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Pharmacy and Medications

Allergic to NSAIDS

05/05/2010

Question:

My wife is facing surgery and is allergic to aspirin / Nsaids. The surgon tells her that she will be in extreme pain because she can not take Nsaids. Is there another drug that she may not be allergic to that can provide relief?

Answer:

As a person who has an NSAID allergy, I can say that there is no good answer to this question.

 

 Firstly, you should determine whether or not your wife has a true allergy to aspirin or other NSAIDS. Severe upset stomach, indigestion or other intolerable side effects are often confused with true allergies. Severe itching, hives, or breathing problems indicate a true severe allergy.

 

Secondly, you should identify which NSAID your wife has taken when she experiences the allergic reaction. Common over-the-counter NSAIDS, like aspirin, naproxen and ibuprofen, are similar and will probably cause the same reaction. Acetaminophen (Tylenol) can generally be used safely, though it may not provide enough pain relief after surgery. It sounds like the NSAID class may help with both pain and inflammation associated with the surgery, whereas acetaminophen will only provide pain relief.

 

Some prescription NSAIDs may have a lower cross-reactivity with the over-the-counter NSAIDs*. These include celecoxib (Celebrex) and meloxicam (Mobic). Your wife may ask to have a prescription filled for one of these agents, then take one under a doctor?s direct supervision to see if she reacts. This can be arranged through an allergist or immunologist.

 

Whether or not you and your wife decide to do this prior to the surgery, I recommend doing so in the near future, anyway. I learned a great deal from my allergist when I saw him after I developed a reaction to ibuprofen, and I was given a medication to use in an emergency if I should somehow react to an accidental exposure.

 

Finally, the surgeon may wish to try a prescription pain reliever. There are several prescription pain relievers, either in combination with acetaminophen or without, that can be prescribed. These can range in potency from a drug like Ultram (tramadol) or Ultracet (tramadol with acetaminophen) to oxycodone or Percocet (oxycodone with acetaminophen). Again, these medications will not have the anti-inflammatory properties of the NSAID class.

 

 *Immunol Allergy Clin North Am 2004; 24:491.

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Response by:

Michael  Ganio, PharmD Michael Ganio, PharmD
Clinical Applications Pharmacist
Wexner Medical Center
The Ohio State University