Anticoagulants and pain medications

[Kristin391]

I take coumadin for a prosthetic mitral valve.  I am trying to find a pain medication that I can safely take.  I have severe osteoarthritis that is very painful and debilitating.  I did take celebrex for a month which helped greatly but my cardiologist felt that it may be too great of a risk to take.  Is there anything else that would not affect my INR or cause a risk of bleeding?  I realize that narcotics wouldn't be a problem but I do not want to go in that direction at all.

A second question;  For heart failure,what is the better medication...ACE inhibitors or ARB in the presence of a normal blood pressure?  I understand that there are combinations of ARB and diuretics.  Are these ever appropriate for heart failure?  I am looking to decrease the financial burden that I have with all the separate medications etc. but want to do it safely etc.  Thanks for answering my questions.

[confused and afraid]

hello

1st timer here my husband is taking Imdur,warfin,diovan,clondine,
norvasc amongst other meds. He diabetic,hypertension ESRD,double
amputee. He was recently in ICU with septic shock. I'm afraid that did more damage to his  heart. He has lost so much weight. Although his Dr has not given  me any reason to believe. I feel like I will be losing him. He has this awful cough. He has also been subcribed Rifampin (is this used to treat TB ?) Is there anything I should do ....It seems he's wasting away.. His appetite  goes and comes

Really afraid !

[Kristin391]

Yes I have heard of sternal problems like yours.  It is hard to say what caused all of this.  I am sure this was very frustrating for you.  I was told to be careful with alcohol but to not abstain from it.  I would say I have about 4 drinks a week when we dine out etc.  I have not noticed any problems with my INR.  As long as it stays where it needs to be, I am happy and will probably continue to enjoy life etc.

[openchestman]

I had an aortic value replacemsnt 6-14 of this year.
It also involved s/p avr, cabg and ascend aortic aneurysm.
I was in intensive care 1 mo and 1/2, had 5 surgeries and was in the hospital 1/2 after that.  
The wires they put in my sternum pulled through.
Also they put screws in that also pulled through.  
I also developed infection in my sternum and a aneurysm.
They ended up taking my pectoral muscle and lower abs muscle to graft me back together.  Are you familiar with this type of surgery?  Also I am on blood thinners.  Is it true that I shouldn't drink any alcohol?  My cardiologist said I could have one or two drinks a day, put my pharmacist said NONE!
Also my lungs are week and having a test, said I was only 40-50 percent as strong as they should be.  I also have a lot of pain in my front chest area, where the boned come together.
When I cough, it is very painful there.Thanks for your help.

[ellentx]

I am sorry that Glucosomine did not work for you. I have to disagree with the Utah study on this.  My hubby was an almost cripple.  My dad also and my neighbor.  What a wonderdul turn around on these men after taking Glucosomine.  I have bad knees and hip.  My Orthopedic surgeon is suggesting I take this and I start tomorrow.  I am very sensitive to Non steroidal (they cause a great deal of swelling) meds and all narcotics except for Torodol which cannot be used for more than five days.

[Kristin391]

A recent study at the University of Utah has demonstrated no benefits from taking glucosamine and chondritin and MSG.  I tried those and they do not work.  My problem with taking medications is that I am very sensitive to most of them which causes increased INRs etc. so I have to be pretty careful with what I do.

[Karonnie]

Are you having inflammation with your osteo? Usually the best relief and positive benefits for osteoarthritis (NSAIDS are for rheumatoid arthritis which has a major inflammatory process which is destructive to both the joint and it's tissues) is achieved with the newer alternatives on the market - I know they are expensive but often the cost over time will outweigh the initial outlay as they have some proven "rebuilding" properties. Usually you begin on a high dosage then reduce it. The supplements I am referring to are glucosamine, chrondotin and msn for the relief of pain also an addition of fish oil will definately benefit you - especially if you also suffer from inflammation with your osteo.  What you may not know is that most NSAIDS don't just have a salicylate chemical which is like asprin and has inflammatory reducing property, but they also have a pain releieving chemical in them as well, why you get relief from your osteo - in fact most people using them will get some relief regardless.  Unless you suffer severe inflammation, which I would be seeking further medical help regarding because this is not usual with osteoarthritis and is what differentiates it from the other types of arthritis, I would steer clear of this type of medication and find a good doctor who understands the difference in medications. I understand that you didn't want to try other pain killers but you may find that a simple tablet of 8mg codeine with 500mg paracetamol pain killer a day will be enough - or even half to give you relief. If you are concerned about the addicition of the codeine you could intermittently take a different type of pain relief - or even up the dose of pure paracetamol to say 2-4 500mg tablets every 2hours, for a few weeks. I suppose at the end of the day you have to weigh it all up as the Doc said based on your age etc

[CCF-M.D.-MJM]

Hi Kristin,

There isn't a good solution to this.  Tylenol does not affect INR but is not as good of a pain reliever for most people as the NSAIDS (ibuprofen, advil).  NSAIDS are great for pain and inflammation, but inhibit platelets and increase the risk of bleeding.  Like anything in life, you have to do a risk / benefit analysis to decide if it is worth it and your doctor should be involved.  Example, if you are a 40 year old person with no medical problems and have osteoarthritis, the risk of bleeding with NSAIDS may be acceptable.  An 80 year old with a histor of a GI bleed clearly should not be taking NSAIDS unless his arthritis is so debilitating that it isn't worth it to live with out it.   These decisions are never easy.

I use genenic lisinopril.  I do not use ARBs unless someone has a symptomatic cough from ACEI.  You should be able to buy a one month supply of generic lisinopril at a discount pharmacy for about 10 dollars.  Remember, free sampls at a doctors office aren't free.  They aren't giving away money.  They only give free samples of their most profitable drugs to get you started on them and they are almost never as well tested as the some of the older drugs.

Thanks for posting and good luck.