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Pain Relievers: Handle with Care

Acetaminophen, a popular pain reliever found in hundreds of products, is generally safe at recommended doses. Taking too much, however, can be dangerous. An FDA advisory committee met to discuss the problem of serious liver damage caused by overuse of this common medication.

The issue is that it’s easy to mistakenly take more acetaminophen than you mean to. Let’s say you’re someone with osteoarthritis who’s fighting a cold. In addition to taking Tylenol for your knee pain, you take a cough-and-cold product for the cold symptoms. You might wind up getting more acetaminophen than you bargained for.

This is important news for people with osteoarthritis of the knee, since over-the-counter acetaminophen is often used to relieve pain. For those with more severe pain, doctors sometimes prescribe medications that combine acetaminophen with a stronger pain reliever, such as codeine or hydrocodone.

Too much of a good thing

The liver problems caused by too much acetaminophen range from abnormal results on liver function tests to acute liver failure — a medical emergency in which the liver rapidly loses its ability to work properly.

The recommended total daily dose for adults is 4,000 mg a day, which is equal to 8 pills of most over-the-counter acetaminophen. Taking a much larger dose can lead to liver damage. But in some people, taking just a little more than the recommended amount can injure the liver, too. Those who drink alcohol or who already have liver disease may be especially vulnerable. 

Echoes of problems past

It’s not the first time the dangers of pain relievers that are common for osteoarthritis of the knee have made headlines. In 2005, the FDA strengthened warnings about potential side effects of NSAIDs (nonsteroidal anti-inflammatory drugs), a group of medications that include over-the-counter and prescription products like ibuprofen, Celebrex® and aspirin. It was found that regular use of NSAIDs has the potential to cause stomach bleeding. In addition, long-term use of all NSAIDs except aspirin may increase the risk for heart attack or stroke.

Make safety your priority

The take-home message: Even the most familiar pain relievers need to be handled with care. All pain relievers are serious, even non-prescription ones. The steps below can help you avoid unintended consequences:

  • Read the package carefully: don’t take more than the recommended dose and don’t take it more often than directed.
  • Know what you’re taking: check a medicine’s label to see if it contains acetaminophen. On a prescription medication, acetaminophen is sometimes listed as “APAP.”
  • Talk with your doctor: make sure your doctor knows all the medications you’re taking, even over-the-counter. Check with your doctor or pharmacist before taking a new medication.

PLEASE NOTE: Tylenol is a registered trademark of The Tylenol Company. Excedrin is a registered trademark of Novartis Consumer Health, Inc. Vicodin is a registered trademark of Knoll Pharmaceutical Company. Percocet is a registered trademark of Endo Pharmaceuticals Inc. Celebrex is a registered trademark of G.D. Searle, LLC.

PLEASE NOTE: The studies and their findings that are presented in this article are for informational purposes only and are not meant to take the place of the advice of your doctor. By providing you with this information, Sanofi Biosurgery is not endorsing its content nor does it represent that the information is necessarily appropriate for you. You should consult with your doctor before starting any new health or exercise regimen.

References

“Acetaminophen and Liver Injury: Q&A for Consumers.” Food and Drug Administration. Accessed August 9, 2009.

“Health Bulletin: Use Caution With Pain Relievers.” Food and Drug Administration. Accessed August 9, 2009.

“Acetaminophen Overdose and Liver Injury: Background and Options for Reducing Injury.” Food and Drug Administration. Accessed August 9, 2009. (p. 1 What Is Acetaminophen and What Is It Used For?)

“FDA Announces Series of Changes to the Class of Marketed Non-steroidal Anti-inflammatory Drugs (NSAIDs).” Food and Drug Administration. Accessed August 9, 2009.

“The Benefits and Risks of Pain Relievers: Q&A on NSAIDs With Sharon Hertz, M.D.” Food and Drug Administration. Accessed August 9, 2009.

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Indication

Synvisc-One® (hylan G-F 20) is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen.

Important Safety Information for Synvisc-One

Before trying Synvisc-One, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Allergic reactions, some which can be potentially severe, have been reported during the use of Synvisc-One. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, and should be used with caution when there is swelling of the legs due to problems with venous stasis or lymphatic drainage.

Synvisc-One is only for injection into the knee, performed by a doctor or other qualified health care professional. Synvisc-One has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds – such as feathers, eggs or poultry – or if your leg is swollen or infected.

Synvisc-One has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child.

Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after Synvisc-One include (<2% each): pain, swelling, heat, redness, and/or fluid build-up in or around the knee. Tell your doctor if you experience any side effects after treatment with Synvisc-One.

 

View the Complete Prescribing Information for Synvisc-One

 

Indication

SYNVISC® (hylan G-F 20) is used to relieve knee pain due to osteoarthritis (OA). It is for patients who do not get enough relief from simple painkillers such as acetaminophen, or from exercise and physical therapy.

Important Safety Information for SYNVISC

Before trying SYNVISC, tell your doctor if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to SYNVISC or any hyaluronan-based products. Serious allergic reactions have been reported. Should not be used in patients with an infected knee joint, skin disease or infection around the area where the injection will be given, or circulatory problems in the legs.

SYNVISC is only for injection into the knee, performed by a doctor or other qualified health care professional. SYNVISC has not been tested to show pain relief in joints other than the knee. Tell your doctor if you are allergic to products from birds - such as feathers, eggs or poultry - or if your leg is swollen or infected.

SYNVISC has not been tested in children (≤21years old), pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant or if you are nursing a child. Talk to your doctor before resuming strenuous weight-bearing activities after treatment.

The side effects sometimes seen after SYNVISC include pain, swelling, heat, redness, and/or fluid buildup in or around the knee. These reactions were generally mild and did not last long, but in rare occasions these side effects were more severe. The most commonly occurring adverse events outside of the injected knee were rash, fever, nausea, and headache.

View the Complete Prescribing Information for SYNVISC

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Important Safety Information: SYNVISC and Synvisc-One are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee.