Is ibuprofen gel sold in the U.S.?

The FDA have not approved it

@Stinley Hmm, bizarre. I find it hard to believe that somewhere like England would sell it if it wasn’t safe, or at least as safe as the oral medications. Sigh. But thank you for finding that for me, it was informative, regardless.

@DrasticDreamer I suppose you could order it online from Canada, Mexico or one of the many other enlightened countries.

It appears there is also a Ketoprofen gel that might work. I know I used to take Orudis before they started selling it OTC (which I understand they have stopped doing again) and it worked better than the Naproxin I now have to take.

Many drugs such as paracetomal (a strong pain reliever) are available OTC in England and Europe that are not available here. Conversely, some years ago, I couldn’t buy Tylenol or acetaminophen there at all.

@janbb Paracetamol is acetaminophen is tylenol (and not tylenol 3, just OTC tylenol). Paracetomal is not anything, as far as I know.

Also, @DrasticDreamer, the FDA and other countries’ regulatory agencies have different metrics. In 2009, they didn’t have the data to impress the FDA, despite garnering support with the others, but these are not exactly uncommon conflicts. The major one in recent memory is Thalidomide, where several countries in Europe, most notably Germany, declared it safe while the FDA held off. This led to a huge spike in (mostly fatal) birth deformities in Europe that many people in the US don’t even known about because it never happened here. On the other end, european countries banned aspartame for many years based on a terribly done trial that the FDA rightly declared as inconclusive, and it was only recently (as in, in the last few years) that the EU finally took a second look and agreed. And I’m sure there are examples going the other direction where the EU was correct and the FDA had to change course (as seems like may be the case here), but I don’t know them off hand

I also haven’t seen much follow up from that article (it was 2009), though I have seen some noises that they’re available in the US, just not widely, though no reason as to why. Pharmaceutical companies may have cleared the hurtle but decided it wasn’t worth the hassle to market them.

@BhacSsylan Excuse my poor spelling but that is not my understanding or experience with paracetamol. It was much stronger than acetaminophen at least when I took it years ago and I believe may have had some codeine in it. I was told in many chemists over there that acetaminophen was not available in England. Perhaps it has changed.

Actually, I just did some reading and you are correct; they are the same. So I wonder why I was never told that by the chemists when I asked for acetaminophen.

But your main point is the same as mine that there are different standards for drugs in different countries.

@BhacSsylan a newer (2011) Article about the testing and use of Thalidomide in the US. In June 1962, Merrell’s Director of Medical Research Dr. Carl Bunde testified before Congress that thalidomide was never sold in the U.S., leaving out the fact that 2.5 million doses had been distributed to 20,000 people by 1,200 doctors. – from above source.

And, evidently it is still used in the treatment of Leprosy: In 1998, thalidomide was approved by the U.S. Food and Drug Administration for the treatment of leprosy and, subsequently, for multiple myeloma. – from highlighted source.

@janbb I work with acetaminophen on a regular basis. I can assure you it’s the same thing as paracetamol, which is Tylenol. Now, codeine, that means Tylenol 3, which is a mixture of paracetamol and codeine and a strictly regulated drug used mostly in hospitals. They are different substances mixed together for that pill. Also, you seem to be getting a little confused, since you said “I was told in many chemists over there that acetaminophen was not available in England.” and yet “Many drugs such as paracetomal (a strong pain reliever) are available OTC in England and Europe that are not available here”, so you may be misremembing.

@rojo Yes, but it was never cleared for sale for morning sickness, which is what it was originally formulated for, and its birth defects do not matter in a leprosy case where there is not pregnancy complications (it’s also in trials for anti-cancer uses). My apologies for not being more clear.

Also, that article is indeed worrying, though it still makes clear that it was never cleared for sale, and thus we never had the widespread issue with it here like it was in Europe. It was a failure of the FDA to allow that distribution to occur, but since they never allowed it to be sold and marketed, there were a total of 17 malformation cases that are known in the US, as opposed to tens of thousands across Europe. Even if the article is correct in it’s assessment of many more (which, while surely exaggerated to help their case, it quite possibly still close), that only means several hundreds of thousands more would have been affected in other countries.

I have done a little more research. The FDA has approved Voltaren Gel or diclofenac sodium which is in the same family (NSAIDs). This website appears to be quite authoritive

@BhacSsylan As I said in my second paragraph, I was wrong in thinking they are not the same> It might be possible, however, that paracetamol years ago had some codeine in it as Tylenol 3 does yet was sold OTC, My experience of that was 30 years ago but it was more recently that I was told that Tylenol was not available and not told that paracetamol is its equivalent. In any case, you are more knowledgeable than I and I will bow out.

I realize that anecdotal information is not the same as real knowledge.

Hmm, did you edit it? I’m sorry I didn’t see that second paragraph. Also, I didn’t realize ‘years ago’ was 30, that could indeed have been a different formulation then for tylenol.

@BhacSsylan

Since you mention that you work with Tylenol a lot, perhaps you can help answer a question I’ve had buzzing around in my brain for the longest time.

Since the discovery of the hepatoxic effects of it, they’ve reduced its amount in common formulations like Vicodin and others.

However, afaik, there is no availability of Hydrocodone without any additive at all and I’m just wondering why.

If Tylenol is so harmful, why not just take it out altogether? Or did they just keep it in to punish drug addicts?

Kind of like: “Well, if you’re going to abuse our drug and give it a bad name, we’ll make sure that you won’t be around as long as if you weren’t doing this.”

Yes, I know that’s kind of strange, but it has occurred to me at times.

But seriously, it’s not that effective a painkiller compared to Ibuprofen (or even aspirin) so why not just take it out altogether and leave Hydrocodone as a single ingredient formulation?

Interesting, I don’t know much about the formulation of hydrocodone, though I can give it a look. My gut feeling would be that, while tylenol is hepatotoxic, that effect is less of an issue than other painkillers. The dose makes the poison, after all. While all NSAIDs have similar effect, they take different routes to do and have different side effects as a result, and both the direct action and/or the side effects may conflict with hydrocodone, and hydrocodone may also need an NSAID to tamp down it’s own side effects. Drug formulations are very tricky and are typically the result of cost/benefit analysis. No drug is harmless, you have to find a way to minimize the risk. If they didn’t have any chance of harm it would probably be because they wouldn’t work at all (helloooo homeopathy).

This also isn’t to say that your theory isn’t incorrect. Bitterants are added to aerosols for that exact reason, for instance. I don’t think that it’s what’s going on here but you could still totally be right.

That’s totally off the cuff, though, I’ll do some actual research and see if I can find something more substantial.

So, that took a surprising amount of digging, but I did manage to find this article from 1981 detailing the affect of various drug combinations. In general, it seems that acetaminophen has a real and sustained increase in the effects of various narcotics. It’s more noticeable in oxycodone (and surprisingly, really really small for codeine) but it’s definitely there for hydrocodone, and basically the effect is so strong that taking one without the other is actually more risky, because you need more of a substance with a bad side effect to get the same pain relief.

Now, the exact formulations have gone down as you said, they use 1000 mg acetaminophen in this study and i think standard of care would really suggest against that now. But even at lower doses the effect is still seen. So I think that it really is risk-benefit. Without acetaminophen you need a lot more of an addictive substance in your system to get the same effect, and thus a greater chance of getting addicted. Or alternately you have to kill your liver to get the same degree of pain relief from tylenol. So while it has it’s dangers, the combination is still worth it.

Also, that first sentence of my second paragraph above should read “This also isn’t to say that your theory isn’t correct”.

Also, another fascinating thing from that study? Excedrine is acetaminopen, aspirin, and caffeine. I always thought that the caffeine was there to counteract the drowsiness effect of the two analgesics, but according to this it actually makes them way more effective. a combination of just acetaminopen and aspirin is actually slightly less effective than the lone drugs, but the two plus caffeine is almost twice as effective, depending on dose. The more you know.

My Mom told me that the doctor offered her thalidomide for her morning sickness when she was pg with me.

I experience chronic pain in my feet from peripheral neuropathy, and I find Solarcaine (active ingredient lidocaine hydrochloride) is really good at taking the edge off. It’s sold as a sunburn ointment. You may have more luck finding that.

It should be pointed out that even though its applied topically it still effects the stomach. Ibuprofen effects a metabolic pathway to bring about pain relief. A side effect of this is it inhibits production of the chemical the stomach uses to protect itself from stomach acid.

Paracetamol does increase the effect of other analgesics but it’s worth pointing out that it’s actually pretty effective on its own. A double blind trial (where neither the doc or the patient know which drug they’re getting) comparing the effect of the standard doeses of either parecetamol or morphine for treating post operative pain found that patients had better pain control from just paracetamol than morphine. Interestingly if the patient knows they’re getting parecetamol the pain relief is not as effective.

As for parecetamol and the liver. Parecetamol is the analgesic of choice for people with chronic liver disease (often three times a day instead of four). NSAID’s like ibuprofen are also hepatotoxic and can bring about acute on chronic liver failure even in small doses. (Ibuprofen is hepatotoxic too). Opioids are avoided as they can make you drowsy and may mask one of symptoms of liver disease which is encephalopathy. The first symptom is drowsyness and it can progress to coma very quickly.

@SmashTheState Thank you, I’ll look for it.

I did know that caffeine helps with the action of paracetamol and ibuprofen. if I have pain and i am taking a painkiller I will usually have a coffee at the same time.

Can someone tell me the active ingredients of the american brands. People have mentioned Advil and Tylenol. What are the common brands? Here in the UK we have Nurofen which seems to me to kind of obvious that it is ibuprofen. For children’s syrup based paracetamol we nearly always refer to that as Calpol (I’m a bit of a stickler and tend to call things by their generic names but do get funny looks when i say ‘liquid paracetamol…you know… Calpol’)

Paracetamol/acetaminophen – Tylenol
Acetylsalycilic acid – aspirin
Ibuprofen/Naproxen sodium – Motrin, Advil
Aspirin, acetaminophen, caffeine – Excedrine

Those are the major ones I’ve run in to, but I’m sure there’s others.

Arnica.