Which drug is suitable for the treatment of osteoarthritis pain for users of the blood thinner Marevan?
The expert answers:
THE QUESTION concerns many and is therefore important. Osteoarthritis is a common disease that, as the disease progresses, makes it difficult to move and causes pain in the joints. Drug-free treatment is the most important, and medical treatment is used as an aid if necessary.
In the treatment of osteoarthritis, the primary painkiller is paracetamol. If it doesn’t help enough, let’s move on to using anti-inflammatory drugs. Sometimes you may also have to use mild opioids, such as tramadol or codeine, for a short time. Other medical treatment options include glucocorticoid and hyaluronate injections that are injected into the joint.
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Warfarin (Marevan) is an anticoagulant that affects blood clotting, which aims to prevent blood clot formation, growth and the disintegrating blood clot from drifting to other parts of the bloodstream. The use of warfarin is associated with an increased risk of bleeding, which is why the treatment’s effect on blood clotting is monitored by the so-called With INR measurements and the drug dose is adjusted according to the measurement result.
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Many medications interact with warfarin. Among the drugs used in the treatment of osteoarthritis pain, especially anti-inflammatory drugs increase the possibility of bleeding when used with warfarin.
No anti-inflammatory drug can be considered risk-free in this regard, as their long-term use is associated with an increased risk of gastrointestinal bleeding without warfarin; the magnitude of the risk depends on the drug used and the dose. The combination of paracetamol and warfarin should also be avoided, although when using paracetamol less than 2 g per day, the increase in the risk of bleeding is likely to be small. However, the pain-relieving effect of paracetamol in small doses is not always enough.
Unfortunately, combining tramadol with warfarin treatment also increases the tendency to bleed.
The combination of codeine and paracetamol might be suitable for short-term use with warfarin, as long as the dose of paracetamol is kept low and INR monitoring is enhanced.
Codeine strengthens the pain-relieving effect of paracetamol, but on the other hand, its use is associated with other side effects and a small risk of developing addiction. It is worth noting that only paracetamol and some of the anti-inflammatory drugs are self-medications and other painkillers require a doctor’s prescription and thus an assessment of the patient’s situation.
There is therefore no unequivocal solution to the question posed. It is always good to talk to your doctor about different options. As for painkillers, paracetamol in a small dose can be used together with warfarin, although the combined use is associated with an increased risk of bleeding. Therefore, enhanced INR monitoring is necessary and treatment should not be started without a doctor’s supervision.
Glucocorticoid treatment injected into the joint can be an alternative for the exacerbations of osteoarthritis pain. It is also worth noting that warfarin treatment should not be stopped without the doctor’s permission.
This article has appeared in Hyvä tervey magazine. As a subscriber, you can read all issues free of charge digilehdet.fi service.
Source: www.hyvaterveys.fi
