OTC drugs vs prescription intervention

I know we have had many many discussions about OTC meds, which are better, etc.  What I would like opinions on is the balance between OTC and the "right" prescription interventions..

I am going to talk to Dr. about ADs or pain meds, but not sure what to tell him I want.  After 7 months of tx (shot 34 down, 26 to go) he pretty much just does what I want him too, (OK, maybe being a pushy broad has it advantages..) Not sure what is the correct approach, I don't think I am depressed, I just get "wired" feeling, hyped up like, and irritable...ok, maybe more than a little.  I just called a fly a b@st@rd and told him he had to die.  And again, I ache so much I can't sleep, so the question  (((oooooohhhhh, swatting him on the back of my hand was both painful and gross....but the b****** is dead, and I'm lookin for his momma!!!)...is the balance between prescription drugs and OTC meds.  I can't imagine one or two pills specifically targeting symptoms can be worse than 9-14 ibuprofen a day??????  Will an AD help with the hyper feeling?  If I don't feel that way all the time, do I want to medicate?  It seems like I am like an ADD child, I am fine, but get hyped up at the drop of a hat...So do I need a sleep aid, or a pain medication?  Somehow, I know I am not the only one with these symptoms...

BTW waiting on procrit approval, HBG down to 10.6 from 11.6 two weeks ago..

[bobbyullc]

jus tfound this article on 48 weeks vs 72 weeks.

hope you can understand it.
bobby

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16618403&dopt=Abstract

[bobbyullc]

the only fun i had during tx was lying in wait and pouncing on them little buggers. it was safer than doing that to my spouse.

hgb 10.7 after 34 weeks is great. i am suprised it took so long to drop. if i could get by without procrit i would as the sides are bad. it can make the dif tween stop or go.
luck
bobby

[mkeela]

ANGEL FISHIE DOC!!!!! GET YOUR BOOTIE UP TO THAT E.R.!!!!!! I can't believe you aren't there yet!! Any chest pain is an emergency!!! (Even a tingly finger gets in before a broken arm! Let alone chest pain!! Thats some serious sh*t my dear!)

I agree with the comparison between 9-14 ibuprofen and a simple pain med...gee whiz. I'm surprised you haven't got some already.

DIDJA GET HIMS MAMA YET?????? (hee hee hee) Don't hurt yurself this time tho!!!

[mkeela]

oooops...lol...I replied to the message you left in the Tired place on here too...so have you left for the E.R. yet??? ah hem?

[GoofyDad]

If you're having trouble sleeping, it's a no-brainer to me that you should go after that. I'm a fan of the ambian. Others prefer lunesta. AS for raceyness, well maybe ya want to ge a fuller coverage bikini and consider something more supportinve when you do the morning jumping jacks. Har-dee-har. Actually, we're it me, rather than a blanket AD, I'd try low dose ativan or vallium for the specific events. And sure, go for a pain med to. I had Ultram prescribed... but never ended up taking it.

As an aside, didn't you mention you had a girlfriend who had to take ADs for an obsessive habit of a self gratifying nature? Sounds like the ADs replaced what we she was gettin' from the diddling, if you ask me. Not too much of a stretch, if you'll forgive the pun, that a daily visit to the man in the boat might burn off that nervous energy that's got you a twitchin'.

[fishdoc]

Goofers.... my sweetie is 58, and works long hours....most times he is just not "up" for another chore.....I'm going to put together a list, the pain med, I have not heard of it, whats that about??

Mekeela...I posted to you on tired site too...his momma is a red n black spot on my monitor now...they are going nuts out here!!!

Bobby-the HBG is both bad news and good news... i posted several months ago (fishdocs consult in archives) where I failed to meet the 2 log drop, went to a ribavarin expert and he upped me to 8 a day....with the lack of HBG drop cluing him in that I metabolize drugs too well...my HBG was still at like 13.5 after 3 months...I think he still thought my HBG would plummet after upping the riba..but it hasn't.  I am 10 weeks past undect at 24 weeks...

[jmjm530]

I think the last time my doctor asked me if I'd like to go on ADs was around the 24th week of treatment when I got into a shouting match with one of his admistrative assistants in his office hallway.

In any event, when he finally did see me 1.5 late (part of the reason for the "shouting" :) )I explained I didn't think I was "depressed", but his response was that ADs often help prevent you from "kicking the dog".  So, in this sense -- at least from his point of view, and from anecdotal stories here  -- ADs might help the hyper feeling you're talking about.

On the other hand, you mention you "don't feel that way all the time" and expressed a concern about more medication -- which is more or less my treatment experience. In my case I never ended up taking ADs, but I live and work alone. If I had to interact more with others during treatment, I probably would have gone on them to keep the peace.

Regarding sleep aids, I've always viewed them as a slippery slope and therefore never took them. plus I just didn't want any more drugs in my system. It seems that once folks start, it becomes a lifelong habit. Still, if you really need them to get through treatment, you got to take what you got to take. But just go into it lightly, knowing that you may end up with an eventual withdrawal issue if your plan is to stop some day.

You mentioned "ibuprofen". I know there's been a back and forth on this here --  but from my doctor, most of what I've read, and from what they do in some trials I'm familiar with -- the only pain killer allowed is Tylenol. You might want to discuss with your doctor or do more independent research on that.

As an aside, we talk so much about "meds" here that one can become desensitized to the fact the toxicity of what we're putting in our body. It becomes easy to pile on the drugs when we read that everyone else seems to be taking them. Without many of these helper drugs. many of us have made it through treatment, but I still think a lot of folks are taking too much medication on treatment -- pain, sleep, etc, etc. Just an observation.

Prior to treatment I took no drugs, besides a one-a-day vitamin when I remembered, and that's my regimen now that I'm finished treatment.

Hope this helps and you start feeling better soon.

-- Jim

[Morgaina]

Hi Fishdoc.........Iwas up to 4T3's in am and 4 in pm (that's 240 mg. of codiene, never mind the tylenol) I was really hurtin. My doc put me on 30 mg. codien contin taken am and pm and it worked like a charm. Some am's still needed a tylenol but most were doable. He also gave me Remeron which is an AD but puts you to sleep too. I slept well at night and helped to cut back the anxiety during the day. After treatment it was too much seratonin (I was also using prozac) but it was easy to just cut it out. Sleep is more restless but that's been the same my whole life. On really bad nights (maybe once or twice a month) I'll use a travel sickness pill (gravol) and it works just fine with no hangover. I'm down to no pain meds and .5 of Lexapro so things are working out. Getting through is the thing and for heaven's sake, dont play with heart pain!! I had some of that too and just had a whole patched and anyurism fixed a couple years ago so my doc freaked. It was fine , but get it checked!!! Take good care.......Diane

[fishdoc]

Part of the hesitation about the sleep aids is I sleep fine, unless I am in pain (hard body aches).....so will the sleep aids overcome that?  Otherwise, a pain pill and a benadryl... JMJM, totally understand where your coming from...so far, I just take OTC stuff, but when does 12-15 ibuprofen (Dr. recommends ibuprofen only) become harder on your body than one or two pain pills...that is something not often discussed..

[giddyup]

I agree about asking your doc about Ativan.I was told it's better on your liver then Valium.It worked well for me,I took it near the end of tx. Vicoden is a great pain reliever. However since it contains Tylonol I decided to switch to Oxycodone. However my pain is chronic and I'm still taking pain relievers post tx.I did'nt want to keep taking tylonol in the Vicoden. Many people have a difficult time at your stage of tx so if you feel like you need helper meds don't feel bad. One of my doctors said to me "I hope your not taking Ibuprofin", others didn't seem to be bothered by it.I don't like it because it's not effective for me and shreds my stomach.I hope you feel well and keep up the good fight.

[Tater-ToT]

It was about at the 24 week Mile marker that I had to up my dosage on ADs for the same reasons.... just irritable, & hyped up.... & I knew when I wanted to make road kill out of the DOT Worker (little traffic Flag dude) that it was clearly time to do something! That's when they put me on Xanex too!

It's okay to take helper drugs, I mean hats off to the folks that don't need ADs.... but unfortunately I was one that required them, & probably would have never made it thru TX without em.... & we don't have to take them forever...the day I took my last Riba, I took my last AD... I didn't even bother to cut the dosage in half or ween myself... the day I stopped TX I stopped every other helper drug all at once... so it's not like we get addicted to them!

So remaining on TX as comfortably as possible is all you need to keep in mind... & mean WHY suffer thru it, if you don't have too... that's what the helper drugs are there for!

Just MHO of-course!

[jmjm530]

If you get a chance, you might want to check out a recent thread over at Janis  http://janis7hepc.com/ on NSAIDs (like Ibuprofen) versus Tylenol on treatment.

For some reason I can't link the thread but you can find it under "Questions and Concerns" on the address bar all the way to the left. The title of the thread is "Tylenol or the NSAID's...which is better" and will be on a list after you click on "30,XXX Msgs" at the top of the "Questions and Concerns" Bar.

Maybe I read your last post incorrectly but you ask if 12-15 ibuprofen are worse than 1-2 pain pills. Ibuprophen are pain pills so maybe you meant something else, but in any event often hard to compare one group of drugs to another, especially in terms of quantity. Look at what one little shot of Peg does :)

-- Jim

[jmjm530]

I'm glad you were able to stop both the ADs and Xanax at the completion of treatment.

Hopefully, I didn't give the impression I was against helper drugs, just thought I'd throw out some personal thoughts/observations where the shoe fit. In your case, you obviously took the right course.

Unlike ADs, I've always heard that both Xanax and many sleep meds are addictive, but apparently you didn't have any problems stopping. I happen to be fairly sensitive to drugs and the one day I took Xanax I became very groggy and kept bumping into walls.

Like anything else, one size doesn't fit all here, and we have to calculate the risks versus rewards of what we pop in our mouth, or for that matter inject in our stomach.

BTW nice pics of yourself, below in the old rosacea thread. Good looking lady for those that might have missed although bikini shots are always preferred :)

-- Jim

[honey11]

Fish,,,I so remember those achy days and feeling like you had been wound up tight!  My dr also told me to take ibuprofen but I didn't take near that many in one given day.  And yes,,,that many vs a couple of pain pills,,,,I would say pain pills would be better if you had to choose.  I would try to take 2 ibuprofen in morning and that would help relieve some of that achy feeling but wouldn't take anymore until later at night and only if it was a bad day.  Those days that you are feeling very tense and agitated,,,,Ask your dr to give you Xanax,,,,that will help you relax and not feel like you are ready to strangle someone or lol chase a fly down all day!  And I only took one of those ever so often!  Hope this helps some and you get something to help you!

[fishdoc]

I guess I should have qualified it: 12-15 OTC pain meds vs 2 or 3 prescription pain meds... there has to be a point that it becomes better to go prescription than to keep on taking that much OTC stuff.........

[jmjm530]

Ahh. Haven't eaten yet, so low glucose levels are my excuse. Never looked into rx pain meds, but I was so foggy/weak  most of the time on tx that I was hesitant to take anything that made things worse. What I didn't take in pain meds, I more than made up for with antibiotics and PPIs like Nexium.

-- Jim

[sfbaygirl]

I sure would think that taking pain meds would be preferable than taking that many advils etc. I take codiene/fiornal for headaches and aches etc. I may take 4-6 a day and need them. Pain is the pits and for me OTC drugs don't usually work. QOL is important and if the rx pain meds help, you should consider taking them.

I take ambien sometimes for sleep. I get hyped up too, probably the Riba, sometimes the pain. One dr. told me taking Ambien 3-4 days a week is how it should be done. They help.

I have tried Xanax for anxiety and it didn't work. I hear ativan is good, but a different type of drug. It puts me out for hours. If I am so shakey (shaky) and haven't slept that would be a good idea. I may get some for those occaisons.

I take Prozac for depression, but it does nothing for any other sx, like riba rage, sleep, etc.

It is amazing how my drawer of pills grew once on tx. I was wondering what everyone was talking about when I started. I know that besides the pain meds, everything else I don't need to take  regularly and therefore will not be dependent on it afterwards.

[Morgaina]

The thing about codiene contin is you never felt altered at all, just not so much pain. And far less codiene thanT3's or Vicoprophen? (sorry, USA drug and I dont know it.) It was no problem to stop because you never took it when you needed it so you kind of forgot you were using an opiate. Just a low dose on a time release consistent basis. I never thought pain would get to me, but I was hurtin! Seems we have a more difficult time with any drug when we are making the choice when to take it. A person gets to be able to handle less pain and less stress when it's only a pill away. One reason I can see sense in perscription drugs over OTC. They work and you aren't getting crazy with anxiety and pain. When you're body is getting better, it's easy to stop because TAKING them feels unatural, uncomfortable. I know the idea of putting that **** in your body almost hurts, but in the long run, it may work out better. Major stress will never be good for anything (not even SVR). Okay, my speech is over!

[jmjm530]

No offense, indeed your post was timely as I had second thoughts anyway about how well (or not well) I got across some points in my original point. I guess all I was trying to say is that these drugs we so frequently talk about aren't candy, and even though they can sometimes be lifesavers, we shouldn't take them lightly.

Kudos to your smart husband for throwing out the Ambien and moving you to a more holistic approach. He probably knows you well enough to have understood you could do better without them in the long term.

-- Jim

[Pdilly]

Okay this is a really elementary question but I don't know the anwser.  I read that you should only take 500mg of Tylenol (my doctor prefers tylenol over Ibuprofen).  That hardly cut anything.  I took a coupld during the day at different times just to ease those flue like symptoms.  Not sure but I am hoping it was okay to take them yesterday as well instead of just during the onslot of the sides.

[jmjm530]

I pretty sure  I've read you can take up to 2000 mg of Tylenol a day on treatment, which would be 4 Xtra Strength in a 24-hour period. Keep in mind that other OTC products may contain Tylenol's active ingredient (Acetaminophen) so that also has to be taken into consideration when computing the 2000 mgs. Of course, check with other sources and perhaps your doctor has a reason for only recommending 500mg based on your medical history.

-- Jim

[fishdoc]

Thanks for so many suggestions...

SFbaygirl, its a fine dance we do along the edge of the precipe,  and I guess I need to try and fine tune it... I think 9-12 ibuprofen a day is too many also..

pdilly- tylenol does not do squat for me... might as well be eating skittles...I cant even tell I took them!!

Hopefully this thread will give folks a reason to ponder the point where otc in quantity are more harmful than prescriptions... I am waiting on a call from my son, I'm going to get his advice, and I will post what he says (PA).

[Tater-ToT]

Yup, your statement is sooo very true.... I really like your train of thought!
;)

[sfbaygirl]

If your ibuprofen is 200 mg, then you are taking up to 3 800 mg. pills a day. This is what dr's say to take with acute pain. Not sure what the max is for us. They help me as much as skiddles (good one!) so I take the codiene. Fine tuning is exactly what needs to be done with these drugs. Figuring out what works, what doesn't etc. takes time too. You have about the same amt. of time left as I do and I know I couldn't go 6 more months with the pain you describe.

Sometimes I do take ambien for mild pain to sleep. It wouldn't work with major pain though. Pain can cause anxiety, so it does sound like you need some RX pain meds. Some here have talked about vicophrofen. Supposedly this goes through the kidneys, not the liver. Perhaps you can ask your dr. about trying it.

[beamishboy]

i take oxycodone for pain-5 mg/350(cuteus swears by vicoprofen) ..1 at a time,often twice aday...very low dosage,but takes the edge off,esp when legpain denys me sleep...i use a xanax, maybe 3 times aweek,very handy for suffering fools gladly or delighting in the amazing flight patterns of flys-what me worry? also will gently lay you down to sleep( i had that wrong before,jim).......i still highly recommend melatonin for sleep,but again,only occasionally...these meds work @ low dosage,esp @ the beggining...make yourself comfortable-yu gotta long ride ahead......can't you put a fish to sleep by gently caressing it's belly?

[fishdoc]

not this fish!!  My cat loves my jelly rolls beyond belief!!  WE actually have a fight every now and then cause he just won't let up, and he has major claws!!  Pain is not my friend!!!  I don't need my dough kneaded, puttytatt....

[fishdoc]

OK, long long talk with PA regarding options....the strategy he suggested for pain:

accept that it will never be totally controlled, and try to manage it.  First use otc, up to 2400 mg of motrin a day, and 1000 mg of naproxen a day, to be taken ONLY with nexium or prilosec and hopefully not daily at that level.  he said even if I have no reflux symptoms, I need to worry about ulcers.  If that does not manage symptoms, he would prescribe small amounts (like 10 a month) of oxycodone or ultram, to be taken when pain hits a 7.  I told him I go to sleep fine, but wake up in 3.5 hours when stuff wears off, and he said only take it then.  Long discussion on opiate addictive behaviors...etc.  

He also said there is a new AD he wants me to try, called Cymbalta, that also is used for diabetic type pain in limbs, as well as an antidepressant.  Zoloft would also be a good choice, but doesn't have the added benefit of pain control. He laughed and told me I might lose weight if i opted for paxil...hhhhmmmmm

He felt these would be more beneficial in the long run than xanax or ativan. He said he would never prescribe xanax or ativan for me, hates those drugs, his residency with a psych -guy told him he would hunt him down and hurt him if he prescribed those....

He also said there is a new antismoking drug that is really promising out, they have some patients trying it: Chantix (not sure of spelling, since I don't smoke ;) that binds to the receptors for nicotene, but activates them only partially. He said you cannot smoke enough to overcome that level...

[jmjm530]

One of Vicophrofen's active ingrdient is Ibuprofen. Ibuprofen, like other NSAID's does stress both the liver and kidneys, as well as possibly causing bleeding ulcers. From what I've read and heard, Ibuprofen is not recommended for those on treatment,
Tylenol (acetaminophen)is preferred.  

http://www.healthsquare.com/newrx/vic1481.htm
http://www.medicinenet.com/ibuprofen/article.htm
http://hepatitis-central.com/hcv/hepatitis/ibuprophen.html
http://www.hivandhepatitis.com/hiv_hbv_co_inf/101501a.html

[fishdoc]

the numbers he quoted were the maximum dosages, and he knows I am a stage 0, grade 1, so NO ONE should take that much without their Drs. Ok, my Dr said absolutely no tylenol, only ibuprofen,

but thats why I started this thread... when is it time to switch to prescription and when is it too much OTC......I am going to try the OTC with prilosec, and I'll see the Dr. soon, and ask for the cymbaltra.. I think, ...

[jmjm530]

Fish: Ok, my Dr said absolutely no tylenol, only ibuprofen,
-----------------------------------------------------------
LOL. The medical profession sometimes kills me. As you can see by some of the articles I posted, they suggest the opposite, at least with those who have compromised livers. Perhaps your stage "0" status effects your recommendation.

One thing I do remember was not to take the NSAID aspirin on treatment. Perhaps the other NSAID's like Motrin (ibuprophen) are more benign. Taking it with a PPI like Prilosec makes sense. It would probably also work with a common antacid like Tums but then you'd have the riba absorption problem. Bottom line is that we must be careful with all the OTC remedies and run the dosing by our doctors. Here Dr. Douglas Dieterich suggests it's all OK:
http://www.thebody.com/Forums/AIDS/Hepatitis/Archive/HepCtreat/Q167554.html
although he doesn't mention dosage.

In any event, it's good your researching it out for yourself. Have you looked into codeine? I haven't  but I do know people use it for pain.

Good luck.

-- Jim

[jmjm530]

Every time I see a new dermatologist, they always ask me what medications I'm taking. Invariably they tell me I'm taking the wrong ones and then suggest something different.

One derm looked at me like I should be in a padded room, and asked "WHO told you put that on your face". I answered, "A dermatologist with even more diplomas on their wall than you have". At least that's what I should have said. LOL.

-- Jim

[sfbaygirl]

I don't take ibuprofen, but I do take asprin. No one has said not to. What is the reasoning? I know the platelets, which amazingly are almost back to normal 137 this week, more than before tx. They have been down to 60 during tx. I am hoping this is because liver damage is improving.

[jmjm530]

I think the reason is the potential for bleeding ulcers, especially with low platelet counts but check with your liver specialist. I never really looked into it, just didn't take aspirin during treatment as the doctor suggested. You can scroll down to "Acetylsalicylic acid (aspirin) and other NSAID" and see what Dr. Melissa Parker has to say on the subject.
http://www.liverdisease.com/painkillers_hepatitis.html

[Tater-ToT]

LoL....I deleted them at that midnight deadline... Haaa, Haa & I'll have you know that with all the atrophy I developed on tx that 5 months post TX I am NOWHERE NEAR getting into a bikini, someone might mistake the blubber & call green peace on me if I even attempted to slide on on.... Tee Hee.....I'm convienced that the bikini days  are forever gone... But Thanks!

BTW... I hadn't even read your post yet when I posted... I had only read Fish's... & then AFTERWARDS I looked & though "Oh Shoot" I hope Jim Didn't take that wrong too... soo nooo nooo.... I should have read first & worded that differently,,,, it is "I" whom hoped you didn't take offence...

I have to be honest & tell ya, I was worried about coming of the Xanax for sure... because I (for lack of a better way of putting it) probably abused those...  It was easy to do because my insuranse would only pay for 17 ambian a month... but I could get 30 dang Xanex (Go Figure)

I mean I built up a tolerance & could eat those things like Candy... I mean I didn't have a job to hold down, pretty much became a recluse...didn't "HAVE" to go anywhere, pretty much quit driving... even had my grocery shopping done for me... so what the heck... I'd just pop XanAx & attempt to sleep my way thru TX & Household stress.. So That's why I quit everything cold turkey...(Now If ONLY I could do that with my Cigarettes) & I didn't have a problem doing that as far as the drugs where concerned because it felt sooo dang good getting all that out of my system... & I wanted to see how quickly I could bounce back, but I literally soaked my bed sheets with night sweats for weeks (probably because I was soo saturated)& was sweating the drugs out of my system.

Also I developed my menses problems AFTER TX, & I am still not all that convienced that I was going menpausal (as I am too young)& that problem seems to be gradually leveling out... so that might of been due to just stopping everything at once... being as I got dismissed as a patient during my PANIC Mode when my Insurance gave out & TX abruptly stopped... I had no Doc to ask these things & just winged it all...

But I had a brief relapse toward my ambien....I did, & still do have MAJOR sleep problems & have broke down & got the ambien script filled, but out of pocket they were sooo dang expensive, that I horded em & saved as an emergency back-up & wouldn't take one until I wind up going like 36 hours with no sleep! But My Better half whom dispises drugs all together FOUND My Stash & Threw them out...LoL...Now No Doc & No Left-over script... That's part of why I am working on this new diet & exercise regime! Hope it works! Haa, Haa!

IF I Had them easily assesable I would probably still prefer my beloved ambien, but as SF mentioned (It was amazing how my drawer of pills grew on tx) Heck my dosages wouldn't even fit in that little ol pill container they give us... Ha... & that container is the FIRST DANG THING I got rid of out too!

Also when I stressed out over my kid once I QUICKLY jumped on that opportunity to call my general practitioner & get a weeks worth of valium... but discoverd I can't take those after 1 dose, call me stupid & I know better, but I had a glass & 1/2 of wine & that pill kicked in & rocked my world, & needless to say I never took another one, & the very thought of one makes me want to toss my cookies... so that's always a good & a hard way to make you never want to take another pill...LoL

Live & Learn... so to be 100% honest, maybe really I did have a few difficulties along the way after-all ehh!!!! I'm not super woman afterall.... Ha!
;)

[Alady1620]

When I first started treatment, I was on a bunch of different meds in addition to the pegasys and NM283.  They really messed me up and I had to stop taking most of them.  I am like minded with Jim on this issue.

My doctor recommends Tylenol for pain but he said if that wasn't sufficient, to alternate the tylenol with ibuprofen.  That usually does the trick.

[Kalio1]

vicoprophen is processed by your kidneys, not your liver. It also has only 200mg of ibuprophen in each pill so even at ma dose you are only consuming 800mg a day. My doctors all said tylenol was OK up to 2000 mg a day but they all prefer vicoprophen over other pain meds for HCV patients.