Posts Tagged ‘NSAID’


By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy


Stephen Harper lost my children.  That’s my story and I’m sticking to it.  In our house February is the beginning of Tax Season.  Doris goes back to work at Meyer’s Norris and Penny as a tax preparer.  She likes the job, but if Stephen Harper was a good Conservative, he would eliminate all income tax and make Doris’s job redundant.  But instead Harper greedily keeps taxing us which causes mass confusion as Doris, myself and the two kids all try to get out the door to work and school at the same time.  Last Monday, in all this Harper taxation confusion, Eric went missing.  Emily had last seen him wearing his snow stuff, so we assumed he left for school.  But at 6 years old, he is supposed to walk to school with his older sister.  Now thanks to Harper taxation madness, no one knew where he was.  Doris eventually found him on the play ground at school on her way to MNP.  However, that wasn’t the end of Stephen Harper’s child disappearance shenanigans.  After school, Doris was still preparing taxes for Mr. Harper.  That meant that instead of the kids walking home after school, they were scooped up by Florence at School Aged Daycare.  Mr. Harper’s change in the after school routine caused Doris to forget to call Judith the tutor.  Emily usually sees Judith on Monday afternoons.  Harper’s taxation-greed caused Judith to worry that Emily had gone missing.  Harper’s taxation-gate has played havoc with my family’s routine and caused my kids to go missing.  Harper’s taxation-gate is a royal pain in the…knee.


Osteoarthritis can also be a pain in the knee.  Osteoarthritis is the most common type of arthritis.  In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.


Arthritis means “inflammation of the joint”.   As the Arthritis Society points out, arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus.  In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused.  Osteoporosis is NOT a form of arthritis.  Osteoporosis can be debilitating and painful, but it does not directly affect the joints.  Osteoporosis is when the bones get weak and break easily.  We will leave osteoporosis for another article.  Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.


In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction.  When we age, the cartilage can break down.  As cartilage breaks down, bits can break off and go into the soft tissue around the joint and cause pain.  I was surprised to learn that cartilage doesn’t have any nerve endings in it.  So cartilage doesn’t feel any pain.  The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down.  When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. 


What symptoms might I have with osteoarthritis?  The hallmarks are pain, stiffness and swelling around a joint that lasts longer than 2 weeks.  Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes.  Although there can be swelling around the joint in OA, it is usually less than would be expected in rheumatoid arthritis.  The joints usually affected are the hips, knees and spine.  Finger and thumbs joints may also be affected.


How is OA treated?  Osteoarthritis treatment is usually a combination of non-drug and drug treatments.  Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other.  OA can also be treated by surgical replacement of the joint.  Drug treatments can be divided into pain killers, steroid injections, and synovial fluid replacements.


One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol).  If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen.  These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure.  There are also topical or rub on forms of NSAIDS which get NSAID to the joint and avoid the stomach.  Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working.  They are mostly done on knees, and should be limited to 3 injections per year.  Synovial fluid replacements can also be injected directly into the joint and help lubricate it.  They are used most often on knees and are expensive.


Maybe it really was poor planning and poor parenting that caused of my kids to go missing when Doris went back to work.  Maybe Stephen Harper isn’t to blame.  But I still think paying taxes is a pain in the knee.  If you think the pain in your knee might be osteoarthritis, talk to your pharmacist.  Maybe we can help that knee pain better than Harper can cut taxes.


As always if you have any questions or concerns about these or other products, ask your pharmacist.


We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at


The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


Arthritis Society’s website :


Osteoarthritis-Mayo Clinic:


Canadian Arthritis Patient Alliance:


By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Some things are better together.  A hammer and a nail.  Toast and Jam.  Sonny and Cher.  Okay, maybe Cher is better without Sonny.  But my favorite combo are Reese’s Peanut Butter cups.  In their commercials, they are always combining peanut butter and chocolate in new and interesting ways.  One time Noah’s neighbors accidentally combine peanut butter and chocolate, proclaim it delicious, but decide to tell Noah after it stops raining.  Another time a spaceman runs into a robot and they mix the two key ingredients and decry the combination delectable.  When we combine medications into one pill is it more like Reese’s Peanut Butter cups or more like Sonny and Cher?

Recently, a young woman asked me to help her pick out a pain killer for her sore knee.  The knee was wrapped in a tensor bandage and had some obvious swelling.  “Great,” I thought, “She can use ibuprofen.”  Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug), so it treats pain and inflammation.  But before I could give her my recommendation, the woman said she couldn’t use ibuprofen.  So I asked why.  She explained she had a certain stomach condition, and ibuprofen would aggravate it.  We talked about acetaminophen or Tylenol, but she had tried it already and it hadn’t helped.  Acetaminophen is a pain killer, but it doesn’t help inflammation.  I eventually had to refer the woman to the walk-in clinic, because nothing over the counter was going to help her.

That is one of the problems with NSAID’s.  They are hard on the stomach.  So sometimes we give them as a drug combo.  To protect the stomach we sometimes also give the person on the NSAID a stomach medication called a PPI (proton pump inhibitor).  There are other alternative drug combo’s we can use with NSAID’s.  We can give the NSAID patient a stomach protector called misoprostol, or an acid reducer called an H2 blocker.  Both misoprostol and PPI’s have been shown to reduce the events of stomach bleeding and ulcers in high risk patients on NSAID’s.  H2 blockers are not as effective in protecting the stomach.  If we give really big doses of H2 blockers, they reduce the chance of ulcers from NSAID’s, but don’t reduce the chance of really bad things like perforations and bleeds.  Misoprostol is effective in protecting the stomach, but you have to give it 4 times a day and it gives some patients diarrhea and cramping.  The PPI’s are generally well tolerated, and are the most commonly used combo to protect the stomach from NSAID’s.

Given that PPI’s are the preferred method to protect the stomach from NSAID’s, it was interesting when AstraZeneca came out with its new combo product called Vimovo.  It has the NSAID naproxen and PPI esomeprazole together in the same pill.  Is this combo like Reese’s Peanut Butter Cups or Sonny and Cher?   On the plus side Vimovo is priced lower than buying the naproxen and esomeprazole separately.  On the down side since Vimovo is new, it will not be covered by Pharmacare.  Vimovo is to be taken half an hour before meals to give the PPI esomeprazole time to work properly.  The naproxen in Vimovo has a delayed release mechanism.  This means it won’t be released in the empty stomach and irritate it.  Vimovo should not be crushed or broken or the delayed release mechanism will not work properly.  Also because of the delayed release mechanism, Vimovo is not for acute pain.  So if you whack your knee, don’t reach for the Vimovo.  The delayed release will mean it won’t help fast enough.  Vimovo is for pain you have all the time like arthritis.

Who should take Vimovo and who should use something different?  It depends.  We need to know how likely the patient is to get an ulcer or bleed.  Risk factors for getting a stomach bleed or ulcer include being over 60 years of age, taking ASA everyday, taking high doses NSAID’s or having a previous ulcer.  If you have 1 or 2 of these risk factors and you need to be on a NSAID, taking a PPI with it may be a good idea.  For patients like that, Vimovo might be a good Reese’s Peanut Butter cup option.  If a patient has 3 or more risk factors, or is on warfarin, on a steroid or has a previous complicated ulcer, Vimovo might not be a good idea.  In this case Vimovo is more like and Sonny and Cher combo.  If a high risk patient like that really needs an NSAID, it should probably be Celebrex and a PPI.  However, if a patient was really at that high of a risk on getting an ulcer and was in pain, we would probably consider a different pain killer like an opioid.

So is Vimovo a good combo like Reese’s Peanut Butter Cups or a bad combo like Sonny and Cher?  It depends on your ulcer risk.  If you are at low risk of an ulcer, you don’t need a PPI at all and Vimovo isn’t for you.  If you have acute pain from a sprained knee or a headache, Vimovo won’t work fast enough and isn’t for you.  If you have a really high risk of an ulcer, your doctor probably shouldn’t use an NSAID on you at all.  For all of those Vimovo is Sonny and Cher.  But, if you are a moderate risk for an ulcer and you need an NSAID, Vimovo might by your Reese’s Peanut Butter cup!

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Reese Peanut Butter cups – Space Man and Robot

Reese Peanut Butter cups –Noah’s Ark

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

If you have any topics you want us to write about, email us at or call 638-4602.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at

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