Painkillers and anti-inflammatories, acceptable options after weight loss surgery

Safe and semi-safe painkillers and anti-inflammatories after weight loss surgery include:

• Tylenol (non-NSAID), available over the counter (OTC), active ingredient Acetaminophen.

Other brand names include, for example, Paracetamol, Nyquil, Dayquil, Excedrin, Mucinex, etc.
Safe to use without antacids. 

Use:
Tylenol does not reduce inflammation; it is a pain reducer used to treat mild to moderate pain such as muscle aches, menstrual periods, colds and sore throats, toothaches, backaches, and reactions to vaccinations (shots) and to reduce fever. 

Dosage:
Regular strength: 325-650 mg pills once every 4 hours as needed; not to exceed 3250 mg/day;
Extra Strength: 1000 mg orally once every 6-8 hours as needed; not to exceed 3000 mg/day; under supervision of healthcare professional, daily doses of up to 4 g/day may be used.

Important! Take ONLY 1 medicine that contains acetaminophen at a time. Why? More than 500 medicines contain acetaminophen, including prescription and OTC medicines such as back pain remedies, headache remedies, sleep remedies, and cold and flu symptom treatments. If you take more than one medicine that contains acetaminophen at a time, it increases your chance of taking too much (more than 4,000 mg in 24 hours), and that could harm your liver.

To learn more about the types of pain Tylenol is good for visit https://www.tylenol.com/safety-dosing/adult-pain-reliever-comparison-chart 

• Toradol (NSAID), prescription is required in the US (in Mexico known as Ketorolac, OTC), active ingredient Tromethamine.

Other brand names: Ketorolac.

Take with antacids only (Omeprazole or Nexium 20 mg 30 min before taking an NSAID), ideally no longer than 3 to 5 days in a row as it is an NSAID (anti-inflammatory), although a mild one.

Use:
Toradol is commonly used short-term after surgery, dental treatments to treat moderately severe pain and inflammation. Toradol is a stronger pain reducer compared to Ibuprofen or other OTC medications.

Dosage:
Patients age 17 to 64: first dosage 20 mg pills sublingually (dissolve under the tongue) followed by 10 mg every 4-6 hours, do not exceed 40 mg/day.

Patients age ≥65, renally impaired, and/or weight<50 kg (110 lbs.): 10 mg pills as the first dosage followed by 10 mg every 4-6 hours, do not exceed 40 mg/day.

Learn about conditions when Toradol is contraindicated at https://www.webmd.com/drugs/2/drug-57954/toradol-oral/details/list-contraindications 

• Celebrex (NSAID), prescription is required in the US (in Mexico OTC). COX2 type of medication, meaning its effect is achieved exactly where it is needed without affecting much other organs.

Other brand names: Celecoxib, or any other COXIB (for example, Rofecoxib, Valdecoxib, etc.)
Safe to use without antacids short term, with antacids long term.

Use:
Celebrex is widely used for the treatment of acute pain and chronic inflammatory joint conditions, ankle sprains, after surgery pain, phlebitis (vein inflammation after an IV treatment), etc. In comparison Celebrex and Ibuprofen provide very similar pain relief for many types of pain.

Dosage:
Instructions vary depending on the condition being treated and available presentation (from 50 to 400 mg), but usually are to take 1 capsule by mouth once or twice a day. As an example: to treat vein inflammation (phlebitis) that is not uncommon after IV treatment during hospitalization, our medical team recommends 200 mg per day for 14 days.

Learn more about types of pain Celebrex reduces and risks of long-term usage at https://www.goodrx.com/classes/nsaids/is-celebrex-better-than-ibuprofen 

• Diclofenac cream (NSAID, topical gel), available OTC.

Other brand names: Voltaren.

Take with antacids only (Omeprazole or Nexium 20 mg 30 min before taking an NSAID), ideally no longer than 3 to 5 days in a row as it is an NSAID. Although it is applied topically, it damages stomach mucosa nonetheless.

Use:
Diclofenac cream is commonly used short-term to relieve pain from arthritis in certain joints such as those of the knees, ankles, feet, elbows, wrists, and hands. 

• Buscopan (IBS relief), available OTC, active ingredient Hyoscine butyl bromide, also known as scopolamine butyl bromide.

Other brand names: in Mexico known as Buscapina.
Safe to use without antacids.

Use:
An anti-spasm medication is recommended for IBS, menstrual cramps, or general stomach and intestinal spasms that are not uncommon after bariatric surgery.

Dosage:
Take 1 pill every 12 hours only when needed.

• Gabapentin, prescription is required in the US.

Other brand names: Neurontin
Safe to use without antacids.

Use:

Gabapentin is commonly used to treat nerve pain that is very common among bariatric patients on the left side under the rib cage, or if the nerve was accidentally damaged by an IV. Some relief comes within hours, but for the full effect it can take 1-2 weeks after starting treatment.

Dosage:
Follow your doctor`s directions as the dosage vary greatly depending on your needs.

• Sumatriptan, prescription is required in the US.

Other brand names: Zembrace Symtouch, Onzetra Xsail, Sumavel DosePro, Alsuma, Imitrex STATdose Pen, Migranow, and Imitrex STATdose Kit Refill.
Safe to use without antacids.

Use:
Sumatriptan is not a painkiller and not a NSAID, but it is a great option for headaches and migraines when regular painkillers or NSAIDs do not work.

Dosage:
Sumatriptan comes in three forms: tablets, nasal spray, injections. Nasal spray and injections are used to treat migraines and cluster headaches. Tablets are for migraines only.

For migraine headaches, oral dosage (tablets):
Adults—25, 50, or 100 milligrams (mg) as a single dose. If you get some relief, or if the migraine comes back after being relieved, another dose may be taken 2 hours after the last dose. Do not take more than 200 mg in any 24-hour period.

Learn more about dosage and proper use at https://www.mayoclinic.org/drugs-supplements/sumatriptan-oral-route/proper-use/drg-20074356 

• Excedrin, available OTC, active ingredients: Aspirin, Paracetamol, Caffeine.

Other brand names: Excedrin Extra Strength, Vanquish.

Take with antacids only (Omeprazole or Nexium 20 mg 30 min before taking an NSAID).

Use:
Headaches (Excedrin Extra Strength Headache Relief), migraines (Excedrin Migraines). For some, headache relief starts in 15 minutes.

Dosage:
Take 2 pills every 6 hours; no more than 8 pills in 24 hours.

• Tramadol, Oxycodone, Hydrocodone, prescription is required in the US. Opioids/narcotics.

Take with antacids only (Omeprazole or Nexium 20 mg taken 30 min before).

Use:
Treats moderate to severe or chronic pain. Highly addictive.

Dosage:
Instructions vary depending on the condition being treated, follow your doctor`s indications.

We recommend informing your doctor (so it remains in your medical file) that after bariatric surgery you are not supposed to use NSAIDs (such as Aspirin, Naproxen, Ibuprofen, Advil, Aleve, Toradol, etc.), unless absolutely necessary and always with antacids taken first. 

Disclaimer: The information provided herein has been verified and approved by the medical team as per the best practices of the Company. Please note that this information should not be treated as a replacement for an individual physical medical consultation or advice. We do not guarantee the accuracy and the completeness of the information provided as every patient`s needs may be different. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company. We do not take any responsibility for the consequences arising out of the aforementioned information and strongly recommend you for a physical consultation in case of any queries or doubts.