I've taken ibuprofen for back pain for years. In fact, some time ago 400mg and then 200mg. It doesn't seem to be an issue looking at my lab reports. 

 

I've been taking enalipril 20mg for decades no I'll effects. 

 

Doctors never flagged the contraindication.

 

I want to swap out Losartan 50mg for the enalipril.  It's ARB not ACE and not diuretic. 

 

Anyone on Losartan? Any issues? I've read it's generic and cheap here as well. 

 

I don't have a regular doctor and think a clinic visit will just cost me 300b for a thumbs up

 

Any information advice appreciated

6 minutes ago, KhaoHom said:

I've taken ibuprofen for back pain for years. In fact, some time ago 400mg and then 200mg. It doesn't seem to be an issue looking at my lab reports. 

 

I've been taking enalipril 20mg for decades no I'll effects. 

 

Doctors never flagged the contraindication.

 

I want to swap out Losartan 50mg for the enalipril.  It's ARB not ACE and not diuretic. 

 

Anyone on Losartan? Any issues? I've read it's generic and cheap here as well. 

 

I don't have a regular doctor and think a clinic visit will just cost me 300b for a thumbs up

 

Any information advice appreciated

Yes, it's possible to take Losartan instead of Enalapril.

Less side effects.

Not expensive.

Ibuprofen should not be taken for such a long time.

It can easily destroy your kidneys,  and this can happen all of a sudden.

 

Losartan generally has less side effects than enalapril (less cough, but it may damage your kidneys). But why change an antihypertensive agent if you have no problems with enalapril?

8 hours ago, Lorry said:

Ibuprofen should not be taken for such a long time.

It can easily destroy your kidneys,  and this can happen all of a sudden.

 

Losartan generally has less side effects than enalapril (less cough, but it may damage your kidneys). But why change an antihypertensive agent if you have no problems with enalapril?

 

I read online prolonged use isn't good tbh the doomsayers are mostly here, but I acknowledge the issue.

 

If you Google safe dosage of ibuprofen and naproxen (I'm going with naproxen now) it says max doses pd are well over 1000mg for both. I just want to take 250mg per day. No?

 

Easily destroy? A bit dramatic ?

 

I didn't know there was an issue and was taking 400mg ibuprofen daily during COVID. On trip to States I bought bottles of 200mg ibuprofen at Costco. Was taking that daily ... plus drinking. Kidneys liver seemed fine.

 

I want to change because regardless of whether I take daily or not I will continue to at least take NSAIDs occasionally. Moreover, I think I do have the dry cough described as side effect of enalipril. Finally, pharma only has 5mg and 20mg. With exercises I want to cut my meds in half. Losartan has 25 and 50mg (internet). 50mg is = to 20mg enalipril. I can perhaps take the 25mg = to 10mg enalipril. 

 

Appreciate any quality feedback. Thanks 

If you are having dry cough on ACE inhibitor then a switch to an  ARB may help. If not  having side effects ( you initially said "no issues" ) then no reason to change. 

 

Losartan (local brands) is cheap here though  enalapril even cheaper.

 

I think you have misunderstood an equivalency chart.  Equivalencies listed for enalapril are relative to other ACE inhibitors only. Equivalencies listed for Losartan likewise are relative to other ARBs only. There is no direct equivalency between ACEs and ARBs as they are different drug classes. 

 

Usual dose of losartan is 50 -100 mg. Usually start with  50 mg Losartan and then adjust as/if needed based on BP monitoring. 

 

In terms of risk both ACEs and ARBs have a good safety profile. What is risky is your long term regular NSAID use.

 

Chronic regular use of NSAIDs is hard on kidneys. By the time you have abnormal lab results, damage may be permanent. Ditto liver damage though its frequency from NSAID use is lower then kidney damage (but when it occurs, can be severe). 

 

NSAIDs can also lead to GI bleeding and ulcers, and increase the risk of heart disease.

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC3158445/

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC2997980/

 

The main risk is regular use for a long time.  Occasional use is much less risky. 

 

Risks are also higher in the elderly. 

 

If you can make the NSAID use occasional, you should. Has the cause of your back pain been identified? Have exercises/PT,  epidural injection etc been tried?

 

 

 

5 minutes ago, Sheryl said:

Has the cause of your back pain been identified? Have exercises/PT,  epidural injection etc been tried?

 

 

Thanks for all that. 

 

I had appointment lined up with a spine doctor from Sirirat but cancelled bc The hours were very inconvenient and he was on the other side of the river. 

 

I'm feeling my old self compared to a week ago when my back really hurt

 

I went to a Chinese medicine doctor a few days ago, but not seen a proper physician. It's kinda constant / chronic but not acute enough for epidural.

 

Yesterday I did a really strenuous massage and I think it really helped immensely. It also further leads me to believe it's tight muscles, overstretching and especially sitting too much. My BMI is good but really out of shape and soft. I really didn't have serious problems until covid.

 

I want to solve this kinda naturally if possible. 

 

Today is a really good day. I did easy stretching, reduced sitting early am and walking. I only have slight constant pain on straining back. I'm going back out and doing more walking off to big C 

 

I'm going to give acupuncture 1-2x more and continue heavy massage weekly. The masseuse even after working my lower area continued to remark how tight I was. 

 

I was really in a bad place a week ago.

 

I just want to be able to take 250mg naproxen as needed without harm. 

 

Thank you 

My lower back pain was diagnosed as osteoarthritis, L5. Seen 2 Ortho Specialists.

 I was given arcoxia (NSAID) which helped but I took it on rare occasions.

 

 Tried tiger balm patches, some relief at first.

 

Also tried a Thai mixture of longan seed and laokhao spirits. Some relief at first.

 

Now arcoxia is not very effective!

 

I tried 2 sessions of acupuncture but it made it worse.

 

I then tried CBD oil, not much help either.

 

Now trying diclophenac patches overnight ( 96 baht each) which has been very effective, so far!

Good luck. 

17 hours ago, Tazmo said:

My lower back pain was diagnosed as osteoarthritis, L5. Seen 2 Ortho Specialists.

 I was given arcoxia (NSAID) which helped but I took it on rare occasions.

 

 Tried tiger balm patches, some relief at first.

 

Also tried a Thai mixture of longan seed and laokhao spirits. Some relief at first.

 

Now arcoxia is not very effective!

 

I tried 2 sessions of acupuncture but it made it worse.

 

I then tried CBD oil, not much help either.

 

Now trying diclophenac patches overnight ( 96 baht each) which has been very effective, so far!

Good luck. 

 

Thanks. I think you've mixed my threads up, but appreciate the input. 

 

I've never heard of Diclofenac patches. The gel does nothing for me.

So, anyone interested and keeping up.

 

I cancelled the acupuncture. At b1200 session it just wasn't effective compared to the massage. I'm going for massage today and Friday. 

 

I'm thinking about doing massage every other day for a week just to see if I can rid myself of the tightness 

 

I believe I've boiled my particular issue down to muscle tightness. The area is mid buttock, side pain points and running upper pelvis all in muscle tissue. If that's you here's what's working for me... 

 

First, stretching, but not extreme or jerky stretching. Slow stretches until I get a bit of pain... hold and release . 

 

These are easy stretches that do not require being on the floor -

 

Sit on a low chair, bend and slowly touch the floor in front of you. Release 

 

Cross one leg, press down and hold till bored. Release. Now, pull knee up to chest hold and release. Repeat on other leg

 

Stand and left one leg to 90 degree angle from the other. Hold as long as possible or 30 seconds. Repeat other leg. 

 

Sitting: place pillow(s) in back, but also hard flat pillow under you. Sit as little as possible especially on any sofa / incline 

 

====================

 

I'm curious if I can buy muscle relaxers here in Thailand? If they might make me drowsy, lazy or high I don't want them. Thank you 

 

On another note, I'm out of sleeping gel tab from US. I bought same medicine in my pharmacy some years back but wasn't cheap maybe 7b per tablet pack only 10. It's basically benedryll. I've heard not good over long periods. Any suggestions? Should not fog me in the morning. Thank you 

54 minutes ago, KhaoHom said:

So, anyone interested and keeping up.

 

I cancelled the acupuncture. At b1200 session it just wasn't effective compared to the massage. I'm going for massage today and Friday. 

 

I'm thinking about doing massage every other day for a week just to see if I can rid myself of the tightness 

 

I believe I've boiled my particular issue down to muscle tightness. The area is mid buttock, side pain points and running upper pelvis all in muscle tissue. If that's you here's what's working for me... 

 

First, stretching, but not extreme or jerky stretching. Slow stretches until I get a bit of pain... hold and release . 

 

These are easy stretches that do not require being on the floor -

 

Sit on a low chair, bend and slowly touch the floor in front of you. Release 

 

Cross one leg, press down and hold till bored. Release. Now, pull knee up to chest hold and release. Repeat on other leg

 

Stand and left one leg to 90 degree angle from the other. Hold as long as possible or 30 seconds. Repeat other leg. 

 

Sitting: place pillow(s) in back, but also hard flat pillow under you. Sit as little as possible especially on any sofa / incline 

 

====================

 

I'm curious if I can buy muscle relaxers here in Thailand? If they might make me drowsy, lazy or high I don't want them. Thank you 

 

On another note, I'm out of sleeping gel tab from US. I bought same medicine in my pharmacy some years back but wasn't cheap maybe 7b per tablet pack only 10. It's basically benedryll. I've heard not good over long periods. Any suggestions? Should not fog me in the morning. Thank you 

 

Seems I followed up the above post making the same mistake 😆

Sooo... don't make the switch?

 

Enalipril + occasional NSAIDs ok? I've been doing it for years already. 

10 hours ago, KhaoHom said:

Sooo... don't make the switch?

 

Enalipril + occasional NSAIDs ok? I've been doing it for years already. 

As previously mentioned, enalpril has a good safety profile and no reason to switch unless experiencing annoying sidxe effects (dry cough being the more common of these)

 

Occasional NSAIDs...depends entirely on what you mean by "occasional".  Frequent use is inadvisable, infrequent use in someone without kidney or liver disease (or history of gastritis/ ulcers) usually OK.

 

 

11 hours ago, KhaoHom said:

. It's basically benedryll.

Be careful as the Benadryl they usually sell here is 50mg, compared to the usual 25 mg in the USA.  50mg is very strong and you will feel it the next day so defiantly break it in half as least. 

12 hours ago, KhaoHom said:

 

Thanks. I think you've mixed my threads up, but appreciate the input. 

 

I've never heard of Diclofenac patches. The gel does nothing for me.

Diclofenac gel is worhtless for me but the cheap sodium tablets(25 baht for 10 pack) here are miraculous when it come to back pain.  I take the 25mg a day after a few days of 100 mg to get a head start. I somtimes take this dosage for up to a year. 

 

 My bro also takes after I recomended and he also has had incredible results.  He takes 75 mg which is still a low dose but prolonged use might cause problems.  He tells me he doesn't care and would rather die a few years early and feel the way he does now.  He is extremely healthy and both of us get regular blood work and  kidney funtion tests. My Kidney numbers are comparable to someone in their twenties and I'm 58.

 

Have you had kidney and liver tests lately?  Not a bad idea and go for the Cystatin C Kidney test.  More expensive but my last one was only 1,200 baht.  The normal kidney test uses creatinine as a marker to determine kidney health but in your case it might be deceiving.  You said you have a good bmi but lack muscles. Muscles produce creatinine which wil be an issue for you because your muscles don't produce much which will throws off the test results.

18 hours ago, atpeace said:

Diclofenac gel is worhtless for me but the cheap sodium tablets(25 baht for 10 pack) here are miraculous when it come to back pain.  I take the 25mg a day after a few days of 100 mg to get a head start. I somtimes take this dosage for up to a year. 

 

 My bro also takes after I recomended and he also has had incredible results.  He takes 75 mg which is still a low dose but prolonged use might cause problems.  He tells me he doesn't care and would rather die a few years early and feel the way he does now.  He is extremely healthy and both of us get regular blood work and  kidney funtion tests. My Kidney numbers are comparable to someone in their twenties and I'm 58.

 

Have you had kidney and liver tests lately?  Not a bad idea and go for the Cystatin C Kidney test.  More expensive but my last one was only 1,200 baht.  The normal kidney test uses creatinine as a marker to determine kidney health but in your case it might be deceiving.  You said you have a good bmi but lack muscles. Muscles produce creatinine which wil be an issue for you because your muscles don't produce much which will throws off the test results.

 

Thanks for all that information 

 

I took am a fan of Diclofenac tablets, but Dave them for emergencies. Probably four times a year plus every time I'm on overnight bus up / back from south. I go the full 50mg. 

 

I've always been semi cautious with this stuff. Most daily was 200mg ibuprofen just to ease my back. 

 

Both you and your brother take a great deal if the stuff. 

 

TBH it pretty much solves my problem in one tablet. 

 

I've moved from 200mg ibuprofen daily to 250mg naproxen as needed. It's said to be better on the body and acts longer.

 

I'd recently read not to mix NSAIDs, but obviously if you take something less strong and need to bump up that's reasonable. Not so much contraindications, just ineffective and they're not good for you from get go

 

I've not had lab work in about six months. It's time, but I'll probably wait until after new year 

 

19 hours ago, how241 said:

Be careful as the Benadryl they usually sell here is 50mg, compared to the usual 25 mg in the USA.  50mg is very strong and you will feel it the next day so defiantly break it in half as least. 

 

Noted.

 

It wasn't cheap. I was surprised. The packet of 10 or a dozen tablets cost half amount as a bottle of 50 60 gels in States.

 

Do you have another sleep tab recommendation? want to go back to States in April I'm going to pick up some melatonin. I can't find it on Lazada. I've heard it's not illegal but entire frowned on to sell and effectively considered a date rap* substance 

19 hours ago, Sheryl said:

As previously mentioned, enalpril has a good safety profile and no reason to switch unless experiencing annoying sidxe effects (dry cough being the more common of these)

 

Occasional NSAIDs...depends entirely on what you mean by "occasional".  Frequent use is inadvisable, infrequent use in someone without kidney or liver disease (or history of gastritis/ ulcers) usually OK.

 

 

 

Thank you again for your input. You seemingly don't like NSAIDs. Makes me careful.

 

I'll just stick with the enalipril 🙏

Yesterday I for deep tissue massage. 350b one hour. It was fantastic. While it helped my back (at the line of upper pelvis) it totally loosened my muscles throughout my legs. The muscles in my legs are insanely tight. I'm definitely going to go back and do this once a week. I could probably use it twice but It's just another expense I can't manage at the moment. 

 

One thing I'm doing in changing my routine is stretching. When I wake up and before I go to bed I will do a few minutes of stretching. 

 

I put off the exercise and just stretch this morning for over an hour. 

 

I return home from Big C, did an hour walking this am totalling 9km. Another thing I'm doing here is during the walk I'm stopping and stretching and when I finish I'll stretch.

 

If you have back problems and you're not stretching give it a big try. Might not even recognize how tight your legs are simply because they're always tight like mine. So, try stretching and massage and see where you are with it all. 

 

My legs felt amazing after the massage. This part of my body not felt that good in years. 

12 minutes ago, KhaoHom said:

 

 

Noted.

 

It wasn't cheap. I was surprised. The packet of 10 or a dozen tablets cost half amount as a bottle of 50 60 gels in States.

 

Do you have another sleep tab recommendation? want to go back to States in April I'm going to pick up some melatonin. I can't find it on Lazada. I've heard it's not illegal but entire frowned on to sell and effectively considered a date rap* substance 

Nobody considers melatonin a "date rape" drug.

 

There is a Thai FDA brand called Circadin available in.pharmacies. Or you can get various US brands from iHerb. 

https://www.iherb.co.th/en

 

In terms of antihistamine drugs used for sleep,   most common one here is doxylamine, brand name Sominar.  Like other drugs of this type, regular (i.e. nightly) long term use is not recommended especially in the elderly but occasional use is OK gir most oeople. Most pharmacies carry it.  It comes in 25mg scored tabs, personally I take just half as whole tab leaves me groggy in the morning but YMMV. 

 

Other option here is hydroxyxine, many brand names including Histan.  Comes in 20 and 25mg forms. 

2 hours ago, Sheryl said:

hydroxyxine

It has a longer half life, so many people find it leaves them groggy in the morning.  Always try a lower dose first. If you tend to drink at night them reduce the dosage a LOT. Alcohol will multiply the effects. Be careful and definitely stay at home.

16 hours ago, Sheryl said:

Nobody considers melatonin a "date rape" drug.

 

There is a Thai FDA brand called Circadin available in.pharmacies. Or you can get various US brands from iHerb. 

https://www.iherb.co.th/en

 

In terms of antihistamine drugs used for sleep,   most common one here is doxylamine, brand name Sominar.  Like other drugs of this type, regular (i.e. nightly) long term use is not recommended especially in the elderly but occasional use is OK gir most oeople. Most pharmacies carry it.  It comes in 25mg scored tabs, personally I take just half as whole tab leaves me groggy in the morning but YMMV. 

 

Other option here is hydroxyxine, many brand names including Histan.  Comes in 20 and 25mg forms. 

 

Thanks again Sheryl. About the melatonin. I swore I read that on AN. Not surprised lol. Thank you. 

 

hydroxyxine seems more aggressive. The Amazon OTC antihistamine works/ed fine. I've cut back to 1x a week perhaps now supply low. 

 

I don't sleep enough, but rarely tired. Usually 6.5 hours 10 to 530. Plus waking up in the night.

 

I think doxylamine is what I was given here last time. TY. I'll just get what they have. I doubt my chemist has both doses.

 

@how241 ty

 

Back screwed up again this morning. Took a tablet, stretched 30 mins then went walking. More stretching while walking in my legs. Felt good 

 

I'm going to get out for evening walk and not sit on expensive leather sofa, but on the floor.

 

As the kids say ...fighting!!! 

You might also want to consider your mattress, does it give enough support while still allowing butt, hips & shoulder some give?

3 hours ago, KhaoHom said:

Back screwed up again this morning. Took a tablet, stretched 30 mins then went walking. More stretching while walking in my legs. Felt good 

 

I'm going to get out for evening walk and not sit on expensive leather sofa, but on the floor.

 

As the kids say ...fighting!!! 

Neither sitting on the floor nor on the sofa will do your back any good.

You should sit

1. high (a bar stool has the right height, not a Thai plastic chair or a sofa)

2. hard (not a sofa)

3. If possible, no back rest - but sit straight like a Thai beauty!

4. If possible, a wedge-shaped bolster (Lazada has them for cars)

 

Best are those orthopedic "chairs" that move,  so your back has to adjust every second. Expensive and hard to find. An example (there are many others, some people just sit on a ball):

 

https://www.desertcart.com.om/products/123782080-sleekform-ergonomic-kneeling-chair-back-correction-posture-wooden-stool-for-office-home-back-support-neck-pain-spine-tension-relief-rocking-kneel-seat-with-orthopedic-soft-knee-cushions

19 hours ago, Lorry said:

Neither sitting on the floor nor on the sofa will do your back any good.

You should sit

1. high (a bar stool has the right height, not a Thai plastic chair or a sofa)

2. hard (not a sofa)

3. If possible, no back rest - but sit straight like a Thai beauty!

4. If possible, a wedge-shaped bolster (Lazada has them for cars)

 

Best are those orthopedic "chairs" that move,  so your back has to adjust every second. Expensive and hard to find. An example (there are many others, some people just sit on a ball):

 

https://www.desertcart.com.om/products/123782080-sleekform-ergonomic-kneeling-chair-back-correction-posture-wooden-stool-for-office-home-back-support-neck-pain-spine-tension-relief-rocking-kneel-seat-with-orthopedic-soft-knee-cushions

 

No argument. I'm limited to the furniture in the rented condo. Actually, sitting on floor against sofa a bit is good. Basic hard chair limited time

 

19 hours ago, Sheryl said:

You might also want to consider your mattress, does it give enough support while still allowing butt, hips & shoulder some give?

 

I can't change the bed if I wanted to. It's an expensive Dunlopilo bed. I've had harder beds, but it's fine. 

 

It's my sitting and poor posture on sofa. I might sit and lay about from 5 to 10 at night. Time catching up with me.

 

 

On another note. The masseuse was correct. Changed to use phone and pocket right. Neck pain disappeared 

 

@Sheryl your opinion of Orphenadrine? Norgesic? 

 

Norgesic.. ok with aspirin. It also contains caffeine. So, that would be a morning thing. 

 

Sounds a bit heavy duty tbh. I'm uncertain I'd want to take it daily. Warns of drowsiness.

 

Perhaps instead of days of Diclofenac I could use lower dose of Diclofenac+ this. Beneficial?

5 hours ago, KhaoHom said:

@Sheryl your opinion of Orphenadrine? Norgesic? 

 

Norgesic.. ok with aspirin. It also contains caffeine. So, that would be a morning thing. 

 

Sounds a bit heavy duty tbh. I'm uncertain I'd want to take it daily. Warns of drowsiness.

 

Perhaps instead of days of Diclofenac I could use lower dose of Diclofenac+ this. Beneficial?

Norgesic has different ingredients in different countries. Thai Norgesic does not contain coffein. Neither does aspirin.

 

Less Diclofenac, and Norgesic instead, is a good idea.

Diclofenac plus aspirin is not a good idea,  especially without added omeprazole (danger of bleeding ulcers)

9 hours ago, KhaoHom said:

@Sheryl your opinion of Orphenadrine? Norgesic? 

 

Norgesic.. ok with aspirin. It also contains caffeine. So, that would be a morning thing. 

 

Sounds a bit heavy duty tbh. I'm uncertain I'd want to take it daily. Warns of drowsiness.

 

Perhaps instead of days of Diclofenac I could use lower dose of Diclofenac+ this. Beneficial?

It is a muscle relaxant plus aspirin and caffeine.

 

Muscle relaxants in my experience don't do much. Also should not be used daily long term.

 

Aspirin of course has pain relieving and anti-inflammatory effects. But can also cause GI irritation and bleeding problems. Should  not take together with an NSAID....much increased risk of gastritis, ulcers, bleeding.

 

Frankly if your pain is so constant and so severe that you must take pain killers daily,  you should prioritizs getting to the bottom of what is causing it. Invest in an orthopedic consult to rule out structural cause in lower spine or hip joints. Then if nothing significant found, get a good PT evaluation to pinpoint the muscle(s) involved and advise on appropriate stretches and exercises.

 

Yes, this will cost something. But remember the saying"pennywise, pound foolish". You will end up spending more in the long  run on massages, meds, accupuncture etc etc. 

 

 

Addendum: @Lorry is correct, Norgesic in Thailand does not contain aspirin or caffeine. It is muscle relaxant plus paracetemol.

 

I am doubtful it will do much more than paracetemol alone. And will have more side effects than plain para. 

3 hours ago, Sheryl said:

It is a muscle relaxant plus aspirin and caffeine.

 

Muscle relaxants in my experience don't do much. Also should not be used daily long term.

 

Aspirin of course has pain relieving and anti-inflammatory effects. But can also cause GI irritation and bleeding problems. Should  not take together with an NSAID....much increased risk of flgastritis, ulcers, bleeding.

 

Frankly if your pain is so constant and so severe that you must take pain killers daily,  you should prioritizs getting to the bottom of what is causing it. Invest in an orthopedic consult to rule out structural cause in lower spind or hip joints. Then if nothing significant found, get a good PT evaluation to pinpoint the muscle(s) involved and advise on appropriate stretches and exercises.

 

Yes, this will cost something. But remember the saying"pennywise, pound foolish". You will end up xoending more jngbe lk b run on massages, meds, accupuncture etc etc. 

 

 

 

Understood 

 

It's just sort of low level, chronic pain. It only becomes off the charts when I do something I probably shouldn't like working on the floor repotting plants for hours or overnight buses, over exercise. 

 

I just can't get the pain points to go away.

 

I dropped the acupuncture ineffective. I think the massage is a huge benefit for b350 a week.

 

I'll go see a doctor in next few months I think. 

 

Thanks