Painkillers: Preventing Side Effects

1. Six Tablets Not Enough
Through arthrosis I have pain in almost all my joints. That’s why I use paracetamol. I understand that I can only take six tablets a day, spread over the day. But that won’t get me through the night. I wake up from the pain in my legs, arms and hands. I have never been prescribed any other drug. Would that be an idea?

With long-term use, you can take 2.5 to 3 grams of paracetamol per day. That corresponds to 5 to 6 tablets of 500 mg paracetamol. To keep the level of the active substance in the blood as constant as possible, it is recommended to divide the amount of paracetamol over three to four swallowing moments per day. If you have problems at night, it is best to take two tablets (= 1 gram of paracetamol) before going to sleep.

If you continue to have pain at night, talk to your doctor. He can possibly give you a painkiller from the group NSAIDs to advise. Examples include ibuprofen, diclofenac or naproxen. They work differently and may be able to relieve the pain at night. With these medicines you sometimes have to use a stomach protector (see question 7).

2. Always a headache
Can you get a headache from taking painkillers?

Yes you can, we call this drug-dependent headache. It is caused by the daily use of painkillers for headaches. You can recognize drug-dependent headaches by the pain that is present almost daily despite the painkillers. Often the headache worse if you do not take painkillers for a while. Stopping the use of painkillers is the only thing that helps against drug-dependent headaches. Your GP or pharmacist can help you with this.

3. With or without Vitamin C
Is it wise to choose a painkiller with vitamin C?

No, but it can’t hurt either. Paracetamol has an analgesic and fever-reducing effect. Vitamin C is added to this with the idea that a cold will pass faster if you get enough vitamin C. However, it has never been proven that paracetamol with vitamin C works better than paracetamol alone.

4. Tramadol pros and cons
After a surgery on my hip I take tramadol. The advice is to take one to two tablets twice a day. However, I only take them when I am in a lot of pain. What are the pros and cons of this drug?

Tramadol is a morphine-like painkiller, but it is less effective than morphine. Doctors often prescribe this for severe pain or nerve pains. If you only have occasional pain, it does not hurt to take a painkiller only then. The only downside is that you have to wait half an hour to an hour for it to work. If you take tramadol a few times a day, the pain relief will remain constant.

Tramadol – like all medicines – can cause side effects; drowsiness, confusion and dizziness are especially common. It is therefore advised not to drive a car for the first two weeks after starting tramadol. Most people get used to these side effects and can drive again after two weeks.

Some people experience nausea for the first few days. Less common side effects are blockage of the intestines and a dry mouth. If you suffer from a dry mouth, you can keep saliva production going by chewing gum, for example. You can prevent blockages by high fiber foods to eat.

5. Preventing Bloodshot Eyes
After an accident I was prescribed the painkiller diclofenac. Within a few days I had bloodshot eyes as if veins had burst. “Stop this immediately,” was the doctor’s advice. Suppose I need another painkiller, which one should I take?

Diclofenac belongs to the group of NSAIDs. A side effect of all NSAIDs is that they inhibit the production of platelets. If bleeding occurs in the body, this will stop the bleeding as quickly. Most people who do not use other medicines hardly notice this. They also do not notice that blood clots less quickly after a bleed.

If you also use an anticoagulant in addition to NSAIDs, you may notice a reduction in blood clotting. This can result in red eyes. In that case it is better to use paracetamol; that has no effect on blood clotting. People who regularly go to the thrombosis service to have their blood clotting checked are also advised to report NSAID use there.

6. Stuffy from naproxen
I have asthma. Recently I was prescribed naproxen and then I got very short of breath. The doctor then told me to stop taking this drug. Is this stuffiness from the pain reliever and can I use a different kind?

Some people with asthma get choked up on NSAIDs, such as naproxen. There is a chance that you will also become short of breath from other painkillers from the group of NSAIDs. The use of paracetamol is safe in this case.

7. Stomach protector or not
If I take a painkiller, should I always use a stomach protector?

New. Paracetamol has hardly any side effects on the stomach. That is why you do not need to use a stomach protector with this medicine. Only with painkillers from the NSAID group (such as ibuprofen, diclofenac or naproxen) a stomach protector is sometimes necessary. For example if you have previously had a stomach ulcer or if you are older than 70 years.

You also need a stomach protector if you meet two or more of the criteria below:

• You are taking the NSAID for a longer period of time.
• You are also taking other medications that can affect the rate of blood clotting, such as anticoagulants, some antidepressants, and corticosteroids.
• You are between 60 and 70 years old.
• You suffer from another disease, such as diabetes mellitus, heart failure or rheumatism.

Annemieke Horikx is a pharmacist at the professional organization of pharmacists, the KNMP.