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Oral Prednisolone and Naproxen (Aleve) Equal for Gout Pain | MedPage Today - Before Using |
Prednisolone: interactions with other medicines.
If you're taking gastro-resistant prednisolone tablets, don't take antacids indigestion remedies at the same time of day. Avoid taking antacids within two hours of taking this type of prednisolone tablet. Don't take anti-inflammatory painkillers NSAIDs like aspirin, ibuprofen or naproxen while you're taking prednisolone, unless they've been prescribed by your doctor. This type of painkiller may increase the risk of side effects on the gut, such as stomach ulceration and bleeding.
Remember that many cold and flu remedies and over-the-counter painkillers contain ibuprofen or aspirin and so should be avoided while you're taking prednisolone.
Be sure to check the ingredients of other medicines before taking them with prednisolone, or ask your pharmacist for advice. It's fine to take paracetamol with prednisolone.
You can also take opioid-type painkillers such as codeine or co-codamol. Check with your doctor or pharmacist before using steroid creams eg for eczema or allergic skin reactions or steroid nasal sprays eg for hayfever while you're using prednisolone. Prednisolone can cause fluid and salt retention and so may oppose the effects of the following medicines:. Prednisolone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines.
People with diabetes may need an increase in their dose of insulin or antidiabetic tablets. Prednisolone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. If you're taking warfarin with prednisolone your blood clotting time INR should be regularly monitored, particularly after starting or stopping treatment with prednisolone and after any dose changes.
The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine. Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant.
If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away.
Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist eye doctor.
While you are being treated with prednisone, do not have any immunizations vaccines without your doctor's approval. Prednisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza nasal flu vaccine , poliovirus oral form , rotavirus, and rubella.
Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.
This medicine might cause thinning of the bones osteoporosis or slow growth in children if used for a long time. Background: Non-steroidal anti-inflammatory drugs and colchicine used to treat gout arthritis have gastrointestinal, renal, and cardiovascular adverse effects. Systemic corticosteroids might be a beneficial alternative. We investigated equivalence of naproxen and prednisolone in primary care.
Methods: We did a randomised clinical trial to test equivalence of prednisolone and naproxen for the treatment of monoarticular gout.
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The level of potassium in your blood is more likely to fall too low if you take prednisolone with other medicines that can lower the amount of potassium in your blood, such as: acetazolamide aminophylline amphotericin beta agonists, eg salbutamol, salmeterol, terbutaline carbenoxolone liquorice in large quantities potassium-losing diuretics, eg furosemide, bendroflumethiazide theophylline.
You may need a larger dose of prednisolone if you are also taking any of these medicines: barbituates, eg amobarbital, phenobarbital carbamazepine fosphenytoin phenytoin primidone rifabutin rifampicin. The following medicines may reduce the removal of prednisolone from the body and so may increase its effects or side effects: ciclosporin prednisolone may also increase the blood level and risk of side effects of ciclosporin itraconazole ketoconazole liquorice macrolide-type antibiotics, eg erythromycin protease inhibitors, eg ritonavir.
Can I have vaccines while taking prednisolone? What is prednisolone used for and how does it work? What should I know before using prednisolone? How do I take prednisolone? Who might need a lower prednisolone dose or extra monitoring? Can I use prednisolone while pregnant or breastfeeding?
What are the possible side effects of prednisolone? Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor.
You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine. Blood or urine tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress.
Your dose of this medicine might need to be changed for a short time while you have extra stress. Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
Findings: Data were incomplete for one patient in each treatment group, so per-protocol analyses included 59 patients in each group. After 90 h the reduction in the pain score was The difference in the size of change in pain was 1. In an accompanying comment, Timothy H.
Rainer, M. First, they said, although well-designed, the study was fairly small and was done at one center. It needs to be repeated in other locales with different rates of gastrointestinal disease. Second, they said, changes in clinical practice often need strong marketing forces, which might not occur unless drug companies stand to benefit from newer more expensive drugs. Nevertheless, they concluded, this trial "will go some way to satisfy both rheumatological purists and front-line pragmatists that short-term oral corticosteroids are as equally effective as NSAIDs in the initial treatment of acute gout and gout-like syndrome.
Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; Share on Facebook.
In an equivalence study, pain scores for the corticosteroid and NSAID were similar as were the number of adverse events, which were minor, Hein Janssens, M. Action Points If patients ask, explain that prednisolone, a corticosteroid, was as effective as the commonly used nonsteroidal anti-inflammatory drug naproxen Aleve in relieving the pain of a gout attack.
Yet for gastrointestinal-bleeding reasons, the authors said, the study provides a strong argument to consider prednisolone as a first treatment option over NSAIDs for patients with gout.
Use of cochicine has declined because of its disadvantage in renal failure and NSAIDS have been associated with gastrointestinal and cardiovascular risks often seen in gout patients.
Prednisolone may also turn out to be less costly because they don't require gastroprotective drugs added to treatment with NSAIDs, the researchers said. The researchers undertook a randomized clinical trial to test the equivalence of naproxen and prednisolone for treating monoarticular gout.
From March 24, through July 14,family physicians in the eastern part of Holland were asked to send all patients with monoarthritis to the trial center, even if gout was not the most likely diagnosis. Treatment was masked for both patients and physicians. Data were incomplete for one patient in each treatment group, so analyses included 59 patients in each group. After 90 hours, the reduction in the pain score was The difference in the size of change in the pain score for the whole observation period intervals was 1.
Reductions in the pain scores were equivalent and went from 62 mm to 17 mm for prednisolone and 59 mm to 13 mm for naproxen, in a similar pattern. For general disability, the differences were 0. In all cases these differences non-significantly favored naproxen, the investigators said.
Adverse effects were similar and minor between groups, and resolved by the three-week follow-up. After three weeks, all patients reported, by telephone, complete relief of signs and symptoms, and no patients reported a recurrent attack.
Study limitations included assessment of complete relief based on self-reporting, the use of non-validated scales to assess disability outcomes, and a study population limited to white Dutch people.
Although no patients were excluded in this study because of the risks from prednisolone treatment, a quarter of originally eligible patients had to be excluded because of direct safety risks had they been treated with naproxen. For these patients, a five-day treatment with prednisolone would have been no problem, the researchers said. In addition to better safety, they wrote, the direct drug costs would also be less if systemic corticosteroids, such as prednisolone, were the first-line drug choice.
In an accompanying comment, Timothy H. Rainer, M. First, they said, although well-designed, the study was fairly small and was done at one center. It needs to be repeated in other locales with different rates of gastrointestinal disease. Second, they said, changes in clinical practice often need strong marketing forces, which might not occur unless drug companies stand to benefit from newer more expensive drugs.
Nevertheless, they concluded, this trial "will go some way to satisfy both rheumatological purists and front-line pragmatists that short-term oral corticosteroids are as equally effective as NSAIDs in the initial treatment of acute gout and gout-like syndrome. Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; Share on Facebook. Opens in a new tab or window.
Share on Twitter. Share on LinkedIn. Explain that the study was fairly small and needs to be repeated in larger, broader studies if clinical practice is to change. Point out that for gastrointestinal-bleeding reasons, the authors said, the study provides a strong argument to consider prednisolone as a first treatment option over NSAIDs for patients with gout.
Primary Source The Lancet Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; The researchers and the editorial writers declared no conflict of interest.
How the interaction occurs: When these two medicines are taken together, they may increase. Drug interaction between naproxen and prednisone. Prednisone is a steroid, which works by being in the body by reducing levels of certain. How the interaction occurs: When these two medicines are taken together, they may increase. A 5-day course of oral prednisolone is a reasonable alternative to NSAIDs for treating patients with acute gouty arthritis. Interactions between your drugs Using predniSONE together with naproxen. Although no patients were excluded in this study because of the risks from prednisolone treatment, a quarter of originally eligible patients had to be excluded because of direct safety risks had they been treated with naproxen. It's important to tell your doctor or pharmacist what medicines you're already taking, including those bought without a prescription and herbal medicines, before you start taking prednisolone. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.Background: Non-steroidal anti-inflammatory drugs and colchicine used to treat gout arthritis have gastrointestinal, renal, and cardiovascular adverse effects. Systemic corticosteroids might be a beneficial alternative. We investigated equivalence of naproxen and prednisolone in primary care.
Methods: We did a randomised clinical trial to test equivalence of prednisolone and naproxen for the treatment of monoarticular gout. Primary-care patients with gout confirmed by presence of monosodium urate crystals were eligible.
Treatment was masked for both patients and physicians. Analyses were done per protocol and by intention to treat. Findings: Data were incomplete for one patient in each treatment group, so per-protocol analyses included 59 patients in each group. After 90 h the reduction in the pain score was The difference in the size of change in pain was 1. Adverse effects were similar between groups, minor, and resolved by 3 week follow-up.
Interpretation: Oral prednisolone and naproxen are equally effective in the initial treatment of gout arthritis over 4 days. Abstract Background: Non-steroidal anti-inflammatory drugs and colchicine used to treat gout arthritis have gastrointestinal, renal, and cardiovascular adverse effects.
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