Q: Which products do pharmacists recommend most for osteoarthritis pain?
Because of collaboration between the publications Pharmacy Times and US News and World Report the general public can find out which products are recommended most by pharmacists by category.
For the past 19 years, Pharmacy Times has invited its pharmacist readers to share their expertise in recommending their favorite brand-name non-prescription products. Over 168,000 pharmacists are asked to submit the over-the-counter or non-prescription products (abbreviated as OTC) in 160 categories.
Together Pharmacy Times and US News and World Report have made the results of this survey available online for viewing at www.otcguide.net. There is even a mobile app for it as well, called “OTC Guide.”
Looking over the category of Oral Arthritis Pain Relievers for the 2013-14 study results I saw there were 5 pain relievers recommended. The top pick in this category is Aleve®, with 33% of the pharmacists’ vote. The next two recommendations were pretty close together which didn’t surprise me because they are the same medication: Advil® was second place with 26% and Motrin®-IB third place at 20% of the vote. My personal favorite for arthritis pain, Tylenol Arthritis® was recommended with 17% of the survey responders and Osteo Bi-flex®(glucosamine/chondroitin) rounded out the group with 4%.
The top 3 products recommended by pharmacists belong to a family of compounds called non-steroidal anti-inflammatory drugs, often abbreviated as NSAIDs. Aleve®, the generic name of naproxen is also the number 1 prescription NSAID as well. Naproxen 500mg twice daily is considered the gold standard of pain and inflammation relief among prescription NSAIDS like nabumetone, meloxicam, and Celebrex®.
Since they are very similar, why did naproxen get first place? Pain relief from naproxen lasts for 6-8 hours, while ibuprofen often wears of in 4-6 hours. I have a personal preference for naproxen over ibuprofen as well because of my own experience. I took prescription strength ibuprofen while recuperating from ripping a ligament in my right wrist 20 years ago, injured by chopping wood in 15 degrees below zero weather. My ibuprofen wore off at every night exactly at 3:15 am and it took nearly an hour for the next dose to kick in and allow me to go back to sleep. After 2 weeks of this I tried in desperation 2 tablets of OTC naproxen for a total of 440mg and blessedly slept through the night.
Naproxen gets my vote for best relief of muscle pain, but for osteoarthritis pain, #4 in the survey, Tylenol Arthritis® is MY #1 pick. I recommend this medication for anyone taking blood thinners such as aspirin, warfarin (Coumadin®) or clopidogrel (Plavix®) because it doesn’t have the tendency to cause stomach bleeding. It also works all through the night, lasting 8-10 hours. I recommend taking two tablets twice daily, once every morning and again at bedtime.
The tricky thing about Tylenol Arthritis® is it’s popularity. That’s right, it’s TOO popular. Acetaminophen, abbreviated as APAP on prescription labels, is used as an ingredient in over 200 of OTC products and if that were not enough, it’s one of the ingredients in prescription analgesics like Vicodin®, Lortab®, and Percocet®.
Although the product mentioned in the 2013-14 survey is Tylenol Arthritis®, its manufacturer has long-acting acetaminophen product called Tylenol® 8-Hour. Tylenol® 8-Hour is a brightly colored capsule that contains an extended release formulation of acetaminophen with a similar long acting pattern of pain relief.
Osteo Bi-Flex® are #5 in the current survey. Osteo Bi-Flex® has two ingredients, glucosamine and chondroitin. I like glucosamine because if you respond to it, it is the most safe of all these options for long term pain relief of arthritis. I have not seen any side effects nor any interactions with other drugs in the 15 years I have used it in my patients taking warfarin as a blood thinner.
Glucosamine may take up to 6-8 weeks for a full effect, and while you are trying it can be expensive. Osteo-Bi-Flex retails for around $30-60 for a month’s supply. If cost is an issue, I have recommended getting it as a powder from a company called Bio-Alternative based in Klamath Falls, Oregon. Their glucosamine powder is a bargain at only $20 per a pound jar, a 6-month’s supply, plenty to see whether you will respond to it.
Curious what other products were recommended in other categories? Check it out at www.otcguide.net or get the free OTC Guide app.
