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Beware: Pain pills and water pills don't mix

Gerald W. Deas | , M.D. | , Mph | 5/30/2013, 5:02 p.m.
I can't tell you how many times patients have come to my office complaining about...
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I can't tell you how many times patients have come to my office complaining about swollen ankles due to hypertension and congestive heart failure. Further history revealed that they were also taking pain medication for arthritis.

Of course, the patients are concerned about getting rid of the water from their ankles and the pain from their swollen knees. To reduce the swelling in their ankles, I usually suggest that patients reduce their sodium intake as well as elevate their legs while sitting for long periods of time. This simple lifestyle change will assist in helping to remove fluid. Often, physicians will prescribe a water pill, such as Lasix, or a drug such as Dyazide (hydrochlorothiazide).

In reducing the fluid from the ankles with a water pill, other nutritional elements such as potassium, calcium, magnesium and water-soluble vitamins are lost from the body. These nutrients must be replaced. Otherwise, patients will experience weakness in their legs and arrhythmias (extra beats of the heart).

Painful arthritic knees are usually treated with a medication selected from a group of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs) such as Motrin, Naprosyn, Aleve, Advil, Celebrex and Indocin. These drugs are very helpful in controlling the pain of an arthritic joint, however, they can cause stomach ulcers. In fact, I always warn patients that if they observe a black stool-and I mean black, tarry stools after a bowel movement-to notify their physician immediately. The cause of black stools is a mixture of blood from a bleeding ulcer and hydrochloric acid in the stomach. It only takes 50cc of blood from a bleeding ulcer to produce a black stool.

Recently, investigators from Holland have reported in the journal Archives of Internal Medicine that taking a water pill and a NSAID is a bad mixture. The combination can cause retention of sodium and water and can lead to congestive heart failure. Early signs of heart failure are characterized by shortness of breath, wheezing, swollen ankles and the need to sleep on two pillows. These signs should be reported immediately to your physician.

There are many drugs that can treat arthritis much more effectively and not cause the retention of fluid in the body. Consult your physician about these medications. It has been reported that omega-3 fatty acids, found in fish oils, can reduce painful swollen joints caused by rheumatoid arthritis. I would highly recommend anyone suffering from arthritis to incorporate fish such as sardines, bluefish, tuna, mackerel and salmon in their diets.

Just beware that when taking over-the-counter medicines for pain, you should consult your physician first.