Nurofen, Stomach Ulcers and Bleeding from the Bowel

One of Australia’s biggest-selling headache pills could soon be as difficult to buy as morphine or methadone after an expert committee was flooded with complaints the pills were being abused by addicts and drug dealers.

Nurofen Plus, bought over the counter for toothache and period pain, could be made a Schedule 8 drug, a category that includes some of the most addictive medications on the market, the National Drugs and Poisons Scheduling Committee foreshadowed yesterday. The news comes days after the committee decided that 15 cough medicines would be rescheduled as prescription medications because of concerns about their side effects and the way parents used them.

Nurofen Plus, which contains 200 milligrams of ibuprofen and 12.8 milligrams of codeine, is thought to be used by about half of all adult Australians. It is the strongest over-the-counter painkiller on the market and has been blamed for a spate of hospital admissions where codeine addicts have taken up to 24 tablets a day, not realising the medication’s other active ingredients, ibuprofen, a non-steroidal anti-inflammatory, can cause ulcers in the stomach and duodenum. The committee is also investigating reports that codeine in the tablets is being extracted by manufacturers of illicit drugs.

A recent study found that after three months of regular use, up to 20 per cent of people developed ulcers in the stomach and 10 per cent developed ulcers in the duodenum. Bleeding, perforation or obstruction of the intestines occurred in about 4 per cent of patients who took the medication for a year.

An article in The Medical Journal of Australia  reported misuse of Nurofen Plus was a “significant” problem and outlined two cases of patients with perforated ulcers from consuming up to a packet a day. A British woman, Linda Docherty, 49, died in March last year after taking up to 64 tablets a day for two years.

 

Article taken from The Age.

 

Dr. Hooper’s Comment

What are we doing? Nearly half of all adult Australians are using Nurofen Plus? Not sure where they got their figures from, but half of all adults seems extraordinarily high. Generally you have pain for a reason. Pain is the body’s warning mechanism that something is wrong. Always try to address the cause of the problem rather than masking the symptoms. The most common side effects from ibuprofen are rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn. Ibuprofen, a non-steroidal anti-inflammatory (NSAID) can reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ibuprofen causes ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain, and black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension) due to bleeding may be the only signs of an ulcer. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. Damage to the kidney is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure.

Individuals taking oral blood thinners or anticoagulants, for example, warfarin (Coumadin) should avoid ibuprofen because ibuprofen also thins the blood, and blood thinning may lead to excessive bleeding. People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the foetal heart. Fluid retention (oedema), blood clots, heart attacks, hypertension and heart failure have also been associated with the use of NSAIDs. So be careful with the continued use of all forms of ibuprofen – including Nurofen!

Nurofen Plus however causes more complications because of the addition of codeine. Codeine is an ingredient contained in many analgesic products for back pain, period pain, headaches and migraines. The problem is that codeine can be VERY addictive, particularly when it’s used in large amounts or for a long time. Codeine can have terrible side effects, including liver damage and heart failure. So Nurofen Plus has all the problems associated with ibuprofen, as well as the addictive properties of codeine. There are many natural anti-inflammatory medicines available at the practice that are highly effective and safe to use when compared with drug medications.

 

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