- Nonsteroidal Anti-Inflammatory Drugs
Aches-N-Pains® [OTC]; Actron® [OTC]; Acular® Ophthalmic; Advil® [OTC]; Aleve® [OTC]; Anaprox®; Cataflam® Oral; Children's Advil® Oral Suspension [OTC], Children's Motrin® Oral Suspension [OTC]; Clinoril®; Dolobid®; Excedrin® IB [OTC]; Feldene®; Genpril® [OTC]; Haltran® [OTC]; Ibuprin® [OTC], Ibuprohm® [OTC]; Ibu-Tab®; Indochron ER®; Indocin® SR; Junior Strength Motrin® [OTC]; Lodine®; Lodine® XL; Meclomen®; Medipren® [OTC]; Menadol® [OTC]; Midol® 200 [OTC]; Motrin®; Motrin® IB [OTC]; Nalfon®; Naprelan®; Naprosyn®; Nuprin® [OTC]; Orudis®; Orudis® KT [OTC]; Oruvail®; Pamprin IB® [OTC]; PediaProfen™; Ponstel®; Relafen®; Saleto-200® [OTC]; Saleto-400®; Tolectin®; Tolectin® DS; Toradol® Injection; Toradol® Oral; Trendar® [OTC]; Uni-Pro® [OTC]; Voltaren® Ophthalmic; Voltaren® Oral; Voltaren XR® Oral
- Aspirin
Anacin® [OTC]; Arthritis Foundation® Pain Reliever [OTC]; A.S.A. [OTC]; Ascriptin® [OTC]; Aspergum® [OTC]; Asprimox® [OTC]; Bayer® Aspirin [OTC]; Bayer® Buffered Aspirin [OTC]; Bayer® Low Adult Strength [OTC]; Bufferin® [OTC]; Buffex® [OTC]; Cama® Arthritis Pain Reliever [OTC]; Easprin®' Ecotrin® [OTC]; Ecotrin® Low Adult Strength [OTC]; Emprin® [OTC]; Extra Strength Adprin-B® [OTC]; Extra Strength Bayer® Enteric 500 Aspirin [OTC]; Extra Strength Bayer® Plus [OTC]; Halfprin® 81® [OTC]; Regular Strength Bayer® Enteric 500 Aspirin [OTC]; St Joseph® Adult Chewable Aspirin [OTC]; ZORprin®
- Acetaminophen
Tylenol®
Sources: Research References/Bibliography
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Coverage of Drug-Induced Nutrient Depletion, Drug Brand Names, Contraindications, Warnings/Precautions, Adverse Reactions, Overdose/Toxicology, etc.
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Nonsteroidal Anti-Inflammatory Drugs
Nutrients Depleted: Folic Acid
U.S. Brand Names: Aches-N-Pains® [OTC]; Actron® [OTC]; Acular® Ophthalmic; Advil® [OTC]; Aleve® [OTC]; Anaprox®; Cataflam® Oral; Children's Advil® Oral Suspension [OTC], Children's Motrin® Oral Suspension [OTC]; Clinoril®; Dolobid®; Excedrin® IB [OTC]; Feldene®; Genpril® [OTC]; Haltran® [OTC]; Ibuprin® [OTC], Ibuprohm® [OTC]; Ibu-Tab®; Indochron ER®; Indocin® SR; Junior Strength Motrin® [OTC]; Lodine®; Lodine® XL; Meclomen®; Medipren® [OTC]; Menadol® [OTC]; Midol® 200 [OTC]; Motrin®; Motrin® IB [OTC]; Nalfon®; Naprelan®; Naprosyn®; Nuprin® [OTC]; Orudis®; Orudis® KT [OTC]; Oruvail®; Pamprin IB® [OTC]; PediaProfen™; Ponstel®; Relafen®; Saleto-200® [OTC]; Saleto-400®; Tolectin®; Tolectin® DS; Toradol® Injection; Toradol® Oral; Trendar® [OTC]; Uni-Pro® [OTC]; Voltaren® Ophthalmic; Voltaren® Oral; Voltaren XR® Oral
Use: Management of inflammatory and rheumatoid disorders; gout, ankylosing spondylitis, mild to moderate pain, fever, dysmenorrhea, and acute migraine headache. Specific agents in this class are used in the management of postoperative pain or for closure of patent ductus arteriosus.
Pregnancy Risk Factor and Implications: Many NSAIDs enter breast milk/use caution or avoid use. Etodolac: Excretion in breast milk unknown/contraindicated.
Contraindications: Hypersensitivity to nonsteroidal anti-inflammatory agents, including aspirin, or any component of formulation.
Dietary Considerations: Should be taken with food or milk to minimize gastrointestinal irritation. Food may decrease the rate but not the extent of absorption.
Warnings/Precautions: Use caution in patients with renal or hepatic insufficiency, congestive heart failure, hypertension, history of GI bleeding or ulcers, and patients receiving anticoagulants. NSAIDs may compromise renal function, particularly when pre-existing renal impairment is present. Photosensitivity and severe hepatotoxicity have been reported with some agents. Pain is not a reliable indicator of gastrointestinal damage. Gastrointestinal ulceration and/or hemorrhage may be subtle or even painless in many patients. The elderly are at high risk for adverse reactions. To minimize adverse effects, the lowest effective dose should be used for the shortest possible period of time. Adverse central nervous system effects, including dizziness, hallucinations, agitation, and seizures normally occur only in overdose but may occur with therapeutic dosages, particularly in elderly patients.
Adverse Reactions: Individual NSAIDs may vary in their potential to cause specific adverse effects. The listing below provides a general indication of the spectrum and frequency of adverse reactions to NSAIDs.
1% to 10% experience:
Central Nervous System: Headache, nervousness, dizziness, fatigue
Dermatologic: Rash, urticaria, itching
Endocrine & metabolic: Fluid retention
Gastrointestinal: Heartburn, vomiting, abdominal cramps, indigestion, nausea
Optic: Tinnitus
Less than 1% experience (Limited to important or life-threatening symptoms): Edema, congestive heart failure, arrhythmias, tachycardia, hypertension, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, lupus erythematosus syndrome, Henoch-Schonlein vasculitis, angioedema, aseptic meningitis with fever and coma, neutropenia, agranulocytosis, aplastic anemia, inhibit platelet aggregation, hemolytic anemia, bone marrow depression, leukopenia, thrombocytopenia, eosinophilia, hepatitis acute renal failure, polyuria, azotmia, hematuria, elevated serum creatinine, dyspnea.
Overdose/Toxicology: Symptoms of overdose include apnea, metabolic acidosis, coma, nystagmus, seizures, leukocytosis, and renal failure. Management of nonsteroidal anti-inflammatory (NSAID) intoxication is supportive and symptomatic. Since many NSAIDs undergo enterohepatic cycling, multiple doses of charcoal may be needed to reduce the potential for delayed toxicities.
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Aspirin
Nutrients Depleted: Folic Acid, Iron, Potassium, Sodium, Vitamin C
U.S. Brand Names: Anacin® [OTC]; Arthritis Foundation® Pain Reliever [OTC]; A.S.A. [OTC]; Ascriptin® [OTC]; Aspergum® [OTC]; Asprimox® [OTC]; Bayer® Aspirin [OTC]; Bayer® Buffered Aspirin [OTC]; Bayer® Low Adult Strength [OTC]; Bufferin® [OTC]; Buffex® [OTC]; Cama® Arthritis Pain Reliever [OTC]; Easprin®' Ecotrin® [OTC]; Ecotrin® Low Adult Strength [OTC]; Emprin® [OTC]; Extra Strength Adprin-B® [OTC]; Extra Strength Bayer® Enteric 500 Aspirin [OTC]; Extra Strength Bayer® Plus [OTC]; Halfprin® 81® [OTC]; Regular Strength Bayer® Enteric 500 Aspirin [OTC]; St Joseph® Adult Chewable Aspirin [OTC]; ZORprin®
Pregnancy Risk Factor and Implications: C (D if full-dose aspirin in 3rd trimester), enters breast milk/use caution.
Contraindications: Bleeding disorders (factor VII or IX deficiencies), hypersensitivity to salicylates or other NSAIDs, tartrazine dye and asthma.
Dietary Considerations:
Alcohol: Combination causes gastrointestinal irritation, possible bleeding; avoid or limit alcohol. Patients at increased risk include those prone to hypoprothrombinemia, vitamin K deficiency, thrombocytopenia, thrombotic thrombocytopenia purpura, severe hepatic impairment, and those receiving anticoagulants.
Food: May decrease the rate but not the extent of oral absorption. Drug may cause gastrointestinal upset, bleeding, ulceration, perforation. Take with food or large volume of water or milk to minimize gastrointestinal upset.
Folic Acid: Hyperexcretion of folate; folic acid deficiency may result, leading to macrocytic anemia. Supplement with folic acid if necessary.
Iron: With chronic use and at doses of 3-4 g/day, iron deficiency anemia may result; supplement with iron if necessary.
Sodium: Hypernatremia resulting from buffered aspirin solutions or sodium salicylate containing high sodium content. Avoid or use with caution if CHF or any condition where hypernatremia would be detrimental.
Curry powder, paprika, licorice, Benedictine liqueur, prunes, raisins, tea and gherkins: Potential salicylate salicylate accumulation. These foods contain 6 mg salicylate/100 g. An ordinary American diet contains 10-200 mg/day of salicylate. Foods containing salicylates may contribute to aspirin hypersensitivity. Patients at greatest risk for aspirin hypersensitivity include those with asthma. nasal polyposis or chronic urticaria.
Fresh fruits containing vitamin C: Displaces drug from binding sites, resulting in increased urinary excretion of aspirin. Educate patients regarding the potential for a decreased analgesic effect of aspirin with consumption of foods high in vitamin C.
Warnings/Precautions: Use with caution in patient with platelet and bleeding disorders, renal dysfunction, erosive gastritis, or peptic ulcer disease, previous nonreaction does not guarantee future safe taking of medication; do not use aspirin in children under 16 years of age for chickenpox or flu symptoms due to the association with Reye's syndrome.
Otic: Discontinue use if dizziness, tinnitus, or impaired hearing occurs; surgical patients: avoid ASA if possible, for 1 week prior to surgery because of the possibility of postoperative bleeding; use with caution in impaired hepatic function.
Elderly are a high-risk population for adverse effects from nonsteroidal anti-inflammatory agents. As much as 60% of elderly with gastrointestinal complications to NSAIDs can develop peptic ulceration and/or hemorrhage asymptomatically. Also, concomitant disease and drug use contribute to the risk for gastrointestinal adverse effects. Use lowest effective dose for shortest period possible. Consider renal function especially when CI is less than 30 mL/minute. Tinnitus may be a difficult and unreliable indication of toxicity due to age-related hearing loss or eighth cranial nerve damage. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations, but elderly may demonstrate these adverse effects at lower doses than younger adults.
Adverse Reactions:
Greater than 10% experience:
Central nervous system: Fatigue
Dermatologic: Rash, urticaria
Gastrointestinal: Gastrointestinal ulceration
Hematologic: Hemolytic anemia
Neuromuscular & skeletal: Weakness
Respiratory: Dyspnea
Miscellaneous: Anaphylactic shock
Less than 1% experience: Insomnia, nervousness, jitters, iron deficiency, occult bleeding, prolongation of bleeding time, leukopenia, thrombocytopenia, anemia, hepatotoxicity, impaired renal function, bronchospasm
Overdose/Toxicology: Symptoms of overdose include tinnitus, headache, dizziness, confusion, metabolic acidosis, hyperpyrexia, hypoglycemia, and coma. Treatment should be based upon symptomatology.
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Acetaminophen
U.S. Brand Names: Tylenol®
Use: Provides temporary relief of minor aches and pain with heartburn or acid indigestion and upset stomach associated with these symptoms. Acetaminopehn chewable tablets, elixir, drops, suspension liquid and suspension drops are designed for treatment of infants and children with conditions requiring temporary relief of fever and discomfort due to colds and "flu," and of simple pain and discomfort due to teething, immunizations and tonsillectomy.
Contraindications: Acetaminophen should not be administered to patients who have previously exhibited hypersensitivity to it.
Warnings/Precautions: Do not use maximum dosage for more than 10 days except with doctor's advice and supervision. Do not take this product for pain for more than 10 days, or for fever for more than 3 days unless directed by a doctor. If pain or fever persists or gets worse, if new symptoms occur, or if redness or swelling is present, consult a doctor because these could be signs of a serious condition. Do not use with other products containing acetaminophen. Do not use if carton is opened. Keep this and all medication out of the reach of children. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using this product. In the case of accidental overdose, contact a doctor or poison control center immediately. Prompt medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms.
Dietary Considerations:
Alcohol: If you consume more than 3 alcoholic beverages a day consult with a doctor before using acetaminophen. May cause liver damage.
Overdose/Toxicology: Potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma and thrombocytopenia may also occur.
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