Another reason to be cautious about NSAID use

Many people who have WLS also suffer from depression and take antidepressants.  I saw an article about a study that found a statistically significant increase in intracranial hemorrhage ("brain bleeds") in people taking both NSAIDs and antidepressants.  The type of antidepressant (SSRIs, SNRIs, or tricyclics) did not matter.

I cannot copy the whole study, and the article isn't on a public website, but here is the summary. Although this study was specific to intracranial bleeding, it would seem likely that the combination fi the two drugs would also increase the chance of gastric bleeding as well...

The combination of antidepressants and nonsteroidal anti-inflammatory drugs (NSAIDS) is linked to an early increased risk for intracranial hemorrhage, regardless of the type of NSAID or antidepressant, new research shows.

"The take-home message for clinicians is that special attention should be paid [to] antidepressant users when they start an NSAID prescription," coauthor Byung-Joo Park, MD, MPH, PhD, told Medscape Medical News.

"Monitoring bleeding risk is particularly needed at the initial combined use of both medicines," added Dr Park, who is a professor in the Seoul National University College of Medicine's Department of Preventive Medicine, in Korea.

The study was published online July 14 in the BMJ.

Lora

Thanks for this Lora

I know we RNYers are usually cautious about NSAID use, but for years certain DSers were using the possibility of long term use for DSers and VSGers  as a sales pitch.  

Long term NSAID or acetaminophen use is risk vs reward for everyone - WLS or not!

What scares me about this is the statement that physicians should be aware of the combination, but that assumes that the physician KNOWS that a patient on antidepressants is also taking an OTC NSAID (or asks about NSAID use before prescribing an antidepressant).  

I bet many don't...

More and more people seem to be leaning heavily on NSAIDS. I don't think they were ever intended to be used daily, year after year, but that's how more and more people are taking them. And, like this study, there seems to be increasing evidence that it isn't a good idea for anyone, not just WLSers.

I agree that these were probably not intended to be taken daily (or multiple times daily!) long term for chronic pain.

I have had a couple of people indicate that, basically, they are under the impression that Ibuprofen vel sim and Tylenol are harmless drugs... simply because they are OTC.  The fact that you can buy so damn many different types of NSAIDs doesn't help, either.

They have usually made these comments after hearing that I cannot take NSAIDs (both because of my gastric bypass and because I take an anticoagulant) and that I rely on Tylenol or Tramadol (or Vicodin...) for pain relief, and it is usually accompanied by some type of exclamation that they could never give up their daily Aleve or whatever.

I didn't think Tylenol was a NSAID.  My Dr said I could take it. ????

No, Tylenol isn't an NSAID, and we can take it, but it can cause serious liver issues if taken too frequently (and, like the NSAIDs, many people think it is without potential side effects or consequences).  Sorry, I didn't mean to cause any confusion!

Thank you for posting this info! I have a question...I suffer from end stage arthritis in my weight bearing joints. I've been weaning off my NSAIDS in preparation for my RNY. Tylenol does nothing for my pain, suggestions?

I had "severe" and "moderate" arthritis in my knees before I had surgery, and had been taking Celebrex and occasional Aleve (I wasn't auppsied to take NSAIDS even before RNY because it interferes with my blood thinner). Unfortunately, you are correct that Tylenol is useless.  You will probably need to get a prescription pain med.

Tramadol is common one (it worked about as well as the Celebrex and Aleve did for me, but had to be taken three times a day).  If that ain't enough, you will probably need to find a doctor willing to prescribe something like Vicodin/Norco (hydrocodone). Unfortunately, since the DEA bumped it up to a Schedule II narcotic a few months ago, that is becoming more and more difficult.

The ultimate solution, of course, is replacement of the joints where possible. If you have severe arthritis in joints that cannot be replaced, you might seriously consider the sleeve instead of RNY. The NSAIDs can still result in ulcers, but with the sleeve there is no blind remnant stomach that can develop an ulcer (and cannot be reached except via surgery and systemic drugs),

Lora

I would suggest discussing pain management with whichever doctor is treating you for your arthritis BEFORE undergoing surgery.  This way there won't be any surprises.