: horse-sized 600 or 800 mg tablets anyway. I have refused
: prescriptions for "free" (covered by Workman’s Comp) Ibuprofen
: in favor of taking multiple 200 mg Ibuprofen tablets.

stuh…@great-gray.owlnet.rice.edu (Stuart Robert Hall) wrote:
:I’m not sure how many people’s prescription drug insurance works this way.
:I have PCS insurance for drugs, and if there exists an OTC formulation for
:a drug, PCS will not pay for the prescription dosage.  So, since there’s
:now OTC naproxen sodium in the form of Aleve, I would have to pay full
:price for a prescription for Anaprox.  Your workman’s comp. is a better
:deal in that respect!

There are differences among PCS-branded prescription plans.  Usually
PCS doesn’t pay when there’s an equivalent formulation available OTC, but
the differing tablet dosage _may_ create a loophole. I’ve had PCS pay
for ibuprofen in liquid form for infants; they don’t expect you to
make your own suspension from the OTC tablets.  PCS also covers
prescription-level concentrations of cortizone creams, even though
there are weaker formulations available OTC.  This could be an
_excellent_ reason for Syntex to make Aleve a different dose than
Anaprox. I think it’s safe to assume that more $ would accrue to
Syntex for Anaprox than for the "equivalent" dose of Aleve.

Incidentally, I think W/C would pay for OTC ibuprofen, too.  It’s just
that the burden of the paperwork exceeds the value of the ibuprofen.
—
Craig Hansen, Chief Architect                   Tel: (408) 734-8100
MicroUnity Systems Engineering, Inc.            Fax: (408) 734-8136
255 Caspian Drive, Sunnyvale, CA 94089-1015     Email: cr…@microunity.com
Information superhighway beautification initiative #1: 4-line signature limit

: horse-sized 600 or 800 mg tablets anyway. I have refused
: prescriptions for "free" (covered by Workman’s Comp) Ibuprofen
: in favor of taking multiple 200 mg Ibuprofen tablets.

I’m not sure how many people’s prescription drug insurance works this way.
I have PCS insurance for drugs, and if there exists an OTC formulation for
a drug, PCS will not pay for the prescription dosage.  So, since there’s
now OTC naproxen sodium in the form of Aleve, I would have to pay full
price for a prescription for Anaprox.  Your workman’s comp. is a better
deal in that respect!

Stuart Hall
(stuh…@owlnet.rice.edu)

>SD>Fear of causing GI or renal damage from overmedication or chronic use.
>SD>The same was considered when ibuprofen was made OTC: that’s why each
>SD>tablet contains only 200mg.

>YIKES! I’ve taken *A LOT* of ibuprophen over the years for head and
>back aches. Steve, could you spell out what constitutes "chronic" use?

There’s a phenomenon known as analgesic abuse syndrome which comes
from people taking headache remedies in large amounts constantly for
years and years.  (At least in the US, this was mainly seen in the
south where "headache powders" were popular ways of taking aspirin
and the now obsolete analgesic phenacetin.)  Such people have
reduced kidney function.  Long-term high doses of NSAIDs can also
cause ulcers and GI bleeding.

If you’re not gulping these pills down in large amounts on a daily
basis without any medical supervision, then you probably don’t
have much to worry about.

Especially with these more potent NSAIDs, ibuprofen and naproxen,
there was a desire to build a margin of safety in OTC dosing,
hence the dosage forms which have been introduced.  Like someone
else pointed out, the "if one is good, two is better" phenomenon
is frequently in effect as well.

–
Steve Dyer
d…@ursa-major.spdcc.com

>I would like to know what the relation is between the non-prescription
>dose (220 mg/caplet, Adults under age 65: 1 caplet every 8 to 12
>hours, or 2 caplets followed by 1 caplet 12 hours later) and the usual
>prescription dose.
Steve Dyer <d…@spdcc.com> wrote:
>Anaprox (the Rx-only formulation of naproxen sodium) comes in two strengths,
>275mg (250mg naproxen) and 550mg (500mg naproxen).  A usual dosage for
>pain relief is 550mg initially, and thereafter, 275mg every 6-8 hours.
>Aleve contains 200mg naproxen per tablet.

Craig Hansen <cr…@microunity.com> asks:

>Also I’d like to understand the rationale for specifying a different
>dose for OTC use.
Steve Dyer <d…@spdcc.com> wrote:
>Fear of causing GI or renal damage from overmedication or chronic use.
>The same was considered when ibuprofen was made OTC: that’s why each
>tablet contains only 200mg.

I find it interesting that the 20% decrease in tablet dosage makes it
much harder to match a prescription dosage schedule.  For example to
match a prescription for Anaprox 275 mg every 6 hours or q.i.d.
(4/day), you’d need to take Aleve 220 mg every 4.8 hours, or 5/day.
(What’s the latin initial for 5, anyway.)  [Naproxen sodium has a long
half-life in the body, about 12 hours, so there's no need to take it
as often as 4.8 hours.]  Alternatively, one might take 5 tablets
spread among 3 meals: 2 w/breakfast, 1 w/lunch, 2 w/dinner…

By comparison, Ibuprofen is available in 200 mg
tablets, which makes matching a prescription for 600 mg or 800 mg
easy. It’s easier to take three or four 200 mg tablets over the
horse-sized 600 or 800 mg tablets anyway. I have refused
prescriptions for "free" (covered by Workman’s Comp) Ibuprofen
in favor of taking multiple 200 mg Ibuprofen tablets.

I would speculate that the real rationale for the different dose is to
discourage doctors, used to prescribing Anaprox, from writing notes
for Aleve, or from having consumers fill prescriptions for Anaprox
with Aleve. It would seem to me that Syntex and the FDA are taking a
major risk that errors resulting from confusion in conversion could
cause accidental overmedication.

–
Craig Hansen, Chief Architect                   Tel: (408) 734-8100
MicroUnity Systems Engineering, Inc.            Fax: (408) 734-8136
255 Caspian Drive, Sunnyvale, CA 94089-1015     Email: cr…@microunity.com
Information superhighway beautification initiative #1: 4-line signature limit

SD>Fear of causing GI or renal damage from overmedication or chronic use.
SD>The same was considered when ibuprofen was made OTC: that’s why each
SD>tablet contains only 200mg.

YIKES! I’ve taken *A LOT* of ibuprophen over the years for head and
back aches. Steve, could you spell out what constitutes "chronic" use?

Thanks.

          ****************************************************
          | David Pfarrer           | "Respect means, put    |
          | pfar…@isr.harvard.edu |   yourself out"        |
          | pfar…@harvunxw.bitnet |      - Pascal          |
          ****************************************************

>Fear of causing GI or renal damage from overmedication or chronic use.
>The same was considered when ibuprofen was made OTC: that’s why each
>tablet contains only 200mg.

I think that part of the rationale for low-dose OTC forms of ibuprofen and
naproxen is that for many patients, the old adage "take two aspirin…" is
applied to every OTC med.  Thus, by making the OTC forms essentially "half-
strength", the liklihood of accidental overdose is decreased.

Needless to say, very few people obtain reasonable analgesia from only
200 mg of ibuprofen, so most folks wind up taking two tabs anyway…

- Dan

——————————————————————–
                                  _/_/_/_/    _/      _/    _/_/_/
Dan Blumenfeld                    _/      _/  _/_/  _/_/  _/      _/
Dartmouth Medical School          _/      _/  _/ _/_/ _/  _/
                                  _/      _/  _/  _/  _/    _/_/_/
d…@coos.dartmouth.edu            _/      _/  _/      _/          _/
d…@grip.cis.upenn.edu            _/      _/  _/      _/  _/      _/
                                  _/_/_/_/    _/      _/    _/_/_/
——————————————————————–

Craig Hansen <cr…@microunity.com> wrote:
>I would like to know what the relation is between the non-prescription
>dose (220 mg/caplet, Adults under age 65: 1 caplet every 8 to 12
>hours, or 2 caplets followed by 1 caplet 12 hours later) and the usual
>prescription dose.

Anaprox (the Rx-only formulation of naproxen sodium) comes in two strengths,
275mg (250mg naproxen) and 550mg (500mg naproxen).  A usual dosage for
pain relief is 550mg initially, and thereafter, 275mg every 6-8 hours.
Aleve contains 200mg naproxen per tablet.

>Also I’d like to understand the rationale for specifying a different
>dose for OTC use.

Fear of causing GI or renal damage from overmedication or chronic use.
The same was considered when ibuprofen was made OTC: that’s why each
tablet contains only 200mg.

–
Steve Dyer
d…@ursa-major.spdcc.com

Graham Butler <Graham_But…@mindlink.bc.ca> wrote:
>        Does anyone know of an antipyretic that would be suitable for a
>person who has salicylate allergies, and also has a bad reaction to
>acetaminophen?  Is Ibuprofen a salicylate, and if so, are its antipyretic
>abilities as powerful as good old Tylenol?

If you’re sensitive to salicylates, it would not be a good idea to
try a drug like ibuprofen on your own, because although they are
distinct chemicals, they have similar mechanisms of action, which
can also be at the root of some of their adverse effects.
See your doctor.

P.S.: I’ve never heard of anyone having a bad reaction to typical doses
        of acetaminophen.

–
Steve Dyer
d…@ursa-major.spdcc.com