[UK] Pain medication from GP

I have just been denied a Naproxen prescription despite it being issued previously. I take Naproxen very sparingly, as evidenced by the fact my last prescription for it was 7 months ago!

I have a doctor's appointment soon to discuss this. The doctor who issued the prescription has now left the surgery.

I have no doubt this is due to the recent 'primary pain' NICE guidelines and its recommendation to avoid such drugs. But of course I don't have primary pain.

Anyone been through this, or similar?

 

Can I ask - were you refused a prescription by a doctor or was the naproxen removed from your repeat prescriptions?

If it was removed from the repeat prescriptions then I have been told they do this if the medication hasn't been requested within a certain timeframe. I can't remember how long now. When this happened to me & I spoke to my GP it was simply reinstated.

If you're stuck, have run out & have someone who can get it for you then Feminax is a brand name for naproxen. The pills may be a lower dose than those prescribed but might get you through until you get it sorted.

Good luck with it.

Edit - forgot to say - feminax is available over the counter

 

It wasn't actually on repeat. I just asked for it again (outside of an appointment) and of course it has to be signed off by a doctor. A doctor told reception that I should take Ibuprofen because of the risks of Naproxen! I have booked an appointment to speak to a doctor about it. Hopefully when I explain the infrequent usage and my situation it will be reinstated.

 

I gave up using naproxen around 2000 because I came to realise that the risks of gut haemorrhage are pretty unacceptable. I would not take it myself now. The pharmacological effect is the same as ibuprofen. If I need a stronger effect I use a higher dose of ibuprofen.

 

What I read about the risks of ibuprofen vs naproxen is that the risk of heart attack is higher with ibuprofen and lower with naproxen. But the risk of intestinal bleeding is higher with naproxen than with ibuprofen.

 

I think at the dose and frequency I was using there is minimal risk. I had a pack last 7 months. But yes, I know there are risks.

 

I don't think the frequency matters. A single dose can cause bleeding. The lowest dose I know of is 250mg, which is enough to be a problem.

 

What would be other alternatives, aside from higher doses of ibuprofen?

 

The consensus when I left practice was that if you are going to use a non-steroidal anti-inflammatory ibuprofen is the best choice. Diclofenac definitely has risks in terms of pro-clotting problems like stroke or heart attack and is not that different from some that were withdrawn (Vioxx etc.). Aspirin is fairly similar to naproxen, with other metabolic problems at high dose. Indomethacin has a range of extra nasty side effects.

Paracetamol does not have the platelet and bleeding issues and although limited in effect is not useless. I rarely used the opioids throughout my career although as infrequent one off doses they may not be that bad.

 

When I was going through a phase of almost constant pain from frequent hip subluxations, my GP suggested I take paracetamol and ibuprofen together. It was a mixed type of pain, and the mix of different meds did help quite a bit.

I don't know whether it might be indicated for your pain type, but as long as the GP thinks it's okay and the pharmacist is told about anything else you might be prescribed, it might be another option?

 

There appear to be substantial differences between US and UK when it comes to medications. In the US ibuprofen, diclofenac and naproxen 9at least in the past) are readily available and I've never heard of any risk with these drugs except for liver damage due to overdose of ibuprofen. What gives? Don't ask me--I have no idea.

 

What scared me off NSAIDs was because a patient of mine (as a nurse) who was given naproxyn for arthritis pain was shortly thereafter hospitalized with intestinal bleeding and had a temporary ileostomy, I believe. She was high risk, on heparin for procedures. This was 20 years ago.

 

Some Feminax products are naproxen, some are ibuprofen

 

Just for clarification, I trust you don't literally mean "together"? I thought you had to alternate them if you were taking both, and do it perhaps a couple of hours apart?

 

I've been told by doctors that ibuprofen and paracetamol can be taken together - and yes, I do mean literally "together".

 

No, at the same time. They're different drugs – paracetamol doesn't have the side-effects of potentially raising the risk of bleeding, gastric irritation, and aggravation of asthma.


ETA: Of course, it's always best to check with your doctor first, and if it's a bit of an emergency (such as suddenly getting severe toothache) and you can't access the GP, go through your meds and health conditions with the pharmacist.

 

The risk of bleeding from NSAI like naproxen is very well documented going back to the 1980s - some of it based on NHS based population studies in the UK I think, but also elsewhere. The risk of stroke from Vioxx and diclofenac came up a bit later in the 1990s with the understanding of the roe of cycle-oxygenase 2. Because the complications are common health problems any way it has probably been impossible for individuals to sue on these grounds so maybe it has stayed beneath the radar in the US.