It was found that people who specifically used ibuprofen for more than five years were more than 40 per cent less likely to develop AD. Results also showed that the longer ibuprofen was used, the lower the risk for dementia. In addition, people who used certain types of NSAIDs for more than five years were 25 per cent less likely to develop AD than non-users. While other NSAIDs, such as indomethacin, may also have been associated with lower risks, others, such as celecoxib, did not show any impact on dementia risk; these results suggest that the effect may be due to specific NSAIDs rather than all NSAIDs as a class. According to study author, Dr Steven Vlad, with the Boston University School of Medicine, some of these medications taken long term decrease the risk of AD, but it is very dependent on the exact drugs used. It does not appear that all NSAIDs decrease the risk at the same rate. Vlad believes that one reason ibuprofen may have come out so far ahead is that it is by far the most commonly used. Observational studies such as this one must be interpreted with the understanding that they do not prove that an NSAID has a therapeutic effect. The study is subject to "indication bias," which means that it might not be the NSAID use that drove the lower risk of dementia, but rather something about the people who chose to use the NSAIDs that was responsible. As such, it has been cautioned that these findings should not be taken to mean that NSAIDs should be administered to prevent dementia.

"Recent epidemiological studies have revealed that therapeutic use of non-steroidal anti-inflammatory drugs (NSAIDs) reduces the risk of developing PD. Here, we examined the effects of NSAIDs, such as ibuprofen, aspirin, acetaminophen, meclofenamic acid sodium salt, sulindac sulfide, ketoprofen, flurbiprofen, diclofenac sodium salt, naproxen, and indomethacin, on the formation and destabilization of alphaS fibrils (falphaS) at pH 7.5 and 37 degrees C in vitro, using fluorescence spectroscopy with thioflavin S and electron microscopy. All examined NSAIDs, except for naproxen and indomethacin, inhibited the formation of falphaS in a dose-dependent manner. Moreover, these molecules dose-dependently destabilized preformed falphaS. The overall activity was in the order: ibuprofen approximately aspirin approximately acetaminophen approximately meclofenamic acid sodium salt approximately sulindac sulfide >ketoprofen approximately flurbiprofen approximately diclofenac sodium salt >naproxen approximately indomethacin," wrote M. Hirohata and colleagues, Kanazawa University (see also NSAIDS).

The researchers concluded: "These findings indicate that NSAIDs could be key molecules for the development of therapeutic or preventive agents for LBD and MSA."

Hirohata and colleagues published their study in Neuropharmacology (Non-steroidal anti-inflammatory drugs have potent anti-fibrillogenic and fibril-destabilizing effects for alpha-synuclein fibrils in vitro. Neuropharmacology, 2008;54(3):620-7).

For additional information, contact M. Hirohata, Kanazawa University Graduate School of Medical Science, Dept. of Neurology and Neurobiology of Aging, 13-1, Takara-machi, Kanazawa and Neurological Center, Kanazawa-Nishi Hospital, Kanazawa, Ishikawa 920-8640, Japan.

Publisher contact information for the journal Neuropharmacology is: Pergamon-Elsevier Science Ltd., the Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, England.

"Although Alzheimers disease is a disorder of brain and synaptic function, the effects of NSAIDs on A beta-mediated suppression of synaptic plasticity and memory function have never been reported. We therefore investigated how three different NSAIDs, chosen for their distinct effects on A beta 42 production and the inhibition of the cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, affect memory function and synaptic plasticity. By focusing upon brain and synapse function, we made novel observations about the effects of NSAIDs on A beta-mediated neural processes. Here we report that the selective inhibition of COX-2, but not COX-1, acutely prevented the suppression of hippocampal long-term plasticity (LTP) by A beta. The non-selective NSAIDs, ibuprofen and naproxen, and a selective COX-2 inhibitor, MF-tricyclic, each restored memory function in Tg2576 mice over-expressing APP, and also blocked A beta-mediated inhibition of LTP. There was no advantage of ibuprofen, a selective A beta 42-lowering agent (SALA), over the non-SALAs, naproxen and MF-tricyclic. The beneficial effects on memory did not depend upon lowered levels of A42 or the inflammatory cytokines, tumour necrosis factor (TNF-alpha) and interleukin 1 beta (IL-1 beta). Intriguingly, improved memory function was inversely related to prostaglandin E2 (PGE2) levels. Conversely, exogenous PGE2 prevented the restorative effects of COX-2 inhibitors on LTP. The data indicate that the inhibition of COX-2 blocks A beta-mediated suppression of LTP and memory function, and that this block occurs independently of reductions in A beta 42 or decreases in inflammation," wrote L.A. Kotilinek and colleagues, University of Minnesota (see also Alzheimer Disease).

The researchers concluded: "The results lead us to propose a third possible mechanism by which NSAIDs may protect against Alzheimers disease, involving the blockade of a COX-2-mediated PGE2 response at synapses."

Kotilinek and colleagues published their study in Brain (Cyclooxygenase-2 inhibition improves amyloid-beta-mediated suppression of memory and synaptic plasticity. Brain, 2008;131(Part 3):651-664).

For additional information, contact K.H. Ashe, University of Minnesota, Dept. of Neurology, MMC 295, 420 Delaware St. SE, Minneapolis, MN 55455, USA.

The publisher's contact information for the journal Brain is: Oxford University Press, Great Clarendon St., Oxford OX2 6DP, England.

Q My brother has been treated for painful headaches for the past year, and seems increasingly discouraged and depressed. Could his depression be related to his headaches?

A People who have chronic headaches have a significant risk of major depression. In a study of 177 adults who were receiving treatment for headache, researchers found that 25 percent had major depressive disorder as well, according to a report in the October 2007 issue of the journal Headache. Those whose headaches were more severe, longer in duration (more than six months), or accompanied by multiple symptoms were most likely to experience depression.

I suggest your brother discuss his depression with his doctor, and consider asking for a referral to a mental health professional for evaluation.

Q Should I be taking vitamin E supplements to lower my risk of Alzheimer's disease?

A Researchers have found a significant association between consuming a diet rich in vitamin E--an important antioxidant--and lowered risk for Alzheimer's disease (AD). But assessing the impact of vitamin E supplements on AD risk has been more difficult. Some studies suggest that taking vitamin E in combination with vitamin C can reduce AD risk, while other research has failed to find any effect on AD risk associated with taking the vitamin combination or vitamin E supplements alone.

It was once thought that 400 international units per day (IU/d) of vitamin E was safe for healthy people, although people who are taking blood thinners or anticoagulants or who have bleeding problems usually are advised to avoid vitamin E supplements. However, doubts about supplementation were raised a few years ago when researchers reviewed 19 clinical trials to analyze the relationship between vitamin E supplementation and overall mortality. They found that mortality risk progressively increased with dosages over 150 IU/d, with higher dosages linked to greater risk. In a report published in Annals of Internal Medicine on Jan. 4, 2005, the researchers advised against high-dose vitamin E supplementation for delaying AD until effective and safe levels for the vitamin could be established.

Fortunately, supplements are not the only source of this important antioxidant. Research suggests that dietary consumption may actually be more effective than supplementation. Good dietary sources of vitamin E include fortified cereals; sunflower seeds; nuts such as almonds and hazelnuts; vegetable oils; turnip greens; tomato paste, puree, and sauce; pine nuts; peanut butter; wheat germ; and spinach.

Editor-in-Chief

Maurizio Fava, MD

Source Citation:Fava, Maurizio. "Ask the doctor.(Clinical report)." Mind, Mood & Memory 4.5 (May 2008): 8(1). General OneFile. Gale. King County Library System. 30 June 2008

Andrew J. Whelan, CEO of BioElectronics Corporation, explains, "ActiPatch with its non-invasive, very efficient treatment for swelling and pain while accelerating recovery is the medicine of the future available today. We are actively pursuing additional reimbursement approvals nationally. ActiPatch is an important product that not only works without side-effects, it also has the potential to help keep medical costs down at a time when medical and insurance costs appear to be spiraling out of control," adds Whelan.

ActiPatch(TM) is a wafer thin patch with an embedded battery operated microchip that delivers weeks of continuous pulsed RF therapy for less than a dollar a day. The unique ActiPatch(TM) delivery system, using patented technology, provides a cost-effective, home use method to reduce soft tissue pain and swelling.

ActiPatch has regulatory clearance by the FDA for the treatment of edema following blepharoplasty.

Adverse reactions: GI upset, GI bleed, rash (discontinue if occurs). See literature re: risk of cardiovascular events.

How supplied: Gelcaps--8, 24, 50, 100, 165, 250 Caplets--24, 50, 72, 100, 165, 250 Tabs--8, 24, 50, 72, 100, 165, 250 Liqui-gels--20, 40, 80

ANAPROX Roche Rx

NSAID (arylacetic acid deriv.). Naproxen sodium 275mg; tabs,

Also: ANAPROX DS Rx Naproxen sodium 550mg; tabs,

Indications: Mild to moderate pain.

Adults: Initially 550mg, then 550mg every 12 hrs or 275mg every 6-8 hrs; max 1.375g (first day), then max 1.1g/day.

Children: <2yrs: not recommended. >2yrs: use susp form.

Contraindications: Aspirin allergy. 3rd trimester pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease: not recommended. Active peptic ulcer. History of GI disease. Impaired renal or hepatic function. Heart failure. Edema. Hypertension. Bleeding disorders. Monitor blood, hepatic, renal, and ocular function in chronic use. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid concomitant aspirin. May potentiate protein-bound drugs (eg, hydantoins, sulfonamides, sulfonylureas). Monitor oral anticoagulants. May antagonize diuretics. [beta]-blockers, other antihypertensives. Increased renal toxicity with ACE inhibitors. Methotrexate excretion reduced, Increases lithium levels, Probenecid increases plasma levels and delays elimination. Increased risk of GI bleed with alcohol.

Adverse reactions: GI bleeding, peptic ulcer, constipation, heartburn, abdominal pain, nausea, headache, dizziness, drowsiness, pruritus, rash (discontinue if occurs), tinnitus, edema, nephritis, nephrotic syndrome, jaundice, hepatitis. See literature re: risk of cardiovascular events.

How supplied: Tabs 275mg--100 550mg--100

BAYER Bayer Consumer OTC

Salicylate. Aspirin 325mg; tabs; caplets; gelcaps.

Indications: Pain. Fever,

Adults: 325-650mg every 4 hours.

Children: Use chewable tabs.

Also: EXTRA STRENGTH BAYER OTC

Salicylate. Aspirin 500mg; caplets; gelcaps.

Also: EXTRA STRENGTH BAYER PLUS OTC

Salicylate. Aspirin 500mg; buffered with calcium carbonate; caplets.

Adults: 500mg-1g every 4-6 hours: usual max 4g daily.

Children: Use chewable tabs.

Also: CHILDREN'S BAYER OTC

Salicylate. Aspirin 81mg; chew tabs: orange or cherry flavor,

Children: 2-4 yrs (32-35lb): 162mg. 4-6 yrs (36-45lb): 243mg. 6-9 yrs (46-65lb): 324mg. 9-11 yrs (66-76lb): 324-405mg. 11-12 yrs (77-83lbs): 324-486mg, Over 12 yrs (84lb): as adult. Dose every 4 hours; max 5 doses/day.

Contraindications: NSAID allergy. Viral infection in children and teenagers. 3rd trimester pregnancy.

Precautions: History of asthma or peptic ulcer, Severe hepatic or renal dysfunction. Bleeding disorders. Diabetes. Gout. Pregnancy, nursing mothers: not recommended.

Interactions: Potentiates anticoagulants, hypoglycemics, methotrexate, acetazolamide, valproic acid, highly protein-bound drugs. Urinary alkalinizers, antacids, corticosteroids may increase excretion, May antagonize ACE inhibitors, [beta]-blockers, diuretics, uricosurics. Increased bleeding risk with NSAIDs or chronic, heavy alcohol use. NSAIDs increase risk of renal dysfunction.

Adverse reactions: GI upset/bleed, prolonged bleeding time, anaphylaxis, salicylism.

How supplied: Tabs--12, 24, 50, 100, 200, 300, 365 Caplets--50, 100, 200 Gelcaps--40, 80 Ext Str tabs, caplets, Plus--50 Ext Str Gelcaps--40, 80 Children's--36

CARBATROL Shire Rx

Dibenzazepine. Carbamazepine 100mg, 200mg. 300mg; ext-rel caps.

Indications: Trigeminal or glossopharyngeal neuralgia.

Adults: 200mg once on day 1; increase by 200mg/day every 12 hrs as needed; max 1.2g/day. Usual maintenance: 400-800mg/day. Attempt to taper or discontinue every three months.

Children: See literature.

Contraindications: History of bone marrow depression. Sensitivity to tricyclic antidepressants. During or within 14 days of MAOIs,

Precautions: Evaluate for presence of HLA-B*1502 allele (esp. in Asians), if present carbamazepine should not be used: increased risk of severe dermatological reactions. History of cardiac, hepatic, renal, or hematopoietic dysfunction, Not for trivial aches/pains. Do baseline CBCs then periodically; discontinue if significant bone marrow depression occurs. Monitor lipid profile, and ophthalmic, hepatic, and renal function. Glaucoma. Increased intraocular pressure. Activation of latent psychosis. Suicidal tendencies (monitor). Reevaluate periodically, Avoid abrupt cessation. Elderly. Labor & delivery. Pregnancy (Cat.D). Nursing mothers: not recommended.

Interactions: Possible hyperpyretic crisis, seizures and death with MAOIs. Carbamazepine levels increased by CYP3A4 inhibitors (eg, cimetidine, macrolides, danazol, delavirdine, diltiazem, fiuoxetine, isoniazid, ketoconazole, Ioratadine, propoxyphene, itraconazole, nicotinamide, niacinamide, valproate, verapamil). Carbamazepine levels decreased by CYP3A4 inducers (eg, cisplatin, doxorubicin, felbamate, phenobarbital, phenytoin, primidone, rifampin, theophylline), May increase levels of clomipramine, phenytoin. primidone. May decrease levels of phenytoin, warfarin, oral contraceptives. doxycycline, theophylline, haloperidol, acetaminophen, alprazolam, clonazepam, clozapine, delavirdine, ethosuximide, haloperidol, vaiproate, others metabolized by CYP3A4. May increase lithium toxicity. May reduce effectiveness of hormonal contraceptives and delavirdine. May alter thyroid function with other anticonvulsants. May interfere with some pregnancy tests or thyroid function tests.

Adverse reactions: Dizziness, drowsiness, GI disturbances, heart failure, edema, hyper- or hypotension, arrhythmias, liver or urinary disorders, dyspnea, lens opacities, arthralgia, fever; rarely: rash (may be serious, eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), aplastic anemia, agranuiocytosis, bone marrow depression; others (see literature).

How supplied: Caps--120

CATAFLAM Novartis Rx

NSAID (benzeneacetic acid deny.). Diclofenac potassium 50mg; tabs.

Indications: Pain.

Adults: 50mg 3 times daily: may give 100mg initially.

Children: Not recommended.

Contraindications: Aspirin allergy. Late pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease: not recommended. Peptic ulcer. GI bleeding. Monitor AST/ALT within 4 weeks and then periodically; also blood, hepatic, and renal function in chronic use. Edema. Cardiac failure. Hypertension. Hepatic porphyria. Elderly. Debilitated, Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Digoxin, methotrexate, cyclosporine, lithium toxicity. Antagonizes diuretics, May increase serum potassium level with [K.sup.+]-sparing diuretics. Avoid aspirin. Monitor oral anticoagulants, insulin and sulfonylureas. Increased risk of GI bleed with alcohol.

Adverse reactions: Peptic ulcer, GI bleeding, elevated AST/ALT, abdominal discomfort, constipation, diarrhea, indigestion, nausea, abdominal distention, headache, dizziness, fluid retention, rash (discontinue if occurs), pruritus, tinnitus. See literature re: risk of cardiovascular events.

How supplied: Tabs--100

CELEBREX Pfizer Rx

NSAID (COX-2 inhibitor). Celecoxib 50mg, 100mg, 200mg, 400mg: caps.

Indications: Acute pain.

Adults: [greater than or equal to] 18yrs: 400mg once then 200mg more on 1st day if needed, then 200mg twice daily, <50kg: start at lowest recommended dose.

Children: Not recommended.

Contraindications: Sulfonamide or aspirin allergy, 3rd trimester pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease or severe hepatic impairment: not recommended, Renal or liver dysfunction: reduce dose by 50% in moderate hepatic insufficiency (Child-Pugh class B). Discontinue if liver disease or systemic effects (eg, eosinophilia, rash) develops. History or risk of GI bleed/ulcer (monitor), Fluid retention. Heart failure. Hypertension. Asthma. Alcoholism. Dehydrated, Elderly. Debilitated. Labor & delivery, Pregnancy (Cat.C). Nursing mothers: not recommended,

Interactions: Caution with drugs that inhibit CYP2C9 (eg, fluconazole) or are metabolized by CYP2D6. May antagonize, or increase risk of renal failure with ACEIs, diuretics. Increased risk of GI bleed with aspirin (except low-dose), corticosteroids, smoking, anticoagulants. May potentiate lithium. Monitor warfarin.

Adverse reactions: GI upset/pain, edema, pharyngitis, increase ALT/AST, GI ulcer/bleed; rare: intracranial bleed, liver failure. See literature re: risk of cardiovascular events.

How supplied: Caps 100mg, 200mg--100, 500 50mg, 400mg--60

CYMBALTA Lilly Rx

Serotonin and norepinephrme reuptake inhibitor. Duloxetine (as HCl) 20mg, 30mg, 60mg; e-c pellets in caps.

Indications: Diabetic peripheral neuropathic pain.

Adults: Swallow whole. See literature. Initially 60mg once daily (may start at lower dose if 60mg not tolerated); usual max 60mg/day (doses up to 120mg/day have been given). Renal impairment: consider lower starting dose and slow titration.

Children: Not recommended,

Contraindications: Allow at least 14 days after MAOI discontinuance before starting duloxetine; allow at least 5 days after duloxetine discontinuance before starting an MAOI. Concomitant thioridazine (may cause arrhythmias). Uncontrolled narrow-angle glaucoma.

Precautions: Severe renal impairment (CrCl<30mL/min), end stage renal disease, hepatic insufficiency, evidence of chronic liver disease, or substantial alcohol use: not recommended. History of seizure or mania/hypomania. Controlled narrowangle glaucoma. Decreased GI motility. Cardiac disease. Suicidal patients. Avoid abrupt cessation. Reevaluate periodically. Monitor BP. Elderly. Labor & delivery. Pregnancy (Cat.C) (avoid 3rd trimester; consider tapering, see literature for effects on neonate). Nursing mothers: not recommended.

Interactions: See Contraindications. Concomitant tryptophan, other SSRIs, SNRIs: not recommended. Potentiated by CYP1A2 inhibitors; avoid (eg, cimetidine, fluvoxamine, quinolones). May potentiate or be potentiated by CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) or substrates (eg, tricyclics, phenothiazines, type 1C antiarrhythmics) or other highly protein-bound drugs; caution with CYP2D6 substrates with narrow therapeutic indexes. Caution with triptans, linezolid, lithium, tramadol, St. John's wort; may cause serotonin syndrome. Monitor concomitant CNS-acting dmgs, and with those that affect gastric pH (eg, acid pump inhibitors). Increased bleeding risk with aspirin, anticoagulants, NSAIDs.

Adverse reactions: Nausea, dry mouth, constipation, decreased appetite/weight, fatigue, dizziness, somnolence, increased sweating, mania/hypomania, tremor, blurred vision, insomnia, hot flushes, urinary hesitation, abnormal ejaculation, genital disorders, decreased libido, increased BP, elevated liver transaminases, cholestatic jaundice, hyponatremia, asthenia, others; rare: seizure.

How supplied: Caps 20mg--60 30mg, 60mg--30, 90, 1000

FEVERALL SUPPOSITORIES Actavis OTC

Analgesic/antipyretic. Acetaminophen 80mg, 120mg, 325mg; rectal supps.

Indications: Minor pain. Fever,

Children: Under 3months: not recommended. 3-11months: 80mg every 6 hrs. 1-3yrs: 80mg every 4 hrs. 3-6yrs: 120mg every 4-6 hrs. 6-12yrs: 325mg every 4 6 hrs. [greater than or equal to] 12yrs: 650mg every 4-6 hrs. All: as needed.

Precautions: Hepatic dysfunction. Pregnancy. Nursing mothers.

Interactions: Hepatotoxicity risk increased by chronic, heavy alcohol use.

Adverse reactions: Rash, hepatotoxicity (overdosage).

How supplied: Supp--6

LODINE Wyeth Rx

NSAID (pyranocarboxylic acid deriv.). Etodolac 200mg, 300mg; caps.

Also: LOOINE TABLETS Rx

Etodolac 400mg, 500mg.

Indications: Pain.

Adults: Initially 200mg-400mg every 6-8 hrs as needed; usual max 1g/day in divided doses; may increase to 1.2g/day when needed.

Children: Not recommended.

Contraindications: Aspirin allergy. Late pregnancy. Coronary artery bypass graft surgery,

Precautions: Discontinue if signs/symptoms of liver disease develop, History of upper GI disease. Asthma. Renal or hepatic impairment, Advanced kidney disease: not recommended. Heart failure. Hypertension. Edema. Bleeding disorders. Monitor blood, hepatic, renal, and ocular function in chronic use. Dehydrated, Elderly. Debilitated. Labor & delivery. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Antacids reduce serum levels. Avoid salicylates, phenylbutazone. Monitor anticoagulants, cyclesporine, lithium, digoxin, methotrexate, Renal toxicity may be potentiated with diuretics. May antagonize ACE inhibitors.

Adverse reactions: Dyspepsia, GI upset, edema, asthenia/malaise, dizziness, dysuria, urinary frequency, depression, nervousness, renal or hepatic toxicity, rash (discontinue if occurs), pruritus, chills/fever, GI bleed, peptic ulcer. See literature re: risk of cardiovascular events.

How supplied: Caps, tabs--100

LYRICA Pfizer CV

[[alpha].sub.2]-delta ligand. Pregabalin 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg; caps.

Indications: Diabetic peripheral neuropathic pain. Postherpetic neuralgia (PHN). Fibromyalgia.

Adults: [greater than or equal to] 18yrs: Neuropathic pain: initially 50mg 3 times daily, may increase to 100mg 3 times daily within 1 week. PHN: initially 75mg twice daily or 50mg 3 times daily; max 300mg/day after 1 week then 600mg/day after 2 weeks as tolerated (see literature). Fibromyalgia: initially 75mg twice daily, may increase to 150mg twice daily within 1 week as tolerated; max 450mg/day. For all: renal impairment (CrCl <60mL/min): reduce dose (see literature); hemodialysis: give supplemental dose after session.

Children: <18yrs: not recommended.

Precautions: Avoid abrupt cessation (taper over [greater than or equal to] 1 week). Discontinue if angioedema, hypersensitivity reactions, myopathy or markedly elevated creatine kinase levels occur. CHF. Ocular conditions. Diabetes (monitor skin integrity). Suicidal tendencies (monitor). Labor & delivery. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Potentiates CNS depression with alcohol, other CNS depressants. Additive edema, weight gain with thiazolidinediones. Adverse reactions: Dizziness, somnolence, other CNS effects, dry mouth, edema, ocular/visual effects (eg, blurring), weight gain, infection, asthenia, eresthesias, elevated creatine kinase, decreased piatelets, arrhythmias (PR prolongation); male-mediated teratogenicity; may be tumorigenic.

How supplied: Caps--90

MOTRIN TABLETS Pfizer Rx

NSAID (propionic acid deriv.). Ibuprofen 400mg, 600mg, 800mg.

Also: MOTRIN CAPLETS McNeil Cons & Specialty OTC

Ibuprofen 100mg; scored.

Also: MOTRIN CHEWABLE McNeil Cons & Specialty OTC

Ibuprofen 50mg, 100mg; scored tabs; citrus flavor; contains phenylalanine.

Also: MOTRIN SUSPENSION McNeil Cons & Specialty OTC

Ibuprofen 100mg/5mL; berry flavor.

Also: MOTRIN ORAL DROPS McNeil Cons & Specialty OTC

Ibuprofen 40mg/mL; susp; berry flavor.

Indications: Mild to moderate pain. Fever.

Adults: Pain: 400mg every 4-6 hrs as needed.

Children: Use caplets, chewables, suspension, or drops. <6 months: not recommended. [greater than or equal to] 6 months: Fever <102.5: 5mg/kg every 6-8 hours. Fever >102.5 or pain: 10mg/kg every 6-8 hours; max 40mg/kg/day.

Contraindications: Aspirin allergy. 3rd trimester pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease: not recommended. History of upper GI disease, Active peptic ulcer. Impaired renal or hepatic function. Edema, Hypertension, Cardiac failure, Bleeding disorders. Diabetes. Monitor blood, hepatic, renal, and ocular function in chronic use. Discontinue if visual or liver dysfunction occurs. Dehydration. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid aspirin, May increase bleeding with anticoagulants, toxicity of methotrexate, Increases serum lithium levels. May decrease effect of furosemide, thiazide diuretics.

Adverse reactions: Peptic ulcer or perforation, GI bleeding, vision disorders, nausea, epigastric pain, heartburn, dizziness, rash (discontinue if occurs), edema, renal papillary necrosis, jaundice, hepatitis. See literature re: risk of cardiovascular events.

How supplied: Tablets--100, 500 Caplets, chew tabs--100 Susp--4oz, 16oz Drops 15mL

NALFON Pedinol Rx NSAID (arylacetic acid deriv.). Fenoprofen calcium 200mg; caps.

Indications: Mild to moderate pain.

Adults: 200mg every 4-6hrs as needed.

Children: <18yrs: not recommended.

Contraindications: Aspirin allergy. CABG surgery. Significant renal impairment. 3rd trimester pregnancy.

Precautions: Hypertension. CHF. Edema. History of ulcer disease or GI bleeding. Hearing impaired. Asthma. Monitor blood, hepatic, renal, and ocular function in chronic use. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid aspirin. May potentiate protein-bound drugs (eg, hydantoins, sulfonamides, sulfonylureas). May antagonize ACE-inhibitors, diuretics. May be antagonized by phenobarbital. Increased risk of GI bleed with oral corticosteroids, anticoagulants (monitor), alcohol, smoking. Methotrexate excretion reduced. Increases lithium levels.

Adverse reactions: GI upset, dyspepsia, constipation, tremor, confusion, increased sweating, pruritus, rash (discontinue if occurs), tinnitus, blurred vision, decreased hearing, palpitations, nervousness, asthenia, peripheral edema, dyspnea; GI ulcer/bleed, elevated liver enzymes (discontinue if hepatotoxicity develops), blood dyscrasias, renal papillary necrosis. See literature re: risk of cardiovascular events.

How supplied: Caps--100

NAPRELAN Victory Pharma Rx

NSAID (arylacetic acid deriv.). Naproxen (as sodium) 375mg, 500mg; controlled rel tabs.

Indications: Mild to moderate pain.

Adults: 1g once daily, or 1.5g once daily for a limited period; max 1g/day thereafter.

Children: Not recommended.

Contraindications: Aspirin allergy. 3rd trimester pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease: not recommended. Active peptic ulcer. History of GI disease. Impaired renal or hepatic function. Heart failure. Edema. Hypertension. Bleeding disorders. Monitor blood, ocular, and liver function in chronic use. Discontinue if liver dysfunction occurs. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid aspirin. Serum revels increased by probenecid. May potentiate protein-bound drugs (eg, phenytoin, sulfonylureas, sulfonamides). Monitor oral anticoagulants. May antagonize diuretics, antihypertensives, increased renal toxicity with ACE inhibiters. Methotrexate excretion reduced. Increases lithium levels. Increased risk of GI bleed with alcohol.

Adverse reactions: GI upset, bleeding, or ulceration; headache, flu syndrome, const pat on, abdominal pain, dizziness, paresthesias, insomnia, rash discontinue if occurs), edema, hyperglycemia, arthralgia, myalgia, renal dysfunction, blood dyscrasias, others. See literature re: risk of cardiovascular events.

How supplied: Tabs 375mg--100 500mg--75

NAPROSYN Roche Rx

NSAID (arylacetic acid deriv.). Naproxen 250mg 375m, 500m; tabs.

Also: NAPROSYN SUSPENSION Rx

Naproxen 125mg/5mL; pineapple-orange flavor.

Indications: Mild to moderate pain.

Adults: Initially 500mg, then 500mg every 12 hrs or 250mg every 6-8 hrs; max 1.25g (first day), then max 1g/day.

Children: <2 yrs: not recommended. >2 yrs: use susp forms of naproxen.

Contraindications: Aspirin allergy. 3rd trimester pregnancy. Coronary artery bypass graft surgery.

Precautions: Advanced renal disease: not recommended. Active peptic ulcer. History of GI disease. Impaired renal or hepatic function. Heart failure. Edema. Hypertension. Bleeding disorders. Monitor blood, hepatic, renal, and ocular function in chronic use. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid aspirin. May potentiate protein-bound drugs (eg, hydantoins, sulfonamides, sulfonylureas). Monitor oral anticoagulants. May antagonize diuretics, [beta]-blockers, other antihypertensives. Increased renal toxicity with ACE inhibitors. Methotrexate excretion reduced. Increases lithium levels. Probenecid increases plasma levels and delays elimination.

Adverse reactions: GI bleeding, peptic ulcer, constipation, heartburn, abdominal pain, nausea, headache, dizziness, drowsiness, pruritus, rash (discontinue if occurs), tinnitus, edema, nephritis, nephrotic syndrome, jaundice, hepatitis. See literature re: risk of cardiovascular events.

How supplied: Tabs--100 Susp--pt

NEURONTIN CAPSULES Pfizer Rx

Gabapentin 100mg, 300mg, 400mg.

Also: NEURONTIN TABLETS Rx

Gabapentin 600mg, 800mg; scored.

Also: NEURONTIN ORAL SOLN Rx

Gabapentin 250mg/5mL; strawberry-anise flavor.

Indications: Postherpetic neuralgia.

Adults: 300mg once on day 1, twice daily on day 2, and 3 times daily on day 3; may titrate up to usual max 1.8g/day in 3 divided doses (doses up to 3.6g/day have been used without added benefit). Renal dysfunction: CrCl 30-59mL/min: 400-1400mg/day twice daily; CrCl 15 29mL/min: 200-700mg once daily; CrCl ~15mL/min: 100-300mg once daily (see literature); hemodialysis: 125-350mg after session.

Children: Not recommended.

Precautions: Renal dysfunction. Suicidal tendencies (monitor). Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.

Interactions: Potentiates CNS depression with alcohol, morphine, other CNS depressants. Give 2 hrs after antacids. May antagonize hydrocodone. May interfere with some urine protein tests (eg, Multistix-SG).

Adverse reactions: Dizziness, somnolence, peripheral edema, GI upset, ataxia, visual disturbances, thought disorder, abnormal gait, incoordination.

How supplied: Caps, tabs--100 Soln--470mL

PONSTEL Sciele Rx

NSAID (fenamate). Mefenamic acid 250mg; caps.

Indications: Mild to moderate pain.

Adults: Take with food. [greater than or equal to] 14yrs: 500mg once, then 250mg every 6 hrs; usually for up to 7 days.

Children: <14yrs: not recommended.

Contraindications: Aspirin allergy. GI ulceration or inflammation. Renal dysfunction. Late pregnancy. Coronary artery bypass graft surgery.

Precautions: Active or history of hepatic dysfunction. Bleeding disorders. Fluid retention. Heart failure. Hypertension. Asthma. Monitor for GI ulcer/bleed (risk is increased if patient is otherwise at high-risk, extended drug treatment, high doses, smokers, alcoholics, history of GI bleed or ulcer); blood, renal, hepatic, and ocular function in chronic use. Dehydrated. Debilitated. Elderly (>65yrs). Labor & delivery. Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions: Avoid aspirin. Increased risk of GI bleed with anticogulants, aspirin, corticosteroids. May potentiate methotrexate, oral anticoagulants, lithium; monitor. May be potentiated by magnesium-containing antacids. May antagonize antihypertensives, diuretics. May antagonize or increase risk of renal failure with concomitant ACE inhibitors or diuretics. Caution with inhibitors of CYP2C9.

Adverse reactions: GI disturbances (eg, abdominal pain, constipation, diarrhea, dyspepsia, nausea, flatulence, GI ulceration or bleeding), anemia, dizziness, edema, renal or hepatic dysfunction, headache, pruritus, rash (discontinue if occurs), tinnitus, drowsiness, photosensitivity, CNS effects, alopecia, blurred vision. See literature re: risk of cardiovascular events.

How supplied: Caps--100

TEGRETOL Novartis Rx

Dibenzazepine. Carbamazepine 100mg+, 200mg; scored tabs; +chewable.

Also: TEGRETOL-XR Rx

Carbamazepine 100mg, 200mg, 400mg; ext rel tabs.

Indications: Trigeminal or glossopharyngeal neuralgia.

Adults: Initially 100mg twice daily with food, gradually increasing in increments of 100mg twice daily as needed. Maintenance: usually 400 800mg daily; range 200mg-1.2g daily. Taper dosage or discontinue if possible at 3 month intervals.

Children: Not applicable.

Also: TEGRETOL SUSPENSION Rx

Carbamazepine 100mg/5mL; citrus-vanilla flavor.

Adults: Initially 50mg 4 times daily with food, gradually increasing in increments of 50mg 4 times daily as needed. Maintenance: usually 400-800mg daily; range 200mg-1.2g daily. Taper dosage or discontinue if possible at 3 month intervals.

Children: Not applicable.

Contraindications: History of bone marrow depression. Sensitivity to tricyclic antidepressants. During or within 14 days of MAOIs.

Precautions: Evaluate for presence of HLA-B*1502 allele (asp. in Asians), if present carbamazepine should not be used; increased risk of severe dermatological reactions. History of cardiac, hepatic, renal, or hematopoietic dysfunction, or adverse hematologic reaction to other drugs. Do baseline CBCs then periodically; discontinue if significant bone marrow depression occurs. Monitor lipid profile, ophthalmic, hepatic, and renal function. Glaucoma. Activation of latent psychosis. Suicidal tendencies (monitor). Use minimum effective dose and change dose gradually. Avoid abrupt cessation. Convert tabs to susp with same quantity of mg/day in smaller, more frequent doses; convert tabs to XR on mg/mg basis. Elderly. Labor & delivery. Pregnancy (Cat.D). Nursing mothers.

Interactions: Possible hyperpyretic crisis, seizures and death with MAOIs. Increased plasma levels with CYP3A4 inhibitors (eg, cimetidine, propoxyphene, isoniazid, macrolides, calcium channel blockers, loratadine, fluoxetine, ketoconazole. itraconazole, valproate). Decreased plasma levels with CYP3A4 inducers (eg, phenobarbital, phenytoin, rifampin, theophylline). May increase levels of clomipramine, phenytoin, primidone. May decrease levels of phenytoin, warfarin, doxycycline, theophylline, haloperidol, acetaminophen, alprazolam, clozapine, oral contraceptives, anticonvulsants, others metabolized by CYP3A4. May increase lithium toxicity. May alter thyroid function with other anticonvulsants. Do not give susp formulation simultaneously with other liquid drugs or diluents. May interfere with some pregnancy tests, thyroid function tests. Others (see literature).

Adverse reactions: Drowsiness, dizziness, GI upset, heart failure, edema, hyper- or hypotension, arrhythmias, liver and urinary disorders, dyspnea, lens opacities, arthralgia, fever, hyponatremia; rarely: rash (may be serious, eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), aplastic anemia, agranulocytosis, bone marrow depression; others (see literature).

How supplied: Tabs 100mg--100 Tabs 200mg--100, 1000 XR tabs--100 Susp--450mL

TYLENOL McNeil Cons & Specialty OTC

Analgesic/antipyretic. Acetaminophen 325mg; scored tabs.

Indications: Minor aches and pain. Fever.

Adults: 650mg every 4-6 hours; max 4g/day.

Children: Under 6 yrs: use pediatric forms. 6-11 yrs: 325mg every 4-6 hours; max 1.625g/day.

Also: EXTRA STRENGTH TYLENOL OTC

Acetaminophen 500mg; tabs; caplets; geltabs; gelcaps.

Also: EXTRA STRENGTH TYLENOL GOTABS OTC

Acetaminophen 500mg', chew tabs; contains potassium 5mg, sodium 3mg; per tab.

Also: TYLENOL ADULT EXTRA STRENGTH LIQUID OTC

Acetaminophen 500mg/15mL; mint flavor; alcohol 7%.

Adults: 1g every 4-6 hours; max 4g/day.

Children: Use pediatric forms.

Precautions: Hepatic dysfunction. Pregnancy. Nursing mothers.

Interactions: Hepatotoxicity risk increased by chronic, heavy alcohol use.

Adverse reactions: Hepatotoxicity (overdosage).

How supplied: Tabs 325mg--100 Ext str tabs--30, 60, 100, 200 Ext str caplets--10, 24, 50, 100, 175,250 Ext str geltabs--24, 50, 100 Ext str gelcaps--24, 50, 100, 225 Ext str rapid release gels--72, 100 Ext str GoTabs--6 Adult liq--8oz

ULTRACET Ortho-McNeil Rx

Opioid + non-opioid analgesic. Tramadol HCl 37.5 mg, acetaminophen 325 mg; tabs.

Indications: Short-term ([less than or equal to] 5 days) management of acute pain.

Adults: 2 tabs every 4-6 hours; max 8 tabs/day. Renal dysfunction {CrCl <30 mL/min): max 2 tabs every 12 hours.

Children: Not recommended.

Contraindications: Acute intoxication with alcohol, hypnotics, narcotics, centrally-acting analgesics, other opioids, or psychotropics.

Precautions: Do not give to opioid-dependent patients. Hepatic impairment: not recommended. Respiratory depression. Increased intracranial pressure. Head injury. Seizure disorders. Acute abdomen. Avoid abrupt cessation. Elderly. Drug abusers. Labor & delivery, pregnancy {Cat.C), nursing mothers: not recommended.

Interactions: Concomitant MAOIs, carbamazepine, alcohol: not recommended. Increased risk of seizures with MAOIs, SSRIs, tricyclics, neuroleptics, opioids, naloxone, others that lower seizure threshold. Potentiation with alcohol, other CNS depressants; reduce dose. May be potentiated by CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, amitriptyline). May potentiate digoxin, warfarin. Avoid other acetaminophen-containing products.

Adverse reactions: Somnolence, constipation, dizziness, sweating, GI upset, anorexia, dry mouth, pruritus, insomnia, prostate disorders, seizures, hepatotoxicity (overdosage).

How supplied: Tabs--20, 100, 500

ULTRAM ER Ortho-McNeil Rx

Opioid. Tramadol HCl 100mg, 200mg, 300mg; ext-rel tabs.

Indications: Moderate to moderately severe chronic pain when continuous analgesia is needed for an extended period of time.

Adults: [greater than or equal to] 18 years: initially 100mg once daily, then may increase by 100mg every 5 days; max 300mg/day. Renal dysfunction (CrCl <30mL/min) or severe hepatic impairment: not recommended.

Children: <18yrs: not recommended.

Also: ULTRAM Rx

Tramadol HCl 50mg; scored tabs.

Indications: Moderate to moderately severe pain.

Adults: [greater than or equal to] 16 years: 50-100mg every 4-6 hours; max 400mg/day. Or, 25mg in AM on 1st day, increase by 25mg every 3 days (ie, to 25mg four times daily), then increase by 50mg every 3 days (ie, to 50mg four times daily), then increase to 50-100mg every 4-6 hours; max 400mg/day. >75 years: max 300mg/day. Renal dysfunction (CrCl <30mL/min): max 100mg every 12 hours. Cirrhosis: max 50mg every 12 hours.

Children: <16yrs: not recommended.

Contraindications: Acute intoxication with alcohol, hypnotics, narcotics, centrally-acting analgesics, other opioids, or psychotropic drugs.

Precautions: Do not give to opioid-dependent patients. Respiratory depression. Increased intracranial pressure. Head injury. Seizure disorders. Acute abdomen. Renal or hepatic impairment. Suicidal ideation. Drug abusers. Avoid abrupt cessation. Elderly (asp. >75 years). Labor & delivery, pregnancy (Cat.C), nursing mothers: not recommended.

Interactions: Concomitant MAOIs, carbamazepine, alcohol: not recommended. May potentiate seizure risk with MAOIs, SSRIs, neuroleptics, opioids, naloxone, tricyclics, others that lower seizure threshold. Potentiation with alcohol, other CNS depressants; reduce dose. May be potentiated by CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, amitriptyline). May potentiate digoxin, warfarin. May be affected by CYP3A4 inhibitors (eg, ketoconazole, erythromycin} or CYP3A4 inducers (rifampin, St. John's Wort).

Adverse reactions: Dizziness, GI upset, constipation, headache, somnolence, pruritus, CNS stimulation, asthenia, sweating, dry mouth, seizures, anaphyiaxis,

How supplied: ER tabs--30, 90 Tabs--100, 500

Source Citation:"16A Nonnarcotic analgesics.(SECTION 16: PAIN & PYREXIA)." MPR Monthly Prescribing Reference, 24. Haymarket Media, Inc., 2008. 316(5). General OneFile. Gale. King County Library System. 30 June 2008  <http://0-find.galegroup.com.catalog.kcls.org:80/itx/start.do?prodId=ITOF>.

"We urge consumers to shop for their over-the-counter medicines and not be so slavishly loyal to brand names," said Steve Findlay, a health-care analyst at Consumers Union. "Store brands are exactly the same as name brands. They're not inferior products whatsoever. In fact, they're superior by being less expensive and providing better value."

Among the times to buy name-brand medications are when no store-brand equivalent is available, when you are too rushed to seek out the store brand and compare active ingredients, or when the store brand doesn't offer the form you prefer, such as gel caps over tablets. In the end, you decide how much extra you are willing to pay for the trust and familiarity of name brands.

Annual sales total $2.5 billion for private-label brands of over-the-counter medications and medical supplies. They make up about a quarter of the market for most categories of over-the-counter medications, according to ACNielsen data supplied by the National Association of Chain Drug Stores. For most categories, sales of private-label medications are up about 10 percent from the year before.

Drugstore chain CVS recently conducted focus groups on what consumers thought about over-the-counter store brands.

"About half the group referenced to us the economy and trying to find ways to save money," said Debbie Armstrong, CVS/Caremark divisional merchandise manager of store brands. "They saw buying store brands as a way to help make ends meet."

Here are some questions and answers about non-prescription store brands:

Are store brands safe and effective? While standing in the store aisle, flip over packages of both a store brand and name brand. Examine ingredients on the label. You can see line by line how the store brand is the same as the name brand. Pay special attention to the first several ingredients, which are "active" ingredients, those that work on your symptoms.

Store brands and name brands go through the same rigorous process at the FDA to ensure both safety and effectiveness.

"The signal to consumers here is you're not getting some cheapo generic version that was made ... without any quality control," Findlay said.

In fact, manufacturers that make name brands also frequently make some store-brand products.

If you're in a drugstore and uncertain about buying a store brand for your symptoms, ask the pharmacist.

Some stores will offer a money-back guarantee on private-label items. At those locations, you're putting no money at risk by trying a store brand. If you don't like it for some reason, take it back for a refund.

How much can I save? In part because private-label products have lower advertising and marketing costs, they sell for a fraction of the cost of name brands. At CVS, for example, consumers can save upward of 30 percent with over-the-counter store brands, Armstrong said.

For example, a 10-ounce bottle of CVS nighttime cough relief medicine costs $4.49, while name-brand Nyquil costs $6.49, according to recent online prices. Similarly, the Walgreens' brand of children's aspirin costs $1.59 for 36 chewable tablets. The same type and quantity by name-brand Bayer costs $6.79.

How else can I save? Buying larger quantities usually results in a markedly lower unit price. And you don't have to worry about buying too much. Medications are effective long after their expiration dates, Findlay said, especially if you don't keep them in a humid bathroom medicine cabinet, a practice that might reduce a medication's potency.

If you're buying at a chain pharmacy, become familiar with the drugstore loyalty programs, which can save significant money through discounts and rebates. If you have a medical flexible-spending account, be sure to use that money for over-the-counter medications.

So next time you're shopping for a pain reliever, for example, you don't necessarily have to think Advil and Tylenol. Think of active ingredients, ibuprofen and acetaminophen.

Gregory Karp is a personal finance writer for The Morning Call, and author of "Living Rich by Spending Smart." E-mail him at yourmoney@tribune.com.

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