3 replies to this topic

[Kells]

Hello Dr. Callery,
I was told at a pre-op class that after WLS, we are not allowed any medicines with ibuprophen or aspirin. This concerns me because currently, I take Excederin for occasional migranes, tension or cluster headaches and 600 mg. of ibuprophen as needed for monthly cramps and muscle strain. Nothing else to this point (such as Pamprin, Midol or tylenol) has helped. Is there an alternative you can recommend or will I still be able to manage pain with these OTC drugs? I am planning to have the gastric bypass. Thanks for any help you can offer.

[Dr. Callery]

Good question. Surgeons vary on their recommendations regarding NSAIDs. Most simply say no NSAIDs because of the risk of causing ulcers at the stomach jejunum connection (gastrojejunal stomal or anastomotic ulcer) . Some surgeons' recommendations are more nuanced. They OK limited usage of NSAIDs for specific pain problems, ie. menstrual cramps, headache, and so on. Others allow longer use of NSAIDs if the patient also takes an acid blocker such as omeprazole. Some feel that Cox 2 NSAIDs such as Celebrex are safer than first generation drugs such as ibuprofen.

There is surprisingly little fact based information about the use of NSAIDs after gastric bypass in the medical literature. The reason for this is that it's well known that NSAIDs are associated with peptic ulcer of the GI tract, but little is known about the exact causes of gastrojejunal ulcers in GBP patients. The assumption is that the usual list of suspects are at play: NSAIDs, smoking, poor nutrition, acid stimulating foods, excess stomach acid, poor blood supply to the Roux limb, H. Pylorii bacteria, and so forth. No one has done any research that I know of to show how long you can use NSAIDs and not develop an ulcer. It probably varies from person to person depending on many factors. So, the simple answer is be careful and ask your doc about your specific situation. Tylenol, mild narcotics, and narcotic analogues are fine.

[MandaJo]

Is EXCEDRIN Tension Headache considered safe?  When I was pregnant I could not have the other stuff either, but my doctor allowed me to use EXCEDRIN Tension Headache because it only has acetaminophen and some caffeine -- no aspirin like the others.  It seemed to help better than just using Tylenol alone.  Here is the product label.



EXCEDRIN® Tension Headache Product Information

Drug Facts
--------------------------------------------------------------------------------
Active ingredients (in each caplet) Purpose
Acetaminophen 500 mg ……………………………………………………………………………………….Pain reliever
(formulated with 65 mg caffeine)

[Dr. Callery]

The acetaminophen is fine. You'll have to ask you doc about the caffeine. Some docs advise against it because caffeine increases gastric acid output. This is especially a problem if you are having any trouble with ulcers. If you are not having any problems, occasional use of a drug like this will probably not be an issue.