General Medical issues thread

[Quickstatus]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Interestingly no one has managed to determine the mechanism of action of paracetamol. We know it works but not how. Same with anaesthesia.

There is really good evidence on the other hand that says Nurofen Zavance is more effective than bog standard Nurofen because it's a different formulation and absorption is much faster.

 

[TheRealTMA]

Being higher dose (665 vs 500mg and I think slower release) it means 3 doses a day 8 hrs apart to get 24 hr coverage rather than needing to take a 4th dose in the middle of the night to get 24 hr coverage. I take mine at 7am, 4pm and 10 +/-pm

I find a single malt to wash down the paracetamol is useful.

 

[TheRealTMA]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Interestingly no one has managed to determine the mechanism of action of paracetamol. We know it works but not how. Same with anaesthesia.

There is really good evidence on the other hand that says Nurofen Zavance is more effective than bog standard Nurofen because it's a different formulation and absorption is much faster.

FWIW. My old GP expressed severe caution with Nurofen (ibuprofen) in older patients.

 

[VPS]

FWIW. My old GP expressed severe caution with Nurofen (ibuprofen) in older patients.

what did he say about the single malt?

 

[TheRealTMA]

what did he say about the single malt?

Use in moderation.

 

[VPS]

Use in moderation.

Good thing you listen to him then

 

[RooFlyer]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Dunno, but possibly because it was working better from them, as they weren't missing a dose and were getting a 24hr effect rather than stop/start if they missed the early morning dose f they chose 500mg.

 

[Quickstatus]

stop/start

Though the blood levels of paracetamol is actually more predictable in bog standard paracetamol, this is because the modified release Paracetamol absorption is unpredictable It can actually take more than 24hrs to dissolve in some people. It has 2 layers - the outer layer of the tablet is quick dissolving but it has an inner layer which is slow dissolving.

The risk of overdosage is actually higher as a result - which is why Panadol osteo is "pharmacist only" in AU/NZ

 

[drron]

I guess I am a slow dissolver. I take 2 Panadol Osteo in the morning with good effect. Taking a second dose up until 2000 has absolutely no extra effect so I continue with just my daily dose.

 

[tgh]

slow dissolver.

 

[RooFlyer]

Docs - for arthritis and joints I believe there are two sources of pain - 'bone against bone' where cartilage has gone and then inflammation around the joints.

I guess Panadol osteo is designed to mitigate the former? I have some degeneration in my SI joints (bone scan) and I can't tell that the Panadol does anything, but I do get cortisone injections for the inflammation which helps.

Actually, the best help is massage and dry needling by my physio as it seems the muscles around the joint are tight. Gives me relief for 2-5 days. So, I'm going to experiment (with GP's blessing) with the muscle relaxant Baclofen.

 

[Quickstatus]

I guess Panadol osteo is designed to mitigate the former

That's the problem. No one knows its mechanism of action. There is some evidence that it is an antiinflammatory but of a different mechanism that the usual NSAIDS.

 

[RooFlyer]

There is some evidence that it is an antiinflammatory but of a different mechanism that the usual NSAIDS.

If so, thought to have effect on kidneys? I'd like to take a lot more anti-inflammatories (such as Celecoxib) by my GP limits it, to protect kidneys. Bloods say they are OK but happy to leave it that way. I am taking the max does of panadol osteo, but not every day.

 

[tgh]

I am a bit surprised at the popularity of pain medications and the conversations above sent me reading..

The following article is just one perspective, I am sure there are more..

Andrew Moore, Honorary Senior Research Fellow, University of Oxford

Paracetamol has been around for over 50 years. It’s safe and many guidelines recommend it as the go-to treatment. At least, that’s the conventional view of the drug. It’s a view so ingrained that it’s rarely questioned. The trouble is that the conventional view is probably wrong.

Huge amounts of paracetamol are used to treat pain, measured not in how many tablets are used but in the thousands of tons. For the UK, an estimate of the amount of paracetamol sold is just under 6,300 tonnes a year. That’s 35 tonnes per million of population: 35 grams or 70 paracetamol tablets each, every year.

But does it work?​

The evidence is that it probably does not work at all for chronic pain. Large, good and independent clinical trials and reviews from the Cochrane Library show paracetamol to be no better than placebo for chronic back pain or arthritis. This is at the maximum daily dose in trials lasting for three months, so it has been pretty thoroughly tested.