Tip Sheet: Ulcers and Pain Relievers
Be cautious about taking over-the-counter pain relief drugs if you have an ulcer. Some can worsen your symptoms. These tips will help.
If you have an ulcer, you need to be very careful with over-the-counter pain
medicines. Remember: No drug is risk-free. It is very important to discuss the
use of over-the-counter drugs with your doctor, especially if you have an ulcer
or other medical conditions. Here are some tips from the experts for using
these medicines safely.
- Avoid Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). If
you have an ulcer, use of NSAIDs, such as aspirin or ibuprofen could be
dangerous and potentially life-threatening. A non-NSAID pain reliever, like
acetaminophen, may be a safer choice. Your doctor can recommend appropriate
- Take precautions. If you need to use an NSAID, always take
it with milk or food to make it easier on your stomach. To prevent problems,
your doctor might recommend:
- A prescription proton pump inhibitor (like Prilosec, Prevacid, Aciphex,
Protonix, and Nexium)
- High doses of prescription H2 receptor antagonists (like Pepcid, Tagamet,
Zantac, and Axid)
- Cytotec, a drug to protect your stomach lining
- Look for symptoms. If you have to take an NSAID, know the
symptoms of trouble. If you have an increase in abdominal pain, nausea,
vomiting, loss of appetite, dark stools, weight loss, or fatigue, get checked
out right away.
- Know the risk factors. A lot of the time, ulcers don't
have warning signs. "For many people, internal bleeding is the first sign
that they're having a problem with NSAIDs," says Byron Cryer, MD, a
spokesman for the American Gastroenterological Association. You can't rely on
early symptoms to tell you that something's wrong. Instead, you need to ask
your doctor if you are at high risk of having problems. For instance, people
who take high doses of NSAIDs or are over 65 are more likely to have problems.
If you are at increased risk, take extra precautions.
- Avoid alcohol. Most pain relievers do not mix with
alcohol. If you take an NSAID, including aspirin, just one drink a week can
increase your risk of gastrointestinal bleeding. People who have three or more
drinks a day should not use these medicines. Combining acetaminophen and
alcohol may increase the risks of liver damage.
- Use as directed. Follow the directions for the recommended
dosage. Most painkillers shouldn't be used for more than 10 days. If you're
still in pain by that point, see your health care provider.
- Read the package insert. Admit it: When you buy a bottle
of over-the-counter pain reliever, you likely throw out the printed insert
along with the empty box. But you really should get in the habit of reading it.
Find out what side effects you should look for. Look at the list of possible
drug interactions or ask your pharmacist or doctor to go over it with you.
- Read the ingredients of all medicines.
Painkillers like aspirin, acetaminophen, and ibuprofen can show up in the most
unlikely places. For instance, many over-the-counter medicines for colds also
contain doses of pain reliever. So make sure you know what you're getting.
Even some antacids - such as Alka-Seltzer -- contain aspirin, which can be a
special risk to people with ulcers. "It's very common to see a person with
an ulcer using Alka-Seltzer," says Cryer. "They think that it's helping
but actually they're just making things worse by putting aspirin on top of an
- Tell your doctor about all medicines, herbs, and supplements that
you use. Interactions are a real danger. For instance, taking NSAIDs
along with some common medicines, like some corticosteroids (Prednisone) and
blood thinners (such as Coumadin) can increase the risks for people with
Your health care provider needs to know about all the medicines you take
before you're prescribed a new medicine. Don't forget to mention
over-the-counter medicines, herbal remedies, and vitamins.
"Bring a list of all the medicines and supplements you take to your
doctor," says Nieca Goldberg, MD, a spokesman for the American Heart
Association. "It could actually save your life."