Question:

i find myself allergic to aspirin, paracetomol and ibuprofen, all of which spark off an asthma attack, with throat contractions and sinus problems too. One of these tables can take me a day to get over – AND the pain killing effect seems to be nullified.  Any advice please? I need something for headache and general aches and pains. Many thanks Tom Surrey, England — — Web site:  Journey of Life at                  http://www.lifejourney.co.uk —

Response:

If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. I suggest using Tramadol for headches if that’s bothering you. — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA i find myself allergic to aspirin, paracetomol and ibuprofen, all of which spark off an asthma attack, with throat contractions and sinus problems too. One of these tables can take me a day to get over – AND the pain killing effect seems to be nullified.  Any advice please? I need something for headache and general aches and pains. Many thanks Tom Surrey, England —

— Web site:  Journey of Life at                  http://www.lifejourney.co.uk

– Hide quoted text — Show quoted text – —

Response:

If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. I suggest using Tramadol for headches if that’s bothering you.

Whoa! "allergic" to acetaminophen? Very unlikely. It is NOT an NSAID. (non-steroidal-anti-inflammatory drug). IT does NOT block cyclooxygenase at any achievable blood level.  It has not been reported to contribute to attacks in aspirin-sensitive asthmatics. It has long been outed as the only safe OTC analgesic/antipyretic drug fro aspirin-sensitive asthmatics.  While it may not work for Mr. Cunliffe, it should not be ‘causing’ asthma attacks. Audrey – may I ask your credentials? Most of the people who offer advice on this newsgroup do it in the form of: you should ask your doctor about {such-and-such drug}. IF you are going to ‘prescribe’ drugs, it would be nice to know your qualifications. – Hide quoted text — Show quoted text – — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA i find myself allergic to aspirin, paracetomol and ibuprofen, all of which spark off an asthma attack, with throat contractions and sinus problems too. One of these tables can take me a day to get over – AND the pain killing effect seems to be nullified.  Any advice please? I need something for headache and general aches and pains. Many thanks Tom Surrey, England — — Web site:  Journey of Life at                  http://www.lifejourney.co.uk —

Response:

If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. I suggest using Tramadol for headches if that’s bothering you. Whoa! "allergic" to acetaminophen? Very unlikely. It is NOT an NSAID. (non-steroidal-anti-inflammatory drug). IT does NOT block cyclooxygenase at any achievable blood level.  It has not been reported to contribute to attacks in aspirin-sensitive asthmatics. It has long been outed as the only safe OTC analgesic/antipyretic drug fro aspirin-sensitive asthmatics.  While it may not work for Mr. Cunliffe, it should not be ‘causing’ asthma attacks.

OK, here’s my input, which I will give in the form of quotes from the book ‘The Asthma Sourcebook’, Francis Adams, MD [pulmonary specialist in the field of asthma, Assist. Prof. of Clinical Medicine at NYU & Attending Physician at Bellevue Hospital, NY] "Allergy to aspirin and related medications may trigger asthmatic attacks in as many as 20% of adult asthmatics. This sensitivity appears to be more common in severe adult asthmatics, especially those who have nasal polyps and sinusitis. These patients are also often steroid dependent. However, this reaction appears to be related to inhibition by aspirin of the enzyme cyclooxygenase. A large group of medications that also produce this inhibition, the NSAIDS, may also cause the same asthmatic reaction. Alternatives to aspirin and NSAIDS include acetaminophen, sodium thiosalicylate and choline magnesium trisalicylate. Acetaminophen, widely available without prescription, has reportedly produced asthma attacks in a small number of patients. This reacton is extremely rare and as a rule this drug represents a safe alternative to aspirin and the NSAIDs. Sodium thiosalicylate and choline magnesium trisalicylate are anti-inflamnmatory drugs that do not inhibit cyclooxygenase and are safe alternatives to aspirin and NSAIDs. These medications are only available by prescription." Audrey – may I ask your credentials? Most of the people who offer advice on this newsgroup do it in the form of: you should ask your doctor about {such-and-such drug}. IF you are going to ‘prescribe’ drugs, it would be nice to know your qualifications. — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA

So Andrey Zenovich and Francis Adams, MD say that acetaminophen could provoke an asthma attack, JustPhD says aspirin-sensitive asthmatics don’t have asthma attacks from acetaminophen. How do I interpret this. I guess its possible both sides are correct. I’m just an asthmatic research engineer, no medical credentials at all. So I usually post my sources when giving detailed information. But I do believe in the free flow of information. With the advent of the Internet, and the possibility for laypersons to download complete medical protocols, like the 244 page Expert Panel Report 2 on Asthma, its possible for a patient to be better informed than his doctor. JustPhD, usually I’m on your side, but not this time. Actually, it would be nice if both of you would post your credentials; but it shouldn’t be a requirement. Ellis – Hide quoted text — Show quoted text – i find myself allergic to aspirin, paracetomol and ibuprofen, all of which spark off an asthma attack, with throat contractions and sinus problems too. One of these tables can take me a day to get over – AND the pain killing effect seems to be nullified.  Any advice please? I need something for headache and general aches and pains. Tom Surrey, England

Response:

Again, please see the comments as the post goes along: If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. I suggest using Tramadol for headches if that’s bothering you. Whoa! "allergic" to acetaminophen? Very unlikely. It is NOT an NSAID. (non-steroidal-anti-inflammatory drug). IT does NOT block cyclooxygenase at any achievable blood level.  It has not been reported to contribute to attacks in aspirin-sensitive asthmatics.

****yes, you are right, acetaminophen is not a NSAID. But asthmatics with allergy to NSAIDs sometimes are allergic to acetaminophen as well.. Its a very small population of the patients but still it is there. It has long been outed as the only safe OTC analgesic/antipyretic drug fro aspirin-sensitive asthmatics.  While it may not work for Mr. Cunliffe, it should not be ‘causing’ asthma attacks.

*** yes, but there can be idiosyncrasy, this should be taken into account. The advice was given not to the general population BUT to the particular patient. Asthmatics can present various idiosyncrasies, some of them are such "acetaminophen cases". Audrey – may I ask your credentials? Most of the people who offer advice on this newsgroup do it in the form of: you should ask your doctor about {such-and-such drug}. IF you are going to ‘prescribe’ drugs, it would be nice to know your qualifications.

***** Well… I wrote to someone today, who sent me a private mail with questions about asthma. USENET is a forum of knowledge. People share thoughts and opinions. As you see, the population is VERY diverse. NOONE prescribes a medication on the USENET. All forms of advice on the internet originate from theoretical knowledge of medicine, pharmacology, and everything that you can apply to patient consultations. FINAL DECISION ABOUT A PARTICULAR DISEASE MUST BE MADE BY THE PHYSICIAN WHO CONDUCTS TREATMENT. FINAL DECISIONS ARE ALWAYS MADE AT THE BEDSIDE! Since taking tramadol, as was recommended by me, will involve obtaining prescription for it, the patient will talk to the doctor first. As you may have seen from my other posts, I was writing them as: "the patient should be evaluated… it would be rational,…. my opinion is.." As far as credentials, I am a medical researcher who spent a fair amount of time researching intrabronchial inflammation in asthmatics and other patients combining that with work in the field of broncoscopy.   Regards, — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA

Response:

Please see the comments after this quotation: "Acetaminophen, widely available without prescription, has reportedly produced asthma attacks in a small number of patients. This reacton is extremely rare and as a rule this drug represents a safe alternative to aspirin and the NSAIDs. Sodium thiosalicylate and choline magnesium trisalicylate are anti-inflamnmatory drugs that do not inhibit cyclooxygenase and are safe alternatives to aspirin and NSAIDs. These medications are only available by prescription." So Andrey Zenovich and Francis Adams, MD say that acetaminophen could provoke an asthma attack, JustPhD says aspirin-sensitive asthmatics don’t have asthma attacks from acetaminophen.

may present various allergies even some unheard of. Only in those small percent of patients it will act as a trigger for attacks. I remember seeing one patient four years ago. I was invited by her attending physician. She had asthma attack after taking 2-3 grams of acetaminophen for her headache. The attending physician and me brought medical students to see that rare case. As we went along, the patient told us that she was allergic to NSAIDS, Potassium Gluconate, and even Prednisone!!! Honestly, it was not easy to treat that woman. I do not think that the mechanism of prednisone allergy can be explained at all. This patient, although, appeared to tolerate IV Solu-Medrol. I remember that some students got interested in that topic and we had a case presentation on that done by them later on. JustPhD, usually I’m on your side, but not this time. Actually, it would be nice if both of you would post your credentials; but it shouldn’t be a requirement.

Regards, Mr. Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA

Response:

Tom…have you tried Tyelnol (acetaminophen)?  You can get extra strength

Tylenol (acetaminophen) is paracetamol, so I wouldn’t suggest you take it. Renae

Response:

- Hide quoted text — Show quoted text – If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. I suggest using Tramadol for headches if that’s bothering you. Whoa! "allergic" to acetaminophen? Very unlikely. It is NOT an NSAID. (non-steroidal-anti-inflammatory drug). IT does NOT block cyclooxygenase at any achievable blood level.  It has not been reported to contribute to attacks in aspirin-sensitive asthmatics. It has long been outed as the only safe OTC analgesic/antipyretic drug fro aspirin-sensitive asthmatics.  While it may not work for Mr. Cunliffe, it should not be ‘causing’ asthma attacks. OK, here’s my input, which I will give in the form of quotes from the book ‘The Asthma Sourcebook’, Francis Adams, MD [pulmonary specialist in the field of asthma, Assist. Prof. of Clinical Medicine at NYU & Attending Physician at Bellevue Hospital, NY] "Allergy to aspirin and related medications may trigger asthmatic attacks in as many as 20% of adult asthmatics. This sensitivity appears to be more common in severe adult asthmatics, especially those who have nasal polyps and sinusitis. These patients are also often steroid dependent. However, this reaction appears to be related to inhibition by aspirin of the enzyme cyclooxygenase. A large group of medications that also produce this inhibition, the NSAIDS, may also cause the same asthmatic reaction. Alternatives to aspirin and NSAIDS include acetaminophen, sodium thiosalicylate and choline magnesium trisalicylate. Acetaminophen, widely available without prescription, has reportedly produced asthma attacks in a small number of patients. This reacton is extremely rare and as a rule this drug represents a safe alternative to aspirin and the NSAIDs. Sodium thiosalicylate and choline magnesium trisalicylate are anti-inflamnmatory drugs that do not inhibit cyclooxygenase and are safe alternatives to aspirin and NSAIDs. These medications are only available by prescription." So Andrey Zenovich and Francis Adams, MD say that acetaminophen could provoke an asthma attack, JustPhD says aspirin-sensitive asthmatics don’t have asthma attacks from acetaminophen. How do I interpret this. I guess its possible both sides are correct.

True … acetaminophen, like any chemical, can induce asthma attacks in a small number of asthmatics as the "Sourcebook" reports. BUT it is not an NSAID, does not induce attacks through the same mechanism as aspirin-like drugs and is the first choice for pain relief in aspirin-sensitive-asthmatics. My "whoa!" was about a statement to the contrary by Ms Z – lumping acetamnophen with NSAIDS – it just AIN’T one. I’m just an asthmatic research engineer, no medical credentials at all. So I usually post my sources when giving detailed information. But I do believe in the free flow of information. With the advent of the Internet, and the possibility for laypersons to download complete medical protocols, like the 244 page Expert Panel Report 2 on Asthma, its possible for a patient to be better informed than his doctor. JustPhD, usually I’m on your side, but not this time. Actually, it would be nice if both of you would post your credentials; but it shouldn’t be a requirement. Ellis

Ellis – as I said – it’s the making recommendations to take drugs or try therapies that led me to ask for credentials. It’s not an action, you, Colin or I usually take. We and other helpful posters here usually provide information and recommend only that the info be discussed with a doctor. I have stated my credentials previously – Ph.D. Associate Professor at a midwestern medical school, researcher in airway diseases with a focus on asthma and cystic fibrosis, consultant for a firm producing leukotriene receptor antagonists. My area of expertise is prostaglandins and leukotrienes.  I choose not to post under my ‘official’ position because of potential legal problems if I do so, because of written policy of the university, and because I do not wish to give undue weight to controversial statements I might make. – Hide quoted text — Show quoted text – i find myself allergic to aspirin, paracetomol and ibuprofen, all of which spark off an asthma attack, with throat contractions and sinus problems too. One of these tables can take me a day to get over – AND the pain killing effect seems to be nullified.  Any advice please? I need something for headache and general aches and pains. Tom Surrey, England

Response:

The tone of my post was a little more confrontatnal than I intended. My apologies. – Hide quoted text — Show quoted text – Again, please see the comments as the post goes along: If you are allergic to aspirin, acetaminophen (paracetamol) and ibuprofen, then NONE of the Non-Steroidal Anti-Inflammatory medications will work for you. Whoa! "allergic" to acetaminophen? Very unlikely. It is NOT an NSAID. (non-steroidal-anti-inflammatory drug). IT does NOT block cyclooxygenase at any achievable blood level.  It has not been reported to contribute to attacks in aspirin-sensitive asthmatics. ****yes, you are right, acetaminophen is not a NSAID. But asthmatics with allergy to NSAIDs sometimes are allergic to acetaminophen as well.. Its a very small population of the patients but still it is there.

As are asthmatics who are NOT "allergic" to NSAIDS. It has long been outed as the only safe OTC analgesic/antipyretic drug fro aspirin-sensitive asthmatics.  While it may not work for Mr. Cunliffe, it should not be ‘causing’ asthma attacks. *** yes, but there can be idiosyncrasy, this should be taken into account. The advice was given not to the general population BUT to the particular patient. Asthmatics can present various idiosyncrasies, some of them are such "acetaminophen cases".

True .. I overstated my case — of course it can cause attacks — jsut not via the aspirin sensitivity route. I’m sure Mr Cunliffe doesnt give a rat’s patootie WHY he has an attack, though. My bad. Audrey – may I ask your credentials? Most of the people who offer advice on this newsgroup do it in the form of: you should ask your doctor about {such-and-such drug}. IF you are going to ‘prescribe’ drugs, it would be nice to know your qualifications. ***** Well… I wrote to someone today, who sent me a private mail with questions about asthma. USENET is a forum of knowledge. People share thoughts and opinions. As you see, the population is VERY diverse. NOONE prescribes a medication on the USENET.

that’s why the "quotes" aruond ‘prescribe’. different styles – I’m paranoid that some people will  lean too heavily on advice on forums like this.  It’s cheaper than a doctor’s visit and that matters to some. We listen and talk to them – skills that some doctors still havent developed. So I worry about saying things like: "I suggest using Tramadol for headches if that’s bothering you." All forms of advice on the internet originate from theoretical knowledge of medicine, pharmacology, and everything that you can apply to patient consultations. FINAL DECISION ABOUT A PARTICULAR DISEASE MUST BE MADE BY THE PHYSICIAN WHO CONDUCTS TREATMENT. FINAL DECISIONS ARE ALWAYS MADE AT THE BEDSIDE! Since taking tramadol, as was recommended by me, will involve obtaining prescription for it, the patient will talk to the doctor first. As you may have seen from my other posts, I was writing them as: "the patient should be evaluated… it would be rational,…. my opinion is.." As far as credentials, I am a medical researcher who spent a fair amount of time researching intrabronchial inflammation in asthmatics and other patients combining that with work in the field of broncoscopy.

Cool. Regards,

and to you.  Again I apologize for the tone of my previous post. – Hide quoted text — Show quoted text – — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA

Response:

I’ve been on Relafen for 3-4 years and just this year, in March, started having asthma attacks. I’ve never been asthmatic in my life, though I do have some allergies which always responded to an occasional anti-histamine. Doctor gave me serevent, albuteral, and xanax. I sit here and gasp all during work hours, I still can’t exercise on my treadmill; in short, it’s not working. I am on Relafen because of severe tendinitis in both wrists and because I have a sensitive stomach. Relafen is kind on my stomach. I need to be able to be on some sort of anti-inflammatory but I can’t live with this sudden asthma. Can someone supply some brand names of alternatives (tylenol will not do the trick). Thanks. Lynda

Response:

I’ve been on Relafen for 3-4 years and just this year, in March, started having asthma attacks. I’ve never been asthmatic in my life, though I do have some allergies which always responded to an occasional anti-histamine. Doctor gave me serevent, albuteral, and xanax. I sit here and gasp all during work hours, I still can’t exercise on my treadmill; in short, it’s not working. I am on Relafen because of severe tendinitis in both wrists and because I have a sensitive stomach. Relafen is kind on my stomach. I need to be able to be on some sort of anti-inflammatory but I can’t live with this sudden asthma. Can someone supply some brand names of alternatives (tylenol will not do the trick). Thanks. Lynda

Relafen (nabumetone) is an NSAID; about 20% of asthmatics are sensitive to NSAIDS, often the ones with Severe asthma, nasal polyps and sinusitis. If you are not sensitive to NSAIDS its OK to take them, per current asthma guidelines (EPR2). If you are sensitive to NSAIDS, alternative anti-inflammatory drugs are sodium thiosalicylate and choline magnesium trisalicylate, both prescription. (Ref–The Asthma Sourcebook) It sounds like your asthma may be undercontrolled. Serevent is a long-acting bronchodilator, albuterol is a short-acting bronchodilator, Xanax is for panic attacks. Serevent and albuterol should not be your sole asthma control drugs; a long-acting preventor inhaler should be added; typically a steroid inhaler like Vanceril DS, Pulmicort, Flovent. Another drug that may help is the new antileukotriene drug Singulair, a once/day pill. New asthma guidelines say if you need to use albuterol more than once/day you need to add long-acting preventor meds like inhaled steroids. Note that bronchodilators like albuterol and Serevent can make your panic attacks worse (in some cases your xanax can make your asthma worse). So its important to know which is causing your breathing problems at any time. Use of a Peak Flow meter to monitor lung function at home can be useful in determining how well controlled you are; the object is keep the readings in the Green zone (80% of personal best). Also can help you determine if your breathing problems are due to asthma (peak flows drop) or panic attack (peak flows normal). I suggest you ask your doctor for referral to an allergist specialist. They can test your allergies, so you know what to avoid; and usually know more about asthma than a GP. Here is a link: http://www.ama-assn.org/special/asthma/library/readroom/oc4154.htm "Asthma and Panic Disorder Karen B. Schmaling, PhD; Jon Bell, MD Objective: To compare asthma attacks with panic attacks and identify discriminating symptoms." Ellis

Response:

***** Well… I wrote to someone today, who sent me a private mail with questions about asthma.

I get quite a few like that as well, so I always make it clear that I’m not a doctor, and that they should seek a doctor’s advice if unclear about what is discussed in e-mail or on usenet (see my .sig below). USENET is a forum of knowledge. People share thoughts and opinions. As you see, the population is VERY diverse. NOONE prescribes a medication on the USENET.

However, it is very easy to project a false image of yourself in mere words – sometimes unintentionally, sometimes deliberately. That’s one of the dangers of such groups like this, someone coming in as a "false authority". You’ll notice that regulars like Colin and myself make it very clear what our backgrounds are, and we don’t make any claims – unlike the spammers… All forms of advice on the internet originate from theoretical knowledge of medicine, pharmacology, and everything that you can apply to patient consultations. FINAL DECISION ABOUT A PARTICULAR DISEASE MUST BE MADE BY THE PHYSICIAN WHO CONDUCTS TREATMENT.

No offence, but shouldn’t the PATIENT make the final decision about treatment ? It’s their life and their body after all ! FINAL DECISIONS ARE ALWAYS MADE AT THE BEDSIDE!

I don’t know about you, but I like to make such decisions before things get bad enough for me to be bed-bound ! (i.e. prevention being better than cure…) Chris — Chris King                    | Information provided here should NOT be used http://www.csking.demon.co.uk | practitioner.

Response:

This is a copy of a post I made to another board. I think the question at hand had to do with some other intolerance. You may find it interesting. Basically your best bet (among the NSAIDS that is) would be salsalate. It is most unlike the others. The bad news is that it takes a few weeks to really kick in. So if you try it make sure you give it enough time, like about a month. The best advice is to try to avoid them all together. If you can’t, it may help to try switching among drugs that are least similar. Some of the drugs are more closely related to each other than the others. If you are allergic to a drug in one class it would be wise to try a completely different class. Salicylates:     Aspirin     Diflunisal (Dolobid) Propionic Acids:     Ibuprofen (Motrin, Advil)     Fenoprofen (Nalfon)     Flurbiprofen (Ansaid)     Ketoprofen (Orudis, Oruvail)     Naproxen (Anaprox, Naprelan, Naprosyn, Aleve, Napron)     Oxaprozin (Daypro) Oxicam:     Piroxicam (Feldene) Fenemate:     Meclofenamine (Meclomen) Acetic Acids:     Diclofenac (Voltaren)     Etodolac (Lodine)     Indomethacin (Indocin, Indochron)     Ketorolac (Toradol)     Nabumetone (Relafen)     Sulindac (Clinoril)     Tolmetin (Tolectin) Most people who are allergic to some of the meds have problems with aspirin and Motrin. Piroxicam seems to be less allergenic than the propionic acids and the acetic acids. It may be one to try. There is one agent that is technically a salicylate but seems to be the most different from the others. It is called Salsalate. It is usually better tolerated by the GI tract and the kidneys and is quite effective. It also causes few allergic reactions in NSAID allergic people. The down side is that you have to take it for about three weeks before seeing an effect. There are some new ones comming out that cause fewer GI effects. This is because they inhibit the enzymes in the stomach less than the enzymes in the joints and skin. Lodine already is relatively less irritating to the stomach (theoretically anyway) for this reason. When these new ones come out they will probably provide another class to try. You may want to print this list out to take to the doctor. I had to pull it out and look at it to type it out myself. It is hard to keep track of which ones are related. — Good Luck, CBI, M.D.

t… – Hide quoted text — Show quoted text -I’ve been on Relafen for 3-4 years and just this year, in March, started having asthma attacks. I’ve never been asthmatic in my life, though I do have some allergies which always responded to an occasional anti-histamine. Doctor gave me serevent, albuteral, and xanax. I sit here and gasp all during work hours, I still can’t exercise on my treadmill; in short, it’s not working. I am on Relafen because of severe tendinitis in both wrists and because I have a sensitive stomach. Relafen is kind on my stomach. I need to be able to be on some sort of anti-inflammatory but I can’t live with this sudden asthma. Can someone supply some brand names of alternatives (tylenol will not do the trick). Thanks. Lynda

Response:

Chris King! There was a long discussion of that and it should be available via www.dejanews.com. I meant that if a patient learns something here, it may not be applicable to his/her current situation and that’s why its the role or the physician to explain what is applicable and what can be dangerous. I wrote a lot in the topic in "Medical Advice on the Usenet", Regards — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA – Hide quoted text — Show quoted text – ***** Well… I wrote to someone today, who sent me a private mail with questions about asthma. I get quite a few like that as well, so I always make it clear that I’m not a doctor, and that they should seek a doctor’s advice if unclear about what is discussed in e-mail or on usenet (see my .sig below). USENET is a forum of knowledge. People share thoughts and opinions. As you see, the population is VERY diverse. NOONE prescribes a medication on the USENET. However, it is very easy to project a false image of yourself in mere words – sometimes unintentionally, sometimes deliberately. That’s one of the dangers of such groups like this, someone coming in as a "false authority". You’ll notice that regulars like Colin and myself make it very clear what our backgrounds are, and we don’t make any claims – unlike the spammers… All forms of advice on the internet originate from theoretical knowledge of medicine, pharmacology, and everything that you can apply to patient consultations. FINAL DECISION ABOUT A PARTICULAR DISEASE MUST BE MADE BY THE PHYSICIAN WHO CONDUCTS TREATMENT. No offence, but shouldn’t the PATIENT make the final decision about treatment ? It’s their life and their body after all ! FINAL DECISIONS ARE ALWAYS MADE AT THE BEDSIDE! I don’t know about you, but I like to make such decisions before things get bad enough for me to be bed-bound ! (i.e. prevention being better than cure…) Chris — Chris King                    | Information provided here should NOT be used medical http://www.csking.demon.co.uk | practitioner.

Response:

Oops — I just noticed that Salsalate isn’t on the list. It and a drug named Trilisate are technically not NSAIDS. I forget that sometimes because for all intents and purposes they are just like them. — Good Luck, CBI, M.D. – Hide quoted text — Show quoted text – This is a copy of a post I made to another board. I think the question at hand had to do with some other intolerance. You may find it interesting. Basically your best bet (among the NSAIDS that is) would be salsalate. It is most unlike the others. The bad news is that it takes a few weeks to really kick in. So if you try it make sure you give it enough time, like about a month. The best advice is to try to avoid them all together. If you can’t, it may help to try switching among drugs that are least similar. Some of the drugs are more closely related to each other than the others. If you are allergic to a drug in one class it would be wise to try a completely different class. Salicylates:    Aspirin    Diflunisal (Dolobid) Propionic Acids:    Ibuprofen (Motrin, Advil)    Fenoprofen (Nalfon)    Flurbiprofen (Ansaid)    Ketoprofen (Orudis, Oruvail)    Naproxen (Anaprox, Naprelan, Naprosyn, Aleve, Napron)    Oxaprozin (Daypro) Oxicam:    Piroxicam (Feldene) Fenemate:    Meclofenamine (Meclomen) Acetic Acids:    Diclofenac (Voltaren)    Etodolac (Lodine)    Indomethacin (Indocin, Indochron)    Ketorolac (Toradol)    Nabumetone (Relafen)    Sulindac (Clinoril)    Tolmetin (Tolectin) Most people who are allergic to some of the meds have problems with aspirin and Motrin. Piroxicam seems to be less allergenic than the propionic acids and the acetic acids. It may be one to try. There is one agent that is technically a salicylate but seems to be the most different from the others. It is called Salsalate. It is usually better tolerated by the GI tract and the kidneys and is quite effective. It also causes few allergic reactions in NSAID allergic people. The down side is that you have to take it for about three weeks before seeing an effect. There are some new ones comming out that cause fewer GI effects. This is because they inhibit the enzymes in the stomach less than the enzymes in the joints and skin. Lodine already is relatively less irritating to the stomach (theoretically anyway) for this reason. When these new ones come out they will probably provide another class to try. You may want to print this list out to take to the doctor. I had to pull it out and look at it to type it out myself. It is hard to keep track of which ones are related. — Good Luck, CBI, M.D. e t… I’ve been on Relafen for 3-4 years and just this year, in March, started having asthma attacks. I’ve never been asthmatic in my life, though I do have some allergies which always responded to an occasional anti-histamine. Doctor gave me serevent, albuteral, and xanax. I sit here and gasp all during work hours, I still can’t exercise on my treadmill; in short, it’s not working. I am on Relafen because of severe tendinitis in both wrists and because I have a sensitive stomach. Relafen is kind on my stomach. I need to be able to be on some sort of anti-inflammatory but I can’t live with this sudden asthma. Can someone supply some brand names of alternatives (tylenol will not do the trick). Thanks. Lynda

Response: