What next? Celebrex didn't work

** Originally posted by DaisyAdair **

I've been intermittently self-medicating for a year or so with ibuprofen, but my stomach can't handle it, so when I went to see a rheumatologist for the first time last week she prescribed celebrex, gave me some samples and said to give it a few days. I gave it a week and called her back three days ago to ask what to do next. I really want to take something for the pain!

And, now it's Friday night and she never called back and the spectre of prednisone is haunting me. Is that the next option? I'm nursing, which complicates things, and which is why she tried celebrex first (less excretion into milk).

Also, I can't find any info on google but do you think 24 hours after my last celebrex will be OK to take some ibuprofen? I was taking it twice daily.

Thanks

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** Originally posted by realtor910 **

Hi Daisy: Are you taking any meds to protect your stomach? I think you will find that most of us take Prilosec, Prevacid, Tagamet or the like for this very reason, the nsaids are ruff on the tummy. I persnally am on Tagamet 2 x daily and I take 600mg Ibuprofen 4 x daily and also Tramadol for pain 2 x daily. You have to remember that the nsaids are primarily anti inflamatory, they do help with pain but I find not completely which is why I take and additional pain killer. You just have to find the right mix for you and of course your breast feeding complicates matters. Keep after your Rhuemy about this. Deanna

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** Originally posted by jagfangirl27 **

I am on Nexium for the tummy and take Lortab occasionally for pain, which is really all I need right now. If you can take Tylenol give the arthritis strength a shot, it's pretty good for an OTC pain reliever.

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** Originally posted by DaisyAdair **

Wow, thanks, I had no idea I could take something to help it be easier on my stomach. I'll ask my doc when she gets back to me. I guess though the hope was to find something that works without needing to take another drug on top of it but the nursing really complicates it. Maybe she'll put me on ibuprofen and something for my stomach?

I think I'm at the early stages because if I'm fully dosed up on ibuprofen and I'm careful about what I do I'm pretty close to pain free (luckily). From my reading I'm getting the impression the anti-inflammatory is important to prevent joint damage? Then the pain killer is for comfort, right? It's frustrating because my big issue is not with the classic arthritis symptoms, it's the tendonitis, and FAQs deal with normal tendonitis which responds to rest.

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** Originally posted by jagfangirl27 **

The nursing really does complicate it. You don't want to excrete anything that would hurt that little one. But you shouldn't take too much OTC stuff either because it WILL tear your stomach up. Trust me on that one, been there bought that T-shirt a long time ago!

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** Originally posted by ericw10 **

Wow, thanks, I had no idea I could take something to help it be easier on my stomach. I'll ask my doc when she gets back to me. I guess though the hope was to find something that works without needing to take another drug on top of it but the nursing really complicates it. Maybe she'll put me on ibuprofen and something for my stomach?

I think I'm at the early stages because if I'm fully dosed up on ibuprofen and I'm careful about what I do I'm pretty close to pain free (luckily). From my reading I'm getting the impression the anti-inflammatory is important to prevent joint damage? Then the pain killer is for comfort, right? It's frustrating because my big issue is not with the classic arthritis symptoms, it's the tendonitis, and FAQs deal with normal tendonitis which responds to rest.

Celebrex works, but it requires a pretty big daily dose to have any real effect on PA. 200mg 2X/day is maximum but that is usually what is needed. And at that dose, it is still not completely safe for the stomach.

Ask your doc about an old NSAID called Flurbiprofen (brand name Ansaid). As mentioned above, when combined with a PPI (proton pump inhibitor) like OTC Prilosec it is safe for the stomach and very effective for the inflammation. Much more so than Celebrex for me.


It will pass into the breast milk, but at an extremely low level of .1mg/day. That tiny amount of medicine would be metabolized in a minute or two.

"Concentrations of flurbiprofen in breast milk and plasma of nursing mothers suggest that a nursing infant could receive approximately 0.10 mg flurbiprofen per day in the established milk of a woman taking ANSAID 200 mg/day."

http://www.rxlist.com/ansaid-drug.htm

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** Originally posted by Flycaster **

Sorry to hear about this - I've been down this road. If you're taking any kind of daily NSAID, much less prednisone, you MUST take a daily stomach protecting drug (Nexium, Prilosec, Prevacid, whatever) or else you will eventually have to stop taking them. Moreover, once that happens it can take years before you can start taking them again, if ever. Even Flurbiprofin, which is only slightly less stomach toxic than Celebrex will not be tolerable if your stomach goes out. Trust me on this, there is not a single NSAID that we haven't tried over the past 2 years - it is discouraging as it leaves narcotics as the best, and only, option.

Boy, nursing...that really does complicate matters. Ask you doc if you could take small amounts of straight Oxycodone (they make them as low as 5mg, and they can be split); this is the narcotic without tylenol added (aka, Percocet). Or, if liver toxicity and/or passage thru the breast milk are not issues, perhaps even low dose Percocet/Lortab.

Barring that, use a lot of heat and ice...and remember to try to get some exercise if possible. I hope you feel better.

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** Originally posted by RichJ **

hi daisy,
im sorry that i can't help much with your ? but welcome to the p family. you have meet 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

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** Originally posted by DaisyAdair **

You guys are a goldmine of information, thank you.

I just heard back from the doctor's nurse and her suggestion was Cymbalta. Phone tag is very frustrating. There is no way I can take Cymbalta. I'd prefer to go totally drug free than take an SNRI again, they affect me that badly. So now I have to wait for another call back. And she's referring me for physical therapy.

Flycaster, thank you very much for the info on the stomach protecting. I think I might get some OTC and team it with the ibuprofen until I get a plan from the doctor (I'll discuss it with her, obviously, and I've taken it before, in late pregnancy).

Eric, I was on 200mg twice a day, so I think that's conclusive, right? I will suggest the Flurbiprofen. Thank you for looking up the milk excretion info for me.

Can I be self-pitying for a moment? I realised today that if I'm on something that stops me taking ibuprofen and doesn't work the same way I'm going to spend a couple of days a month immobilised by pain that narcotics can't come close to touching, which terrifies me.

Sorry to be so self-obsessed. Hopefully I'll be able to contribute to the community somehow soon.

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** Originally posted by Flycaster **

200mg/day for at least a month is considered conclusive - unlike regular NSAIDs, Celebrex takes time to build up in the body. If your stomach is already bad, take Omeprazole (generic Priolsec) twice a day and try to keep the NSAIDs at a minimum. I have to say, however, you might still have stomach problems even with the Omeprazole; that's how it is in my case. OTOH, if you find XYZ narcotic doesn't touch your pain, you simply need a different narcotic and/or dose - trust me, they vary in strength and effectiveness considerably. They had me on enough Oxycontin and Percocet during the last spinal surgery rehab that my level 10+ pain was well managed...I certainly wasn't "normal", but I was only uncomfortable, not in pain. If this is your only recourse, a good PM doc CAN come up with the right drug and dose.

I'm with you on the Cymbalta/SNRI/SSRI drugs. In the course of being in Pain Management for almost 3 years I've tried most of them and they ALL whack me out totally. Can you tolerate either Neurontin or Lyrica - those are other options to discuss with your docs.

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