Injectable NSAIDS

[LoriASoCal]

Anyone use an injectable NSAID? How often do you inject? Where you given this to protect your stomach?

[healme7]

Hi! I'm a newbie. I'm on Enbrel Injectables. I've been having trouble injecting. Start in thighs, twice a week, alternating. Haven't been brave enough to inject in stomach yet.

[skwalle]

Anyone use an injectable NSAID? How often do you inject? Where you given this to protect your stomach?


I didn't know they had injectable nsaids...will have to find out about this, as I am currently unable to find anything to put me out of my misery!

Sandy

[skwalle]

[QUOTE=healme7]Hi! I'm a newbie. I'm on Enbrel Injectables. I've been having trouble injecting. Start in thighs, twice a week, alternating. Haven't been brave enough to inject in stomach yet.[/QUOTE

nsaids are something different. Once you inject yourself in the stomach, you won't go back to the thighs, it is much easier!

Sandy

[Momelie]

First I've heard of them! Can you give me a drug name I could run past my doctor (have an appt this week)? I'm at the end of my rope trying to find something my stomach can handle!

[LoriASoCal]

I'm sorry ... I'm trying to research names right now. My own appointment is in a couple weeks. Apparently I have a duodenal inflammation from the NSAIDS.

[RichJ]

Hi! I'm a newbie. I'm on Enbrel Injectables. I've been having trouble injecting. Start in thighs, twice a week, alternating. Haven't been brave enough to inject in stomach yet.
hi healme7,
welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you.

have a good night all

richard

[LoriASoCal]

Everything I'm finding on the injectable NSAIDS is very limited and mostly referring to use in post-operative pain :(
But here is one: Dynastat® parecoxib-Dynastat® (parecoxib) is an experimental painkiller that is essentially an injectable version of Bextra®. Dynastat® is the first injectable Cox-2 inhibitor used in the treatment of pain and inflammation.

and ketoralac
I'm still going to mention it to my rheumy but he's probably going to look at me like I'm some crazy desparate old woman- and he'd be dead on.

[JesseLou]

Lori - Ask if you can have one of the nsaids compounded into an injectable solution by a pharmacist that does compounding.

Can you take the prescription aleve that is combined with prevacid?

[ouchyk]

Lori,

Perhaps you could ask your rheum about www.limbrel.com as well as http://www.nuvoresearch.com/products/pennsaid.asp I'm not sure that the latter is available in the US as of yet...of course you might have to bathe in the pennsaid to get relief.

I keep meaning to ask my rheumy about both. Like you, I can no longer take an NSAID orally, and I have always taken them with prevacid or prilosec rx. :confused: maybe it was the 4 year steady diet of them 3x a day...I'm hoping with some time off from them I will be able to return to using them or perhaps one of the options I have written above. I will have to remember to ask my rheum at my next appt in a few weeks.

Karen

[JesseLou]

Is celebrex out too?

[LoriASoCal]

Hi Karen and Jesse:

Okay, right now I am not to take any nsaids period. I'm taking a drug called sucralfate and it's supposed to heal some of the inflammation and ulceration found during the endoscopy and colonoscopy. Monday I find out about the biopsies and if they came back okay. I'm assuming they did or I probably would have heard something by now.

So my rhuemy will be forwarded all that information and he'll have it when I see him first week of sept. My GP said if they found ulceration(which they did) she would not recommend me taking nsaids anymore (meaning ever?) because even celebrex combined with previcid which is what I was thinking I'd do, is still going to irritate the ulcers. I'm thinking heck no, I need my nsaids.. don't like steriods.

I also took a two week break from mtx, so I'm starting to really hurt. And my remicade is worn off as per usual about 10 days prior to infusion time. I'm supposed to be taking more prednisone but I'm just not in the mood especially since I've lost some weight recently and pred makes me a witch.

Anyway, it's pretty much what we are all going through in various stages so- I definitely will ask him about limbrel and penssaid. Personally, I've had no luck with aspercreme/capsasian(sp?) type products that rub into the skin but maybe the penssaid is better. I'm wondering why these products are only recommended for osteo? It's all inflammation isn't it?

[LoriASoCal]

I'll also ask about the compounding although I'm thinking my rhuemy might nix it.

[Momelie]

Well, since my rheumy and primary care doc got together and sent me for a consultation with a Pharm.D. they have in the practice (I go to a teaching university's medical clinic), I brought the subject up with him yesterday.

He said that studies have found that even when NSAIDs are administered in a non-oral fashion, they still have the same effect on the stomach, due to the fact that they do something to prostaglandins (he really did give me an official, sense-making explanation, but I've slept since then, lol), which protect the stomach.

His solution for me was to put me on a very rarely used, and little known drug called misoprostol (generic name) that will counteract the effect of NSAIDs on prostaglandins, or something like that. I have to take it with meals, 2-3 times a day, which is also how my 800mg dosage of ibuprofen is delivered. BIG CAVEAT!!! I had to sign papers at both the doctor's office AND the pharmacy swearing that there is absolutely no way I can get pregnant - evidently they don't want pregnant women even touching the pills, much less ingesting them. The bottle has a huge red button on the lid with a warning, and the label has a picture of a pregnant womant with one of the red circle with a slash through it. I'm afraid to ask the obvious question, LOL.

I'm in a pretty major stress flare right now, so I'm desperate to find something to help with the pain and inflammation - I'll let you know how it works.

[JesseLou]

My husband just started taking limbrel, the "medical food" cox-2 inhibitor. He read through the package insert, and it did not list GI problems as a possible side effect. He doesn't ever have trouble with his stomach, so I won't be able to report back on that, but I will let you know how he thinks it compares to Celebrex, which he recently stopped, and to vioxx, which he took until it went off the market.

[ouchyk]

He said that studies have found that even when NSAIDs are administered in a non-oral fashion, they still have the same effect on the stomach, due to the fact that they do something to prostaglandins (he really did give me an official, sense-making explanation, but I've slept since then, lol), which protect the stomach.


I'm in a pretty major stress flare right now, so I'm desperate to find something to help with the pain and inflammation - I'll let you know how it works.



Wow the topical NSAID pennsaid was boasting results that did not have GI involvement, probably why the FDA has not approved yet for the US?

Hope that you feel better soon, I'm well past the age of that big ole Red X whew! Be careful with it and let us know how your doing!

Karen

[Elaina]

I have been on Enbrel 4-5 years. Recently I was diagnosed with interstitial pukmonary fibrosis (my lungs have started to get hazy and I have difficulty breathing when it's hot). Please get at CT scan of the abdomen to be safe when using this drug.

[LoriASoCal]

Hi Elaina,

I'm sorry to hear about your troubles with ILD. It's late and I'm a bit hazy myself but I'm trying to understand the correlation between this thread, enbrel, ILD and the need for a CT of the abdomen when using 'enbrel?'.

From what I have read ILD is more common among people with RA and inflammatory conditions. Are you saying that you think enbrel caused you to get this? How would getting a CT scan of the abdomen make it safer? It doesn't appear to be one of the methods for diagnosing ILD. I hope you are doing better soon.

[RichJ]

hi elaina,
sorry to here about your lungs. i hope it get's better. welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you.

try and have a good weekend all

richard

[Had-It-Forever]

Well, since my rheumy and primary care doc got together and sent me for a consultation with a Pharm.D. they have in the practice (I go to a teaching university's medical clinic), I brought the subject up with him yesterday.

He said that studies have found that even when NSAIDs are administered in a non-oral fashion, they still have the same effect on the stomach, due to the fact that they do something to prostaglandins (he really did give me an official, sense-making explanation, but I've slept since then, lol), which protect the stomach.

His solution for me was to put me on a very rarely used, and little known drug called misoprostol (generic name) that will counteract the effect of NSAIDs on prostaglandins, or something like that. I have to take it with meals, 2-3 times a day, which is also how my 800mg dosage of ibuprofen is delivered. BIG CAVEAT!!! I had to sign papers at both the doctor's office AND the pharmacy swearing that there is absolutely no way I can get pregnant - evidently they don't want pregnant women even touching the pills, much less ingesting them. The bottle has a huge red button on the lid with a warning, and the label has a picture of a pregnant womant with one of the red circle with a slash through it. I'm afraid to ask the obvious question, LOL.

I'm in a pretty major stress flare right now, so I'm desperate to find something to help with the pain and inflammation - I'll let you know how it works.

Misoprostol is one serious drug. I have been on it for a few weeks. Here is a link to some more info about it.

http://www.medicinenet.com/misoprostol-oral/article.htm

[Momelie]

WOW! Yep, it seems to be a pretty serious drug - the morning after pill, who knew?

BUT..... (i'm whispering this so I don't jinx it) it seems to be the last ditch miracle it was purported to be! In the time I've been taking it, I'm able to take my NSAIDs and not have the slightest twinge in my stomach.

It almost seems to good to be true - the 800 mg ibuprofen 3x per day is taking care of the flare, and the misoprostol is taking care of my torn up stomach.

The stress of taking 12 graduate hours my first real semester of grad school is still here, but my throbbing joints are settling down, finally. Not going to argue with that, lol.

Now, if we could just get the pill to explain New Criticism and Moral Formalism to me in terms that a brain dead zombie could understand...

[LoriASoCal]

Okay sign me up. How does this mix with methotrexate which is one half of the pill Ru488? I'm not really willing to Expel any of my internal organs any time soon. Well, it's just one more thing to ask my doctor about on Thursday:)

[LoriASoCal]

Okay, my rhuemy appt was Thursday. Just prior to my infusion. This is what I was told about the NSAID situation. They will all cause problems. Injectable NSAIDS are expensive, not covered by my insurance and my rhuemy doesn't think they totally protect the stomach anyway, because of the prostaglandin thing mentioned above.
I asked him what he recommended and he shrugged. he said why don't you pick one. I said arthrotec...he said my insurance won't cover it. btw... arthrotec is diclofenac and mistoprostol. I found out from the pharmacist that it's 177.00 for a one month supply.
So I took a prescription for diclofenac and if it helps the inflammation and pain but gives me a tummy ache.-My DBF, said that he will foot the bill for arthrotec. I feel like such a liability in this relationship. It's a good thing I'm such a great cook. lol.
I mentioned in another post that I got cheated out of an entire vial of remicade and low and behold it isn't working as good as it should. After thinking about it, I've decided to discuss it with my therapist and hope she can help me with what course of action to take.
I only took my first dose of diclofenac today ...so far no stomach upset and it seems to have helped a little although it took about 2 hours for it to kick in. Partly because it said to take AFTER my meal.
He said that he hasn't found any information about limbrel and seemed a little irritated when I asked.
He said Pennsaid probably wouldn't work any better than aspercream. I figure I might hit him up for some of it next time anyway. The main thing is that I walked away with a different NSAID to try and that if it works for pain but not for stomach I can try arthrotec. Then we'll just see if it's worth 177.00 a month. I'd probably end up stretching it out to 2 months though.

Also, it seems if it does work... I should then be able to petition my insurance for denying me medicine that will work? Does anyone know about that?



Anyone on arthrotec? Do you like it?

[JesseLou]

Lori - I'm brainstorming ideas... I wonder specifically what kind of pain do you have? Is your rheumy working to diagnose the source of the pain(s) you have? Has he ever sent you to an orthopod?

When I have pain, it is one of 3 things: enthesistis, most commonly in my trochanters; referred pain to my neck, back, and bicep tendon from swelling in my shoulder; tendons and muscles that are overworked by taking the load from places where enthesitis or swelling has caused a major muscle, like a glute (SI joint inflammation), to malfunction. What feels like joint pain is always soft tissue inflammation or muscle guarding of an inflamed joint.

Most of the time there is something that can be done about it, like an injection of cortisone, or icing. The only thing I take ibuprofen for is rib pain, and then only for a day or two - I started in this game with a bad stomach. I took vioxx only before my diagnosis, and my first rheumy got me off it right away, because he didn't like NSAIDs. Exercise helps tons- even though I aspire to be a couch potato!

With the exception of occasional costrochondritis, I can rarely diagnose the source of the pain myself. My husband can always ask me one or two questions, then zero in on the actual source - but then that's what he does for a living. My pilates instructor is also good at helping pick apart what's going on. And then I get sent to whatever doctor has a solution.

Recently my husband started having trouble with his plantar fasciitis, and he got steroid patches that stick to your skin, and gave him instant relief - not only that, but he wore it all day at work, when he's on his feet for most of 10 hours. This was the first time I'd heard of these.

One more thing you might try, is to ask your rheumy if he will write you a script for an ultrasound maching - it's more money, but it's a one time expenditure. We just got a hand-me-down from a PT friend who was trading up.

Just trying to think of some new avenues to pursue. Maybe I have a completely different brand of PA than those who have written on this thread, or maybe I'm getting a different kind of treatment because my husband knows what the options are - if that's the case, I would really like to help figure out how others can get the same help. What do you think?

[Momelie]

Yep, my insurance wouldn't cover arthrotec, either. BUT - misoprostol is a generic drug, as is ibuprofen. So I got two separate scrips, and even combined, they are much less than the co-pay for the Mobic I used to take.

I got the ibuprofen at Wal-Mart, its one of the $4 scrips. Went to my usual pharmacy for the misoprostol, and it was a $25 copay for a 90 day supply. It would have been $12 for a 30 day supply.

Anyway, its been 10 days - under normal circumstances, any NSAID would have completely destroyed my stomach by now. With taking the misoprostol, I'm doing just fine tolerating the 800 mg ibuprofens. I'll admit to having forgotten to take a dose or two, and I can't tell a difference. The only caveat is to make sure you take with food - I tried taking one I'd forgotten without food and had kind of a woozy nausea for a few hours. Other than that, no problems.

Well, one problem. My SI joints and one elbow seem to be able to defy the help of the NSAIDs and are making me want to scream with pain. Ever tried to study when you can't stay still longer than 90 seconds? Urgh!

Lori, hope you can get straightened out soon!

[LoriASoCal]

Thanks Momelie,
I never would have thought about the arthrotec had it not been for your input on this thread. Perhaps before I spend money that isn't necessary I'll see if I can get the misoprostol as a separate rx.
Jesslou,
My diagnoses is psoriatic spondylitis-but that has not precluded it from affecting my hands, feet, elbows, knees and jaw etc. I get enthesitis especially before infusion time. And yes it's hard for me to pinpoint exactly where the pain is coming from at times because it defers or redirects. Also if I am flaring for more than a few days it tends to become generalized all over pain including muscles, this is also when the fatigue becomes so bad I'm at the point where I can't maintain my very minimalized life. What might start in my neck...moves to my hands...and pretty soon my muscles even start getting cramps.

Remicade has helped a great deal... but it falls short in the sense that it wears off before the next infusion. this was helped by shortening the interval. But the thing is it's never lasted more than 3 to 4 weeks before wearing off. I've gone from 8wks to 6wk to 5wks respectively with my down time decreasing to that effect. Now I have between 4 and 10 days of hell before my infusion whereas it used be ... 4 weeks to 2 weeks.
Recently when my stomach became to messed up for my usual 3 x 800 mg dose of ibuprofen things detiorated from a pain standpoint . I'm hoping with declofenac it will turn back around.
The only surgery that's been offered to me has been on my toes to correct them from slipping under each other which without the right shoes is a trip hazard. I'm considering that. I was told that surgery on my back could make things worse in the long run and at the time in my 30's ... I was told that if possible I shouldn't take such a drastic step at that age.

[KellyPSA]

I just wanted to let you know, I inject in the abdomen all the time now....It actually looks awful when you first do it, but I think it stings less....