Looking for:
Oral Prednisolone and Naproxen (Aleve) Equal for Gout Pain | MedPage Today. |
- Publication types
Naproxen and prednisone
Background: Non-steroidal anti-inflammatory drugs and colchicine used to treat gout arthritis have gastrointestinal, renal, and cardiovascular adverse effects. Systemic corticosteroids might be a beneficial alternative. We investigated equivalence of naproxen and prednisolone in primary care.
Methods: We did a randomised clinical trial to test equivalence of prednisolone and naproxen for the treatment of monoarticular gout.
Primary-care patients with gout confirmed by presence of monosodium urate crystals were eligible. Treatment was masked for both patients and physicians.
Analyses were done per protocol and by intention to treat. Findings: Data were incomplete for one patient in each treatment group, so per-protocol analyses included 59 patients in each group. After 90 h the reduction in the pain score was The difference in the size of change in pain was 1. Adverse effects were similar between groups, minor, and resolved by 3 week follow-up.
Interpretation: Oral prednisolone and naproxen are equally effective in the initial treatment of gout arthritis over 4 days. Abstract Background: Non-steroidal anti-inflammatory drugs and colchicine used to treat gout arthritis have gastrointestinal, renal, and cardiovascular adverse effects.
❾-50%}.
Primary-care patients with gout confirmed by presence of monosodium urate crystals were eligible. Treatment was masked for both patients and physicians. Analyses were done per protocol and by intention to treat. Findings: Data were incomplete for one patient in each treatment group, so per-protocol analyses included 59 patients in each group. After 90 h the reduction in the pain score was The difference in the size of change in pain was 1.
For general disability, the differences were 0. In all cases these differences non-significantly favored naproxen, the investigators said. Adverse effects were similar and minor between groups, and resolved by the three-week follow-up.
After three weeks, all patients reported, by telephone, complete relief of signs and symptoms, and no patients reported a recurrent attack. Study limitations included assessment of complete relief based on self-reporting, the use of non-validated scales to assess disability outcomes, and a study population limited to white Dutch people. Although no patients were excluded in this study because of the risks from prednisolone treatment, a quarter of originally eligible patients had to be excluded because of direct safety risks had they been treated with naproxen.
For these patients, a five-day treatment with prednisolone would have been no problem, the researchers said. In addition to better safety, they wrote, the direct drug costs would also be less if systemic corticosteroids, such as prednisolone, were the first-line drug choice.
In an accompanying comment, Timothy H. Rainer, M. First, they said, although well-designed, the study was fairly small and was done at one center. It needs to be repeated in other locales with different rates of gastrointestinal disease. Second, they said, changes in clinical practice often need strong marketing forces, which might not occur unless drug companies stand to benefit from newer more expensive drugs.
Nevertheless, they concluded, this trial "will go some way to satisfy both rheumatological purists and front-line pragmatists that short-term oral corticosteroids are as equally effective as NSAIDs in the initial treatment of acute gout and gout-like syndrome. Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; Share on Facebook.
Opens in a new tab or window.
It's important to tell your doctor or pharmacist what medicines you're already taking, including those bought without a prescription and herbal medicines, before you start taking prednisolone. Similarly, check with your doctor or pharmacist before taking any new medicines with prednisolone, to make sure that the combination is safe.
If you're taking gastro-resistant prednisolone tablets, don't take antacids indigestion remedies at the same time of day. Avoid taking antacids within two hours of taking this type of prednisolone tablet. Don't take anti-inflammatory painkillers NSAIDs like aspirin, ibuprofen or naproxen while you're taking prednisolone, unless they've been prescribed by your doctor. This type of painkiller may increase the risk of side effects on the gut, such as stomach ulceration and bleeding.
Remember that many cold and flu remedies and over-the-counter painkillers contain ibuprofen or aspirin and so should be avoided while you're taking prednisolone. Be sure to check the ingredients of other medicines before taking them with prednisolone, or ask your pharmacist for advice. It's fine to take paracetamol with prednisolone. You can also take opioid-type painkillers such as codeine or co-codamol. Check with your doctor or pharmacist before using steroid creams eg for eczema or allergic skin reactions or steroid nasal sprays eg for hayfever while you're using prednisolone.
Prednisolone can cause fluid and salt retention and so may oppose the effects of the following medicines:. Prednisolone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines.
People with diabetes may need an increase in their dose of insulin or antidiabetic tablets. Prednisolone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. If you're taking warfarin with prednisolone your blood clotting time INR should be regularly monitored, particularly after starting or stopping treatment with prednisolone and after any dose changes. The level of potassium in your blood is more likely to fall too low if you take prednisolone with other medicines that can lower the amount of potassium in your blood, such as:.
The following medicines may increase the removal of prednisolone from the body, thus reducing its effects. You may need a larger dose of prednisolone if you are also taking any of these medicines:. The effect of corticosteroids may be reduced in the three to four days following use of mifepristone.
The following medicines may reduce the removal of prednisolone from the body and so may increase its effects or side effects:. Prednisolone may weaken your immune system, which means that vaccines may be less effective if given during treatment, because your body won't produce sufficient antibodies in response to the vaccine.
Live vaccines shouldn't be given to people taking prednisolone because they may cause serious infections.
Live vaccines include: measles, mumps, rubella MMRBCG, chickenpox, oral typhoid, yellow fever and the nasal spray flu vaccine for children. You shouldn't be given a live vaccine until at least three months after finishing your course of prednisolone.
Last updated: Type keyword s to search. Can I take over-the-counter medicines with prednisolone? Can prednisolone affect my current medicines? Prednisolone can cause fluid and salt retention and so may oppose the effects of the following medicines: antihypertensive medicines used to treat high blood pressure diuretics, eg furosemide.
The level of potassium in your blood is more likely to fall too low if you take prednisolone with other medicines that can lower the amount of potassium in your blood, such as: acetazolamide aminophylline amphotericin beta agonists, eg salbutamol, salmeterol, terbutaline carbenoxolone liquorice in large quantities potassium-losing diuretics, eg furosemide, bendroflumethiazide theophylline. You may need a larger dose of prednisolone if you are also taking any of these medicines: barbituates, eg amobarbital, phenobarbital carbamazepine fosphenytoin phenytoin primidone rifabutin rifampicin.
The following medicines may reduce the removal of prednisolone from the body and so may increase its effects or side effects: ciclosporin prednisolone may also increase the blood level and risk of side effects of ciclosporin itraconazole ketoconazole liquorice macrolide-type antibiotics, eg erythromycin protease inhibitors, eg ritonavir. Can I have vaccines while taking prednisolone? What is prednisolone used for and how does it work?
What should I know before using prednisolone? How do I take prednisolone? Who might need a lower prednisolone dose or extra monitoring? Can I use prednisolone while pregnant or breastfeeding?
What are the possible side effects of prednisolone? Advertisement - Continue Reading Below. More From Medicines.
How the interaction occurs: When these two medicines are taken together, they may increase. Drug interaction between naproxen and prednisone. Prednisone is a steroid, which works by being in the body by reducing levels of certain. Oral prednisolone and naproxen are equally effective in the initial treatment of gout arthritis over 4 days. Drug interaction between naproxen and prednisone. Prednisone is a steroid, which works by being in the body by reducing levels of certain. Prednisone (Deltasone) is part of a potent class of Prednisone is used to treat prednisone with NSAIDs (such as naproxen or ibuprofen). After three weeks, all patients reported, by telephone, complete relief of signs and symptoms, and no patients reported a recurrent attack. You may need a larger dose of prednisolone if you are also taking any of these medicines:. Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy.In an equivalence study, pain scores for the corticosteroid and NSAID were similar as were the number of adverse events, which were minor, Hein Janssens, M. Action Points If patients ask, explain that prednisolone, a corticosteroid, was as effective as the commonly used nonsteroidal anti-inflammatory drug naproxen Aleve in relieving the pain of a gout attack.
Yet for gastrointestinal-bleeding reasons, the authors said, the study provides a strong argument to consider prednisolone as a first treatment option over NSAIDs for patients with gout. Use of cochicine has declined because of its disadvantage in renal failure and NSAIDS have been associated with gastrointestinal and cardiovascular risks often seen in gout patients. Prednisolone may also turn out to be less costly because they don't require gastroprotective drugs added to treatment with NSAIDs, the researchers said.
The researchers undertook a randomized clinical trial to test the equivalence of naproxen and prednisolone for treating monoarticular gout. From March 24, through July 14, , family physicians in the eastern part of Holland were asked to send all patients with monoarthritis to the trial center, even if gout was not the most likely diagnosis.
Treatment was masked for both patients and physicians. Data were incomplete for one patient in each treatment group, so analyses included 59 patients in each group. After 90 hours, the reduction in the pain score was The difference in the size of change in the pain score for the whole observation period intervals was 1. Reductions in the pain scores were equivalent and went from 62 mm to 17 mm for prednisolone and 59 mm to 13 mm for naproxen, in a similar pattern.
For general disability, the differences were 0. In all cases these differences non-significantly favored naproxen, the investigators said. Adverse effects were similar and minor between groups, and resolved by the three-week follow-up. After three weeks, all patients reported, by telephone, complete relief of signs and symptoms, and no patients reported a recurrent attack. Study limitations included assessment of complete relief based on self-reporting, the use of non-validated scales to assess disability outcomes, and a study population limited to white Dutch people.
Although no patients were excluded in this study because of the risks from prednisolone treatment, a quarter of originally eligible patients had to be excluded because of direct safety risks had they been treated with naproxen. For these patients, a five-day treatment with prednisolone would have been no problem, the researchers said.
In addition to better safety, they wrote, the direct drug costs would also be less if systemic corticosteroids, such as prednisolone, were the first-line drug choice. In an accompanying comment, Timothy H. Rainer, M. First, they said, although well-designed, the study was fairly small and was done at one center. It needs to be repeated in other locales with different rates of gastrointestinal disease. Second, they said, changes in clinical practice often need strong marketing forces, which might not occur unless drug companies stand to benefit from newer more expensive drugs.
Nevertheless, they concluded, this trial "will go some way to satisfy both rheumatological purists and front-line pragmatists that short-term oral corticosteroids are as equally effective as NSAIDs in the initial treatment of acute gout and gout-like syndrome. Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; Share on Facebook. Opens in a new tab or window. Share on Twitter.
Share on LinkedIn. Explain that the study was fairly small and needs to be repeated in larger, broader studies if clinical practice is to change. Point out that for gastrointestinal-bleeding reasons, the authors said, the study provides a strong argument to consider prednisolone as a first treatment option over NSAIDs for patients with gout.
Primary Source The Lancet Source Reference: Janssens H, et al "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial" The Lancet ; The researchers and the editorial writers declared no conflict of interest.
No comments:
Post a Comment