of 8 500mg

tablets or 4000mg/day) have the potential to cause liver failure.

With an impaired liver that limit may be lower. Most other drugs are

processed by the kidneys, so don't stress the liver as much.

Another is the impact on blood clotting (often reported as INR,

normal is 1.0, higher INRs reflect less clotting ability). Aspirin

and NSAIDS (ibuprofen) decrease the ability of the blood to clot

through their effect on blood platelets, making them less sticky, so

they don't clump together to block broken blood vessels. Since with

liver disease clotting ability my already be compromized (increased

INR), increasing INR further may not be wise. Acetaminophen

(Tylenol®) is often assummed to be a safe alternative, but it too can

increase INR. (See reference to a study by Hylek et al. at

http://www.texmed.org/cme/spt/Hour3/stroke16.asp).

A third is the impact on the digestive system. Aspirin is hard on the

stomach, alternatives may be wiser when dealing with potential UC and

Crohn's problems.

Given all that, the recommendation is often tuned to your current

circumstances. Pre-tx I was told not to take Tylenol but to take

ibuprophen instead, to reduce stress on the liver. Post-tx, with good

liver function taking drugs that stress the kidneys, I am instructed

to only use Tylenol if I need an OTC pain med. My INR never increased

to the point of being worrisome and I didn't have any stomach

problems with drugs, so those areas of concern had low priority and I

was advised primarily on the metabolic impact.

Tim R, ltx 4/4/98 U of Mich

> Darin said : " Also avoid Tylenol if possible. "

>

> I think maybe we have been through this before and maybe different

doctors have different ideas but my GI said Tylenol is fine to take

but no aspirin products.

>

> Leona