Newsletter:

FDA Approves First Generic Divalproex Sodium To Treat Seizures, Migraine Headaches And Bipolar Disorder

The U.S. Food and Drug Administration approved the first generic versions of Depakote delayed-release tablets (divalproex sodium). Depakote is approved by the FDA for the treatment of seizures, bipolar disorder and migraine headaches.

“Generic drugs undergo a rigorous scientific review to ensure that they will provide the patient with the same amount of high quality, safe and effective drug as the name brand product,” said Gary J. Buehler, director of the FDA’s Office of Generic Drugs. “This approval provides an additional treatment option for patients who suffer from epilepsy, bipolar disorder and migraines.”

Generic divalproex sodium will have the same safety warnings as Depakote, including a Boxed Warning that cautions about the risk of liver damage (hepatotoxicity), including fatalities, and pancreatitis, or an inflamed pancreas, including fatal cases. The Boxed Warning also highlights the risk of birth defects (teratogenicity), including neural tube defects.

The following firms have received approval to market divalproex sodium delayed-release tablets: Sun Pharmaceutical Industries Ltd., Mumbai, India; Genpharm Inc., Ontario, Canada; Nu-Pharm Inc., Ontario, Canada; Upsher-Smith Laboratories, Maple Grove, Minn.; Sandoz Inc., Broomfield, Colo.; TEVA Pharmaceuticals USA, North Wales, Penn.; Dr. Reddy’s Laboratories, Hyderabad, India; and Lupin Limited, Mumbai, India.

Combination Drug Taken Early Relieves Migraine Symptoms

A combination drug taken within an hour after the start of a migraine is effective in relieving symptoms, according to research published in the July 8, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

The drug combines sumatriptan, a migraine-specific drug that affects the constriction of blood vessels, with naproxen sodium, a non-steroidal anti-inflammatory drug that works on the inflammatory aspect of migraine and relieves non-traditional migraine symptoms such as sinus pain and pressure and neck pain.

“Unfortunately, many migraine sufferers put off treatment,” said study author Stephen Silberstein, MD, of Thomas Jefferson University in Philadelphia, PA, and a Fellow of the American Academy of Neurology. “This study provides more evidence that treating a migraine at the first sign of pain increases the likelihood of relief.”

The research involved two studies with a total of 1,111 people with migraine who had experienced two to six attacks per month in the three months before the study started. Half of the people were given the sumatriptan/naproxen drug within an hour after migraine pain started and while the pain was still mild; the other half were given a placebo.

Two hours after the dose was given, about 50 percent of those who received the drug were free of any pain, compared to about 16 percent of those who got the placebo. The people who took the placebo were also two to three times more likely to progress to moderate or severe pain over four hours than those who took the drug.

Those who took the drug also had fewer traditional migraine-related symptoms such as nausea and sensitivity to light and sound and fewer non-traditional symptoms such as neck and sinus pain than those who took the placebo.

Silberstein noted that only people whose migraines had a mild pain phase were included in the study, so it is not clear whether the results would apply to people whose migraines start at the moderate or severe pain level.

The studies were sponsored by POZEN, Inc., and supported by GlaxoSmithKline.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

American Academy of Neurology (AAN)
1080 Montreal Ave.
St. Paul, MN 55116
United States
http://www.neurology.org

Men And Women With History Of Concussion Mend Differently, Study Finds – Concussion Treatment Needs To Be More Individualized

Female soccer players and soccer players who have had a previous concussion recuperate differently from males or players without a history of concussion, new research released at the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting at JW Marriott Orland Grande Lakes shows. The study found that prior history of concussion and gender account for significant differences in test results following the injury. Because of these differences, the authors urge physicians and coaches to take an individualized approach to treating concussion patients.

“The results of this study suggest that physicians should not be taking a one-size-fits-all approach to treating concussions,” said co-author Alexis Chiang Colvin, MD, Sports Medicine Fellow for the Department of Orthopaedics at the University of Pittsburgh Medical Center. “Our study shows that patients with a history of a previous concussion perform worse than patients without a previous history on neurocognitive tests taken after they sustain a concussion. Furthermore, females perform worse than males on post-concussion testing, as well.”

The authors chose to examine concussion recovery patterns in soccer players due to the popularity of the sport among both genders. Also, it is a non-helmeted sport with identical rules for all participation levels for both genders. In the United States, there are between 1 and 4 million estimated sports-related concussions each year. The most common causes of concussion in soccer include, head-to-head contact, head contact with other body parts and head-to-ground contact.

A concussion is an injury to the brain that results in temporary loss of normal brain function, usually caused by a blow to the head. Concussions can affect memory, judgment, reflexes, speech, balance and coordination.

The study had 234 soccer players (61 percent female, 39 percent male) ranging in age from 8 to 24 years old, who were given neuropsychological tests that measured attention, memory, processing speed and reaction time after their concussion. The results of the tests were analyzed to see if there were group differences in performance between male and female participants and those with a previous history of concussion.

The study found that females performed significantly worse than males on tests of reaction time. Females were also significantly more symptomatic than males. Additionally, there was a trend, although not significant, towards females testing poorly regarding verbal memory and processing speed when compared to males.

Soccer players with a history of concussion performed significantly worse on verbal memory testing after another concussion, the study found.

“There’s a theory that males typically have a stronger neck and torso that can handle forces better,” said Dr. Colvin. “But when we accounted for Body Mass Index in this study, we still found a difference between males and females. Therefore, there are differences in recovery between genders that cannot simply be attributed to size difference. More studies are needed to determine the reason for differences in recovery between males and females.”

The American Orthopaedic Society for Sports Medicine (AOSSM) is a world leader in sports medicine education, research, communication and fellowship, and includes national and international orthopaedic sports medicine leaders. The Society works closely with many other sports medicine specialists, including athletic trainers, physical therapists, family physicians, and others to improve the identification, prevention, treatment, and rehabilitation of sports injuries. http://www.aossm.org

Botox Works on Muscle Disorders But Not Migraines

MONDAY, (HealthDay News) — Botulinum toxin, known to many as Botox, is safe and effective to prevent excessive sweating of the armpits and hands and to treat many involuntary muscle disorders, newly published guidelines suggest.

But while it may rid your brow of unwanted wrinkles and lines, it probably does not help combat migraines and chronic tension headaches.

The guidelines, developed by the American Academy of Neurology and published in the May 6 issue of Neurology,, reinforce that botulinum toxin has become an effective treatment for numerous movement disorders associated with excessive muscle contraction.

The new guidelines approve its use for treating cervical dystonia, a condition of involuntary head tilt or neck movement; involuntary facial contractions, involuntary eye closure, focal limb dystonias (such as writer’s cramp), essential tremor and some spastic bladder disorders. The drug is injected directly into affected muscles.

The guidelines were developed by researchers who reviewed and analyzed all available scientific studies on botulinum toxin. The American Academy of Physical Medicine and Rehabilitation endorsed the guidelines.

The finding that botulinum toxin probably does not help relieve migraine or chronic tension headaches surprised the researchers.

“Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” pain guidelines author Dr. Markus Naumann, head of the Department of Neurology at Augsburg Hospital in Germany, said in a prepared statement. “It is no better than placebo injections for these types of headache.”

While the research suggested the drug may help relieve low back pain, more study was needed before sanctioning it as treatment option, he said.

More information

The National Migraine Association has more about migraine treatment.

Do New ‘Environmental-Friendly’ Light Bulbs Trigger Headaches?

Compact fluorescent light bulbs are part of the big push to go green.

Those corkscrew looking CFL bulbs are supposed to reduce your carbon footprint and save money, but this relatively simple environmental solution is causing headaches.

“We flipped on a light switch in one of the rooms, and within ten minutes, I developed a migraine. And I could tell it was from that light,” said dr. Larry Newman from the headache institute at Roosevelt Hospital.

Neurologist Dr. Larry Newman says patients have called him with similar complaints.

The CFL’s go on and the migraine begins and that includes people who normally don’t get migraines from lights.

“I know as a migraine sufferer, those lights trigger my headaches. Normal fluorescent lights don’t, but those lights have actually given me headaches,” said Dr. Newman.

But not everyone is convinced.

“I’m still waiting for my first patient to come in and tell me, that’s the cause of their migraines, these new energy saving bulbs,” said Dr. Mark Green from Columbia University Medical Center.

Because the bulbs are new, research is limited and there are no studies to support the claims that the lights are causing migraines.

Still lighting researchers say there may be something there.

“I don’t think it should be dismissed because there might be something about the technology that we don’t know yet, we haven’t identified yet that may be triggering that headache,” said Mariana Figueiro from the Rensselaer Polytechnic Institute.

CFL’s use newer technology eliminating flickering associated with older fluorescent bulbs, but it could be something else.

“There might be what we call inter harmonics, which are some low frequencies in between the high frequencies that may be triggering some of those headaches or some people may be more sensitive,” said Figueiro.

And this could be just the tip of the iceberg.

“If in fact it’s just a handful of people who are sensitive to it, then it’s not really a big issue. But if you think there’s 30 million Americans who have migraine and if an overwhelming proportion of people start to develop headaches, it’s going to really be a big health issue,” said Dr. Newman.

Dr. Newman suggests that before switching all of the lights in your home, try one room first to make sure you don’t have a problem.

Source: http://www.woai.com/news/local/story.aspx?content_id=57dbb7fc-ba6c-4e36-b7fd-05b085ba7b32

Migraine – It’s Not All In Your Head

Monique Johannet remembers riding a bike as a child and seeing the light change.

“Suddenly, there’d be cool, wiggly light things going on in my range of vision,” the 55-year-old Watertown artist said.

Although the auras started early, the slamming pain of the migraine didn’t come with the “cool, wiggly things” until her late 30s. Now she keeps a diary to keep track of the new moons, cold fronts, and emergency room visits, all connected to the hand with the long, steel nails that slides into her head and squeezes.

About 28 million people suffer from migraines, including 18 percent of women and about 6.5 percent of men. Although the pain often knocked victims out for hours or even days, migraines used to be seen as merely a quality of life issue – they were painful, they caused problems, but it was just a headache.

But new studies have shown increasing links between people who have migraines and a higher risk of stroke and heart attack. In some cases, the risk is double compared to those who don’t have migraines.

Doctors aren’t sure why there’s a link, but say the new research is a heads up to both patients and physicians that migraines should be seen as more than just recurrent pain, but as a potential warning of something more serious.

“I tell my patients that there is an urgency in controlling their headaches and I don’t want them having more than a couple of attacks a month,” said Dr. Zahid Bajwa, director of education and clinical pain research at Harvard Medical School.

“Anybody who has four to six attacks a month, and they last more than a couple hours – I worry about those patients.”

The risks aren’t slight. A 2005 analysis of 14 studies in the British Medical Journal found that people with migraines had 2.16 times the risk of stroke. Those who took birth control pills were eight times as likely to have a stroke, which doctors attribute to an abrupt estrogen withdrawal – a common migraine trigger – when women cycle off the pill for five days.

Another 2007 study, in the journal Stroke, looked just at women with migraines and found that those who had an aura were up to seven times more likely to suffer a stroke than women who had never had a migraine.

About 15 percent of those who get migraines get an aura – changes in vision or super-sensitivity to sound or smell – about an hour before the headache occurs. But not everyone who gets an aura has the headache. And it’s unclear why those who have auras have more strokes.

“The bottom line is that migraines with aura produce complications,” said Dr. Richard B. Lipton, director of the Montefiore Headache Center and vice chair of Neurology at the Albert Einstein School of Medicine in New York. “It’s a risk factor for heart attacks and stroke in the same way as high blood pressure, diabetes, and high cholesterol.”

Doctors believe the aura is caused by changes in the nerve cells in the brain, which activate neurons in the membranes surrounding the brain and directly cause the pain.

One new theory in the link between auras and strokes and heart attacks came from a study in the April edition of the journal Neurology. It found that those with migraines with aura had lower counts of endothelial progenitor cells, which line the blood vessel walls and help the blood flow smoothly.

The theory is that the frequent expansion and contraction of the blood vessels during a migraine weakens the vessel walls and makes them more prone to the build-up of plaque, which causes blood clots. Those blood clots can then lead to heart attacks and strokes.

Patients with heart disease and stroke have also been found to have lower counts of EPC cells. Those with low counts could mean that the blood vessels have a hard time repairing themselves when damaged.

While doctors know there’s a link, they’re unsure what to do about it.

“You put a physician in front of a patient with multiple risk factors – cigarette smoking, high cholesterol, and migraines with aura – and you add them all up, and the best we can do right now is simple, cheap, and effective daily prevention,” to lower some of the high risk factors for stroke and heart attack, said Herbert Markley, director of the New England Regional Headache Center Inc. in Worcester.

That means, exercise, diet, and possibly drug therapy for high cholesterol and blood pressure, he said.

Johannet, the artist from Watertown, said she’s very careful about watching her cholesterol and other risk factors. She said her goal is to lower the number of migraines she has naturally by watching her diet, doing yoga, and avoiding triggers such as wine.

She says she stopped taking migraine medication because of the side effects, but she regularly discusses her migraines with her primary care doctor.

“I think he really kind of respects my effort to work with this and overcome it,” Johannet said.

Headache specialists believe that lowering the frequency of the migraine attacks will lower the risks of stroke and heart attack. But that theory is still under study.

“Whatever puts migraines into remission is good for them, whether it’s physical therapy, biofeedback, or medication,” such as antiseizure drugs, said Bajwa, the Harvard doctor. “What is bad for them is becoming dependent on the ‘as needed’ medication, like Tylenol 3 or Vicodin, which they take just so they continue to function.”

Part of the problem is that many patients don’t take their migraines seriously.

Kaitlin Wolfberg, 21, the creator of a MySpace migraine support group, said she’s organized her life around her migraines, giving up a loud, intense job at a bar for the quiet solitude of a florist shop.

“I’ve been on migraine medication my whole life and it just didn’t work for me,” she said. “It affected my creativity and my personality and I lost a lot of weight. It was terrible. But it did stop the cycle of migraines.”

Now that she’s given up the medication, she has headaches almost every day. Although she rarely has the aura, she says she’s hesitant to talk to doctors about her headaches – even if they could cause long-term problems.

“After a while, if you don’t start feeling better, doctors just get annoyed and frustrated and give up on you,” she said. ” I just live with the headaches.”

Source: http://www.boston.com/news/health/articles/2008/05/12/its_not_all_in_your_head/

Botox Doesn’t Work on Migraines

MONDAY, May 5 (HealthDay News) — Botulinum toxin, known to many as Botox, is safe and effective to prevent excessive sweating of the armpits and hands and to treat many involuntary muscle disorders, newly published guidelines suggest.

But while it may rid your brow of unwanted wrinkles and lines, it probably does not help combat migraines and chronic tension headaches.

The finding that botulinum toxin probably does not help relieve migraine or chronic tension headaches surprised the researchers.

While the research suggested the drug may help relieve low back pain, more study was needed before sanctioning it as treatment option, he said.

Source: http://health.usnews.com/usnews/health/healthday/080505/botox-works-on-muscle-disorders-but-not-migraines.htm

Migraine Increases Risk Of Severe Skin Sensitivity And Pain

ScienceDaily (Apr. 22, 2008) — People with migraine are more likely to experience exacerbated skin sensitivity or pain after non-painful daily activities such as rubbing one’s head, combing one’s hair and wearing necklaces or earrings, compared to people with other types of headache, according to a new study.

Migraine

Researchers surveyed 16,573 people with headache about their type of headache, frequency, quality of life, depression and other illnesses that cause pain. The survey identified 11,737 participants with migraine, 1,491 with probable migraine (individuals have all but one of the symptoms required for migraine diagnosis) and 3,345 with another kind of headache.The study found that 68 percent of those who reported almost daily headaches (chronic migraine) and 63 percent of those with episodic migraines reported allodynia, the name of this intensified and unpleasant, painful skin sensitivity. Forty-two percent of people with probable migraine reported the skin pain compared to 37 percent of those with daily or tension headache.

“This condition causes discomfort or pain even during everyday activities like touching one’s hair or putting on clothes,” said study author Marcelo E. Bigal, MD, PhD, with Albert Einstein College of Medicine in Bronx, NY. “More importantly, this condition may be a risk factor for migraine progression, where individuals have migraines on more days than not. Identifying risk factors for progression is a very important public health priority. For example, it may be that individuals with allodynia should be more aggressively treated in order to prevent migraine progression, as well as to decrease this sensitivity on the skin.”

The study also found this type of skin pain was more common in women with migraine and people with migraine who were obese or had depression.

This research was published in the April 22, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

The study was supported by the National Headache Foundation through a grant from Ortho-McNeil Neurologics, Inc.

Adapted from materials provided by American Academy of Neurology, via EurekAlert!, a service of AAAS.

Does this really cure back pain – as well as asthma and migraine?

By James Connell

SHOULDER and neck pain can cause people no end of torment as anyone who has ever suffered from it can tell you in excruciating detail.

But now those with the complaint no longer need to suffer in silence – a tried-and-tested technique could make their pangs a painful but soon to be distant memory.

Experts say Bowen therapy not only helps ease pain in the shoulders and neck but can benefit people with conditions as diverse as asthma and migraines.

The non-invasive technique involves small circular movements of the fingers and thumbs over muscles and tendons that are claimed to release energy that triggers the body’s own natural healing system.

Unlike massage, no oil is used and the aim is that the fingers and thumbs work without slipping on the regions where the pain is deeply rooted.

Tim Willcocks, who is based at the Malvern Natural Health Centre in Abbey Road, Malvern, has been using the technique for the last 12 years and said some people who have the treatment receive instant benefits, although others may need a series of sessions to realise the full benefits.

Now he is offering three treatments this month and next to those with neck and shoulder problems so they can see for themselves the advantages of the technique.

During a nationwide back pain project held last year, there were 22 participants in the Worcester area who had three treatments each and more than 50 per cent reported a “great improvement” in their back pain, while nearly another 40 per cent found some improvement, and only 10 per cent reported “no change”.

Bowen therapy practitioner Tim Willcocks treats Anna Brazier, who had suffered from back pain since the age of 18, and decided to try the technique after reading about it in your Worcester News. Picture by Simon Rogers.

That was broadly similar to results over the whole country, with 351 people taking part – 35 per cent reported full recovery, 55 per cent partial recovery and 10 per cent no change.

One woman who needs no convincing of the benefits of Bowen is Anna Brazier, aged 65, of Pickersleigh, Malvern. Mrs Brazier has suffered from a bad back since the age of 18 when she injured it bending down.

The pain really began to develop in her 40s and she was determined to do something about it. She has visited her doctor, had hospital appointments and tried acupuncture and physiotherapy to try and stop her back from hurting – but she says the best thing for has been Bowen therapy.

Mrs Brazier only encountered the Bowen technique after reading an article in your Worcester News, when she decided to try it as a last resort when all the other treatments had failed.

She said: “I was getting pain from my back — sometimes I could hardly move. I now feel much better and happier and Tim is now working on my neck and shoulders which has helped with my migraines. For me it has been life-changing. I only wish I had found out about it years ago.”

Mr Willcocks’ personal findings for back pain over the past 12 years show a 48 per cent “good-to-excellent” improvement, he said.

His corresponding 12 years’ records for neck and shoulder pains indicate an even greater improvement of about 60 to 65 per cent.

Mr Willcocks also said the technique could benefit people with asthma, frozen shoulder, whiplash, migraine, IBS, sports injuries and fertility issues.

FACT FILE

* Tom Bowen (1916-1982) who devised the technique in Geelong, Victoria, Australia, used to say that his healing ability was a gift from God’. But like a gifted musician he worked on this gift and developed it all through his life. Before his death in 1982 he even said that: “I have taught you boys 10 per cent of what there is now you go and find out the rest.”

* Bowen Therapy now comes in a wide range of flavours: Bowen for Sports Injuries; Fascial Bowen for kids with cerebral palsy, autism or ADD, Neurostructural Integration Technique and Neural Touch which integrates Bowen with other developments.

* The Bowen Therapist’s European Register (BTER) is the largest registration body for the whole range of Bowen therapists. All are fully qualified and insured. For more information visit www.bter.org.

Source: http://www.worcesternews.co.uk/display.var.2182254.0.0.php

Choose your over-the-counter weapon for the battle against aches and pains

By R.J. Ignelzi

UNION-TRIBUNE STAFF WRITER

April 1, 2008

It’s 2 in the morning and you wake up hurting with – pick your pain – a headache, backache, toothache or menstrual cramps. You look in the medicine cabinet in search of relief and the over-the-counter regulars stare back at you: aspirin, ibuprofen, naproxen and acetaminophen, along with a couple of combination medications that are supposed to help you sleep and ease your migraine.Now, your pain is compounded by confusion. Which one is the right one? Which pain reliever will work quickly, safely and not produce more problems than you started with?

American consumers love to have choices, but when it comes to pain relief, we just want something that works fast, effectively and without troublesome side effects.

“Although we’re lucky to have these options at our fingertips, drugs that are usually very safe, cheap and beneficial in relieving pain for many people, it can sometimes be confusing,” says Dr. William Norcross, chief of family medicine at the University of California San Diego Medical Center.

“Go with the one that works best for you,” he continues, noting that it’s important to consider your individual circumstances, pre-existing conditions and the risks of each medication.

“Over time, you’ll find out which of these over-the-counter drugs does the best job for you and your (particular pain),” he says. “Stick with that one.”

San Diego doctors look at the advantages and disadvantages of each of these OTC pain relievers and which is most effective for certain common ailments.

ASPIRIN

You may know it as: Bayer, Aspergum

Pros: Effective pain reliever and anti-inflammatory drug. Cheap. Thins the blood so it’s protective against heart attacks and stroke.

Cons: Can be irritating to the stomach. Has a short shelf-life, so you need to take it every four hours, which increases the risk of stomach problems. Large doses may cause tinnitus, ringing in the ears.

Contraindications: Aspirin should not be taken by children under 18 because of the risk of Reye’s syndrome, a rare but very serious liver and central nervous system condition.

People with asthma should consult their doctor before taking aspirin since there’s “a strong correlation between asthma and aspirin and other nonsteroidal anti-inflammatory drugs,” says Dr. Davis Cracroft, medication safety officer and emergency physician at Scripps Mercy Hospital.Shouldn’t be taken by people with stomach ulcers or with a history of internal bleeding.

Not recommended for pregnant or breast-feeding women.

Note: All of the nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen and naproxen, can cause stomach and GI tract irritation. To reduce this risk, take with food or as an added measure take with stomach-protecting drugs such as Prilosec, Zantac or Tagamet.

IBUPROFEN

You may know it as: Advil or Motrin

Pros: Good anti-inflammatory medication. Generally safe and cheap. Doesn’t need to be taken as frequently as aspirin, usually every six hours.

Cons: Does not offer the same cardiovascular protection that aspirin does. Can irritate the stomach and GI tract. May increase the risk of heart attack or stroke, especially for those who have taken it for a long time.

Contraindications: People shouldn’t use ibuprofen if they have a history of bleeding disorders or if they have stomach problems or an ulcer. Prolonged use may cause kidney problems.

As people get older, it’s recommended they lessen the dose of ibuprofen since, if taken regularly or in high doses, it can cause high blood pressure, Cracroft says.

Not recommended for pregnant women and only short-term use for breast-feeding women.

NAPROXEN SODIUM

You may know it as: Aleve or Naprosyn

Pros: Very good anti-inflammatory drug. Usually safe and cheap. Only needs to be taken every eight to 12 hours.

Cons: Can be very irritating to the stomach and GI tract. Does not offer cardiovascular protection. May increase the risk of heart attack or stroke, especially for those who have taken it for a long time. Prolonged use may cause kidney problems.

Contraindications: People shouldn’t use naproxen if they have a history of bleeding disorders, stomach problems or an ulcer. Not recommended for pregnant or breast-feeding women.

ACETAMINOPHEN

You may know it as: Tylenol

Pros: One of the safest pain relievers and fever reducers. No adverse effects on the stomach or GI tract. Safe for children. The safest pain choice if you also take a daily aspirin to protect your heart. Safe for pregnant women.

Cons: When taken regularly or in high doses, it can cause injury to the liver or liver failure. Not an anti-inflammatory drug.

Contraindications: Don’t take if you have liver disease. People who consume more than two alcoholic drinks a day should not take acetaminophen because of risk to the liver. People with healthy livers should take no more than 4,000 milligrams a day (about eight tablets).

Since acetaminophen is often compounded in other types of drugs, including cold medications and narcotic drugs, it’s important for regular acetaminophen users to read ingredient labels and talk to your doctor before taking other medicines.

Migraine pain relievers:

Products such as Excedrin Migraine are a mixture of acetaminophen, aspirin and caffeine. The pain of migraines is caused by the dilation of the arteries, and caffeine helps constrict those arteries, Norcross explains. If you’re very sensitive to caffeine, beware of taking these migraine medications at bedtime.

Pain relievers with sleep-aid: Pain meds such as Tylenol PM and Advil PM contain the drug diphenhydramine, commonly known as Benadryl, which acts as a gentle sleep aid for some people. Norcross cautions about taking too much or using the product if you’re already taking an antihistamine for allergies or a cold. It can dry you out, resulting in constipation, urinary retention, dry eyes and dry mouth.

Source: http://www.signonsandiego.com/news/health/20080401-9999-1c01otcm.html

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