Can I Take Indomethacin + Acetaminophen + Codeine

[LittleJoe]

I had a gout attack and I have the anti-inflammatory Indomethacin that my doctor prescribed for me.

I also have separate pills my mother gave me today of Acetaminophen + codeine on one pill.

Is it safe - for my liver - health - to take these at the same time?

Thanks if anyone can help.

[Sheryl]

Combining tylenol (aectaminophen or paracetemol) and indomethacin or other NSAID is not absolutely contraindicated on a short term basis. However both drugs are potentially hepatotoxic (toxic to liver) and nephrotoxic (toxic to kidneys) and in combination more so, so this should never be done on a long term basis nor by anyone with abnormal liver or kidney function.

The codeine aspect is not a problem (except that one would also not want to take codeine on a long term basis for other reasons e.g. constipation, addiction). Issue is the combo of the aceteminophen/paracetemol and NSAID in terms of increased risk of kidney and liver damage. In a person with normal kidneys and liver to begin with and taken only occasionally the risk is very small, but chronic use or any pre-existing liver or kidney problem changes ups those risks considerably.

In summary, provided you have no liver or kidney problems and are doing thus under a doctor's care, it is OK as a short term measure, but should not be taken long term.

If you do have liver/kidney problems, or do not know if you do or not, no.

[LittleJoe]

Thanks for the info, Sheryl. Much appreciated.

[Mossfinn]

I also have separate pills my mother gave me today of Acetaminophen + codeine on one pill.

Is your mother a Doctor? If so I would suggest asking her, if she isn't, stop taking them and see a Doctor or Nurse, relate your history and see what she/he says then.

[jsflynn603]

Has your doctor suggested allopurinol or colchicine, two medications that inhibit uric acid production (excess uric acid is the cause of gout)? These are front-line medication used to arrest the gout attack.

Have you learned about purines in food? If you like drinking a lot of beer, eating beef and other purine rich foods, you are likely to have attack after attack. Chronic attacks create permanent joint damage, so it's wise to attempt to reduce or eliminate the gout attacks.

Indomethacin is the most commonly prescribed medication for gout pain. I think Sheryl's advice is good. Yet though two medication might potentially cause liver problems, that does not mean necessarily that they will in every person. The liver has many systems to break down and remove toxins (a medication would be considered by the liver a "toxin" and thus removed). Predominantly is the Cytochrome P-450 enzymatic system which has many, many sub-systems. If two medications utilize the same subsystem it can become overloaded and can result in drug levels going higher and higher in the body. But if two medication utilize different subsystems, even if each "could" be nephrotoxic, it may not be nephrotoxic i you. The bottom line is to use your PCP (Primary Care Practitioner) and double check on combinations with a pharmacist. At least in America combinations are cross-checked to warn of potential problems.

[zzdocxx]

There are a lot of "it depends" in this scenario.

It may be OK for you, depending on how long you are taking the medications, your baseline health (including kidney function), what other medications you are taking, etc.

Absolute safest course would be as Sheryl has suggested although it is possible that in your circumstances it would be OK.

I do also like the suggestion made that a "workaround" solution which involved different medications could be used.

BTW it is not clear to me what your mom gave you those pills for. Are you having some pain elsewhere, or was it related to the gout? ? ? Has the indomethacin been ineffective?

Maybe getting to a good doctor would help.

Good luck!

[LittleJoe]

Has your doctor suggested allopurinol or colchicine, two medications that inhibit uric acid production (excess uric acid is the cause of gout)? These are front-line medication used to arrest the gout attack.

Thanks for the post jsflynn603

I have used Colchicine in the past. I just found a regular primary care doctor and he prescribed Allopurinol. I'll start taking the allopurinol after this recent gout attack completely goes away.

Have you learned about purines in food? If you like drinking a lot of beer, eating beef and other purine rich foods, you are likely to have attack after attack. Chronic attacks create permanent joint damage, so it's wise to attempt to reduce or eliminate the gout attacks.

Yes, I have self-educated my self on purines in foods and drink. I have altrered my diet, and I've basically given up beer, except for maybe once per week or every two weeks, and even then, I only have 2 or three beers.

When I do want a drink, I order a Vodka tonic of a vodka cocktail, which are ok to have if you have gout, or are prone to having gout attacks.

Indomethacin is the most commonly prescribed medication for gout pain.

Yes, indomethacin is what I usually take when I have an attack.

I think Sheryl's advice is good.

Yes, Sheryl's advice and your advice and comments are much appreciated.

Mossfin: no my mother is not a doctor. She just gave me here aceto + codein pain pills that had for her pain.

I too the acetomenahine + codeine pill twice without the indemathacine, and It gave me (I believe) a headache and made me feel a littley "different." I don't like it as a pain pill.

Now I'm taking Indomethacin + naproxen

And yes, I have to watch the liver and the chronic gout attack on my joints.

Thanks for the comments and replies.

[zzdocxx]

LittleJoe, I want to make something clear. Both indomethacin and Naproxen are NSAIDs, (that is a class of drugs, you can look it up on Wikipedia or something).

Therefore you should NOT be taking both of those! ! !

This is kind of important! ! !

Also on another note, you do realize the codeine is an opioid ("narcotic") and that is probably why it made you feel weird.

I think you'd be better off with plain acetaminophen without codeine to get you through this exacerbation, if you need it. (Again I am guessing that you are having a flare-up and that is why she gave you the extra medication to take? ? ?)

Edited August 23, 2010 by zzdocxx

[Mossfinn]

Mossfin: no my mother is not a doctor. She just gave me here aceto + codein pain pills that had for her pain.

I kinda guessed that, get yourself to a Health Practioner who will take your history, what is right for your mother, maybe highly inappropriate for you.

As for the codeine,it may make you feel weird at first as has been descibed already, but you can soon get used to it, maybe.

[LittleJoe]

LittleJoe, I want to make something clear. Both indomethacin and Naproxen are NSAIDs, (that is a class of drugs, you can look it up on Wikipedia or something).

Therefore you should NOT be taking both of those! ! !

This is kind of important! ! !

Thanks for the FYI, zzdocxx.

I will stop taking Naproxen immediately, and continue with Indomethacin, until I am clear of the gout.

Thanks. I do not want to burn my liver out.

[Sheryl]

Yes indeed.

You can take indomethacin OR naproxen but definitely not both!!!

[LittleJoe]

Yes indeed.

You can take indomethacin OR naproxen but definitely not both!!!

I'm glad I only took them together a couple of times. I'll never do it again.

Thanks for the info.