How long is too long for NSAID Mobic?

** Originally posted by bunnychan **

I've now been taking daily doses of either 15mg or 7.5mg of Mobic for around 6 weeks. Every morning I get up hoping I won't need it but my hand is not usable if I don't take it, so I do.

Just wondering with the risk of stroke, heart attack increased, how long is too long to take a NSAID?

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** Originally posted by Ranger05 **

I think that's a catch 22 kinda deal. NSAIDS increase your chances of cardiovascular disease, but so does inflammation. So taking NSAIDS may help with the inflammation but increases heart attack risk. However, not taking NSAIDS could lead to more inflammation and therefore a greater chance of heart attack due to the inflammation. No way out. We're at an increased risk for heart disease no matter what we do. Kinda depressing.

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** Originally posted by lisaann **

I swore up and down - on this site and off- to my doctors and myself - Said I would never take Over the counter things for this condition. I reasoned, if I have a life long disease, one that causes such extreme pain, why wasn't the doctors prescribing something for the pain. Both mine refused.

I made it 99% through this last major flair with out any pain pills. Not a one...

That said, there are no words on this earth to verbalize how much pain I was in. Leave it to say that I made more then one phone call begging for something and was denied...

One day I went in for my Remicade IV appointment. My Rheumatologist must of been having a bad day. With out warning she started yelling at me in front of everyone, "I just deal with the arthritis part of this disease. Not the pain, not the other issues this might cause. Just the arthritis alone. Anything else you have to goto another doctor for."

I went home a few hours later in tiers and in a full blown panick attack... I mean, my god! I could not go through that amount of pain again with out SOMETHING!! Not again! So I called my regular doctor crying.

I told him, "You are leaving it to the rheumatologist so you don't step on toes, and she is leaving it to you for the same reason. In the end I just went through months of the most painful flair in my life - pill free." He promised never to make that mistake again...

In the end, I will never be afraid to ask for another pill! Expecially since I am a person who has went a lifetime refusing them before now...

Personal choice for us all to make. All medications have dangers...

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** Originally posted by bunnychan **

Ranger05 - That is depressing :-(

Lisaann - What a terrible story. It sounds like rheumatologists work differently in the US and Australia. Mine would prescribe whatever is required to live with the arthritis but my family doctor would probably be the person I go to to get repeats. They would work together with the rheumy writing to the GP to explain the treatment. When I hear stories like that I really do wonder whether the universities are choosing the most suitable people to study medicine. My cousins are both hoping to get into medicine and I sincerely hope they don't come out with such an uncaring attitude.

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** Originally posted by MarjD **

I'm not sure about the long term effects of NSAIDS. I've been on them for 6 months and neither my PCP or Rhuemy seems inclined to take me off of them. That said I did just start prednisone and was told not to take Celebrex.

Lisaann- my PCP is who prescibes my pain pills. She has been great about listening to me and at the beginning of this journey in May, she started out with 30 .5 lortab. Every month she has upped the meds as my pain has gotten worse- and as she has seen that I don't abuse them, just use as prescribed. She does work in conjunction with my Rhuemy, but seems to have a different phliosphy regarding pain as in she seems to think that there isn't any reason to be in constant pain. At our appt yesterday we discussed weaning off the pain meds when I start the biologics as hopefully I won't need them. With all of that said, sometimes I wonder if the pain pills aren't half of the problem. They seem to make me spacey and tired, but since I've been taking them since being diagnosed, I don't know if it's the pills or the PsA causing my fatigue. Anyway- keep standing up for yourself and the squeaky wheel gets the grease!

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** Originally posted by Flycaster **

bunnychan, the increased odds for cardiovascular disease is relatively small unless you have a number of the associated risk factors. Ditto with liver problems. The most common issue is with stomach problems, and those can get serious. It would be a good idea to discuss the addition of a daily stomach protectant to the mix (e.g., omeprazole) with your doc the next time you go in.

Due to being on high dose Preddy and 2400 mg/day of ibuprofin for an extended period of time, I ended up with stomach bleeding and horrible GERD. The result is I can never take another NSAID again; instead, I have no option but to take narcotic pain meds. It's a true bummer because the NSAIDs worked well for me. Just fwiw.

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** Originally posted by realtor910 **

Hi bunnychan - Just wanted to say that I understand your concern and in the end it's your decision. Personally I was on 600 mg Ibuprofen for like 2 years and now am on Mobic 15mg per day. I now have high blood pressure due to this, so now I have been instructed to decrease the Mobic to 7.5 mg per day, and skip it altogether when I have good days, only take 15mg if I am flaring badly. Also, I have had GERD for over 15 years, I take Prilosec 2 pills per day and it works well for me, no stomach issues. When I am in real bad pain I take Tylenol Arthritis Pain formula and Flexeril (muscle relaxer) as well. I choose not to take narcotic pain meds at this time.

Deanna

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** Originally posted by bunnychan **

My doc didn't prescribe me a stomach protector but I think I'll take your advise and ask for one. How effective are they supposed to be and are they okay to use for a long time?

Flycaster - that truly sucks for you. Were you on a stomach protector at the time? Also, did you have any warning signs before it got so bad? At the moment I don't have any side effects from taking the Mobic but I'd like to know what to look out for. Also, I take it in the morning after a bowl of yogurt. Today my mum said I should eat more food before taking it to help protect my stomach. Is this true?

realtor910 - If you have GERD are you supposed to take a NSAID? Also, just wondering why you take the Tylenol only if it's really bad? Is it just 500mg of Acetemophin or does it contain Codeine too? I've been taking 2-4 Panadol daily (think it's the same as regular Tylenol) and I've read on the packet you're not supposed to take them for a long time. I always thought they were a safe drug.

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** Originally posted by Flycaster **

bunnychan, no, I was not taking a stomach protectant. It was my pharmacist who caught this, not the rheumy. When he saw what kind of stomach pain I was in, plus the fact that I was seeing evidence of bleeding (I was dinking 1/2 bottle of Mylanta every night), he instructed me to call my PCP immediately. I've since cycled thru a number of PPI meds and I'm currently taking Aciphex ($$$) which does the job for me. Unfortunately, OTC Prilosec (omeprazole) was not strong enough, even at 2 per day.

Your mum is right: it is essential to take any NSAID with food. Acetaminophen (Tylenol) can be quite effective, but in my case I can't take it often as my liver enzymes are slightly elevated as well. Make sure you stay at or below 2 gms of acetaminophen per day: it slams the liver.

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** Originally posted by realtor910 **

Hi bunnychan, I do have GERD and I do take prescribed NSAIDS under medical supervision. As for the Tylenol, I take the "Arthritis pain Formula" and it is 600mg tablets. The reason I use Tylenol (Panadol) is simple, I was on Tramadol a prescription pain killer which is a synthetic opioid and I became physically dependent, it actually made my pain worse, and after I went through withdrawls getting off of it I swore off pain killers until such time that I just can't stand it anymore! By the way after getting off the pain killers I realized that my pain was actually much less then I felt and thought it was while on them. Interesting, huh.

Definately ask your Rheum about something to protect your stomach, it will be worth it. As for length of time you can take NSAIDS, again when prescribed for you and under supervision such as getting your blood work done, having urine tests for Renal function, etc... My doctors, both GP and Rheum really stay on top of this with me, I go for lab work every 6 weeks like clockwork and so far everything is normal, just the BP issue which we are working on. Deanna

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** Originally posted by bunnychan **

I've just had 2 days without the Mobic and it's a nightmare. I am such an idiot. I thought I only had pain if I was using the joint. I obviously forgot all about the dull ache ALL OVER. It's so weird. I look completely normal bar the knee which is swollen yet I feel like this all over dull pain, especially my hands, mid and lower back and feet.

Tomorrow I am seeing my doctor and telling her I want the monitoring you both describe (very annoyed I'm not getting any kinds of tests) and some stomach protectants. I really need to take the Mobic. Even if I put up with the pain I hate to think what all the inflammation is doing to my joints.

Just wandering, if you take an NSAID and get the inflammation under control, doesn't that also mean there is no further joint damage?

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** Originally posted by lisaann **

Getting the disease under control slows down the damage - while pain and swelling speeds it up...

I don't think it ever stop per say... But when all is working (Medications & treatments) like they are intended, you can go long periods of time with out major damage.

Does that help? Sorry to hear your in such pain... I wish I could give everyone at least one whole pain free day!

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** Originally posted by bunnychan **

Thanks Lisaann. I too wish this disease didn't exist. It breaks my heart when I read about children getting it (or RA) or when people have the severe PsA.

What I don't understand though is if the NSAIDs reduce inflammation, do they stop progression of the disease or do you have to go on a DMARD or biological for that? What I'm asking is is the disease silently damaging even if you feel no pain because you are on NSAID?

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** Originally posted by Ranger05 **

Most folks will tell ya that NSAIDs do nothing to slow the disease. My Rhuemy however is of the opinion that when NSAIDs work they do actually slow the disease a bit. BUT thats not really what they are intended to do. But remember, PsA doesn't cause unrelenting damage in the vast majority of cases. Many people can go decades without any severe damage at all. And some go their entire lives w/out severe damage.

That said, I was told once that pain does not always cause damage, and damage does not always cause pain.

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** Originally posted by lisaann **

You could feel completely normal and this disease could be damaging your joints. One day your going about your business and ------bam!------

From what I understand... in order to slow damage, you need to stop the swelling/inflamation...

If it is a PsA medication that helps control the swelling - then that medication is helping slow the damage. When the flairs kick in and the medication stops, the damage speeds up again...

Over the counter does not stop PsA. PsA designed medications do.

Does that help?

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** Originally posted by lisaann **

I should note though I am one of the unlucky ones.

There are people I read on here that are some of the lucky ones...

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** Originally posted by bunnychan **

I think mine might be getting worse. I never had hand or ankle involvement to this degree. I'm also going to ask my doc for hand x-rays. I'm so tired now. Was very impatient with my son the last few days and now see it coincides with when I'm in more pain. Now worried that even with the Mobic I won't be able to go back to the way it was a few days - pain on rising, take a Mobic, mostly better.

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** Originally posted by Rolacoy **

I am 71 years old and had PsA for about 3 years. I was on 15mg Mobic, maybe 5 years before that. I also have been on Loratab and a muscle relaxer for 3 years.

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** Originally posted by Roni_M **

I've been on NSAIDS for 12 years... I don't think there is a "too long". Luckily and maybe even a little unluckily, my GP doesn't seem interested in putting me on anything else. He'll play with the dosage and switch up NSAIDS if I'm having a flare til everything gets under control again. I say luckily because of the side effects of some of the other drugs, I say unluckily because part of me wonders if delaying (12 years) is the best thing to protect my joints.

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** Originally posted by bunnychan **

Thanks guys. Today went to my GP and she said Mobic doesn't damage the stomach so I don't need a protecter. Also felt better this afternoon pain wise.

Rolacoy - Did you have psoriasis before?

Roni - That's a long time. Have you been to a specialist also? Since normally I can keep it somewhat under control with an NSAID, I do wonder whether I should go with my rheumy's advice and try methotrexate. He even told me that the latest studies are showing that people on methotrexate end up preventing other diseases caused by inflammation (can't remember what but think it's the heart related stuff). He said most of the big side effects happen to people with a lot of other health problems, often elderly.

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** Originally posted by Roni_M **

Yes, I've been to rhuematologists over the years and a Rehab Dr once when I was having a hard time walking. I've also been to see a hemotologist/diagnostician. I'm 38 so I don't think I fall into the elderly category yet. I do have other autoimmune disorders which I think may be partly responsible for the long time on NSAIDS. But generally if I have a major flare the doctor just bumps up my NSAID dosage or switches me to a different one. It's not a perfect solution because I'm never ache free but it works for me. :)

I am glad that I have always been able to manage without going on some of the other drugs because of the side effects. I think you should use the smallest least harmful drugs for as long as you can since PA is not something they can cure. I'm sure at some point the NSAIDS won't work for me and I'll have to go to something else. I am content to wait though :)

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