Type 2 War between painkillers and Gliclazide.

[cineman]

Hi, sorry for confusing title. I have recently been put on 40mg Gliclazide daily. I see in the notes, that I cannot take aspirin or Ibuprofen while on them. This is awkward, as I have bad arthritic pain in my hips (as well as other places), that is threatening to stop me performing many daily tasks, including walking! Ibuprofen is one of the best things for this, only now I seemingly cannot take it anymore. I am also on 15/500 x2 Co-Codamol, which doesn't seem to do anything, even when taken regularly. Also, I occasionally (mostly at night) get chest pain which is general tightness, making it difficult and uncomfortable to sleep, so I have been taking one single aspirin, which may only be for reassurance, but does seem to take the pain away, whereas now, the pain continues for quite some time and again I cannot take that! Or can I? As it is only the lowest dose of Gliclazide that I am on, would one small aspirin really do that much harm? (BTW I have been checked out for heart trouble and don't seem to have any problems with that). My blood sugars have been a bit funny lately. They go up and down and the first day I took a Glic, I had a reading of 6.3 the next morning! Having been getting scores between 8.5 and 13.6! Though only rarely for that high one. So I started cutting the tablet in half, stupid I know, as the result has never been as low as 6.3 since and I am back on a whole tablet every day. My bloods are now between 7.0 and 9.0 most mornings, though due I think, mostly to Christmas! Having had a free 12 week membership to Slimming World (referred by my surgery), I have discovered that their diet is not good for diabetics. They even told me that I mustn't exercise! So I am now back on a low-carb one and that seems to be helping slowly to get it all back to normal. Sorry for waffling on so much. My question is just about the NSAID's really, as though it sounds bad, I don't need any help with the blood sugars, as they are falling back into place. Just for info, my meds are currently 2000mg slow-release Metformin, 25mg Alogliptin and 40mg Gliclazide daily. I am also on perindopril (to help kidney function rather than high blood-pressure) and also a statin to control triglycerides as cholesterol is fine.

 

[Rachox]

Hi cineman, I’m glad you’ve seen that SW meals aren’t suitable for Type 2s and you have reacquainted yourself with low carbing. I hope you see a continued improvement in your blood sugars.
As for your question about NSAIDs you need to ask your HCPs as we onthe forum cannot advise about drug doses or combinations etc.. I do sympathise as I have arthritis but can’t take NSAIDs as they mess up my asthma

 

[Boo1979]

Hi, sorry for confusing title. I have recently been put on 40mg Gliclazide daily. I see in the notes, that I cannot take aspirin or Ibuprofen while on them. This is awkward, as I have bad arthritic pain in my hips (as well as other places), that is threatening to stop me performing many daily tasks, including walking! Ibuprofen is one of the best things for this, only now I seemingly cannot take it anymore. I am also on 15/500 x2 Co-Codamol, which doesn't seem to do anything, even when taken regularly. Also, I occasionally (mostly at night) get chest pain which is general tightness, making it difficult and uncomfortable to sleep, so I have been taking one single aspirin, which may only be for reassurance, but does seem to take the pain away, whereas now, the pain continues for quite some time and again I cannot take that! Or can I? As it is only the lowest dose of Gliclazide that I am on, would one small aspirin really do that much harm? (BTW I have been checked out for heart trouble and don't seem to have any problems with that). My blood sugars have been a bit funny lately. They go up and down and the first day I took a Glic, I had a reading of 6.3 the next morning! Having been getting scores between 8.5 and 13.6! Though only rarely for that high one. So I started cutting the tablet in half, stupid I know, as the result has never been as low as 6.3 since and I am back on a whole tablet every day. My bloods are now between 7.0 and 9.0 most mornings, though due I think, mostly to Christmas! Having had a free 12 week membership to Slimming World (referred by my surgery), I have discovered that their diet is not good for diabetics. They even told me that I mustn't exercise! So I am now back on a low-carb one and that seems to be helping slowly to get it all back to normal. Sorry for waffling on so much. My question is just about the NSAID's really, as though it sounds bad, I don't need any help with the blood sugars, as they are falling back into place. Just for info, my meds are currently 2000mg slow-release Metformin, 25mg Alogliptin and 40mg Gliclazide daily. I am also on perindopril (to help kidney function rather than high blood-pressure) and also a statin to control triglycerides as cholesterol is fine.

Speak to a pharmacist or your doctor about what pain relief might work best for you
. NSAIDs are discouraged for long term use for anyone as they have been found to increase heart risk and also to have potential gastric problems increasing risk of stomach ulcers

Edited to add
https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107856.htm

 

[bulkbiker]

also a statin to control triglycerides as cholesterol is fine.

Your trigs should improve greatly with your dietary change to low carb which may make the statins unnecessary (which I would say they probably are anyway)...

 

[cineman]

Thank you all for such quick replies! I shall be in touch with my doc's soon then! (If I can get them to talk to me), they're usually too busy to do anything with patients!

 

[SimonCrox]

The catch is "protein binding". All these drugs are bound to protein in the blood, so that if on gliclazide, adding another protein bound drug like aspirin should theoretically displace the gliclazide from the protein so more free gliclazide around so more effect eg hypos.
I have never seen this happen despite seeing a lot of people on gliclazide and aspirin. Also, if one is on a regular dose of aspirin / NSAID, then gently adding in gliclazide on top is not going to lead to a sudden surge in free active gliclazide in blood stream.
So, no worries there.
As above, I would be more bothered by the use of ibuprofen - if it cannot be avoided, then that is the case; ibuprofen and NSAIDs are very effective painkillers for many people in an easy to take dose, but there are side effects, so good to see if a topical NSAID would work or smaller dose; ibuprofen or naproxen seem to be the safest
best wishes

 

[desidiabulum]

It means nothing, but I have been on low dose of aspirin (post-angioplasty) and gliclazide -- among other things -- for 5 years and not one HCP (including some top people) has batted an eyelid

 

[What is in a name]

Sorry for being so late to the party.
I am in a similar position to the OP, which is why I was looking for the answer to the NSAID vs Gliclazide question.
Upon prescribing Gliclazide my GP told me she was not happy to continue my Indometacin which I had been on for 14 years without any issue (I know the received "wisdom" is that is too long) The Indometacin is for arthritis in both hips, lower spine, both shoulders and neck.
So dutifully, I stopped the Indometacin and switched to the recommended paracetamol, which might as well be a tablet of air for all the good they do. Even co-Codamol 8/500 are ineffective and the pain is now literally debilitating.

At one point I stopped taking the Gliclazide for four days so I could take some Indometacin to get some relief form the pain.
Naturally my sugars spiked back into the low double digits during my rest from Gliclazide.

Generally, the only web based information I can find on interactions between the two seems to be a situation of too low blood sugars, but since I'm on the lowest single daily dose of 40mg which puts me in the 5.5 to 8 range daily I'm pretty sure I can adjust my diet to account for any possibility of a low sugar count.

I know what you're thinking, "speak to your GP" BUT! While she is very keen to get and keep my diabetes under control, she is less inclined to listen to my concerns and often speaks over me while trying to explain them.

So has anyone tried an NSAID / Gliclazide combination?

To end on a bit of a positive, one of the best meals for me to have a 5-6 reading is x2 fish in butter source with mixed veg - Cauliflower, broccoli, Sprouts, Diced Swede, Long Beans, Baby Carrots and no more than x4 small new potatoes.

 

[Antje77]

Sorry for being so late to the party.

Hi @What is in a name , welcome to the forum.
Late to the party indeed, which means your question won't be very visible. I'd post a new thread on it if I were you so it will be seen by more people.

Generally, the only web based information I can find on interactions between the two seems to be a situation of too low blood sugars, but since I'm on the lowest single daily dose of 40mg which puts me in the 5.5 to 8 range daily I'm pretty sure I can adjust my diet to account for any possibility of a low sugar count.

Should you decide to take the route of simply trying, it could be worth using a Freestyle Libre CGM to wake you up in case you go too low at night.
If you've never used one before you can order a two week free trial here: https://www.freestyle.abbott/uk-en/getting-started/sampling.html

I hope you'll find a solution, your pain sounds pretty horrible.

 

[JoKalsbeek]

Sorry for being so late to the party.
I am in a similar position to the OP, which is why I was looking for the answer to the NSAID vs Gliclazide question.
Upon prescribing Gliclazide my GP told me she was not happy to continue my Indometacin which I had been on for 14 years without any issue (I know the received "wisdom" is that is too long) The Indometacin is for arthritis in both hips, lower spine, both shoulders and neck.
So dutifully, I stopped the Indometacin and switched to the recommended paracetamol, which might as well be a tablet of air for all the good they do. Even co-Codamol 8/500 are ineffective and the pain is now literally debilitating.

At one point I stopped taking the Gliclazide for four days so I could take some Indometacin to get some relief form the pain.
Naturally my sugars spiked back into the low double digits during my rest from Gliclazide.

Generally, the only web based information I can find on interactions between the two seems to be a situation of too low blood sugars, but since I'm on the lowest single daily dose of 40mg which puts me in the 5.5 to 8 range daily I'm pretty sure I can adjust my diet to account for any possibility of a low sugar count.

I know what you're thinking, "speak to your GP" BUT! While she is very keen to get and keep my diabetes under control, she is less inclined to listen to my concerns and often speaks over me while trying to explain them.

So has anyone tried an NSAID / Gliclazide combination?

To end on a bit of a positive, one of the best meals for me to have a 5-6 reading is x2 fish in butter source with mixed veg - Cauliflower, broccoli, Sprouts, Diced Swede, Long Beans, Baby Carrots and no more than x4 new potatoes.

Is there something you can do so you wouldn't need the glic anymore? I know, you (and your GP) want your blood glucose in the normal range, but you don't take extreme amounts... And with your diet, I think just dropping the new potatoes and the beans from that example meal might've given you decent, potentially non-diabetic numbers without the gliclazide.

Sometimes we have to choose the lesser of two evils, and you seem to be in quite a serious amount of pain without the Indometacin. Personally, I'd look for other methods of blood glucose control, because you've already tried other methods for the arthritis, and those didn't help. Maybe a low carb diet would give you enough room to go back to pain medication that does work for you. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might give you some ideas on how to tackle that, but do NOT mix a low carb diet with gliclazide, because you'll likely hypo if you do. Discuss it with your GP, (if you can get a word in edgewise; or just write a letter so you can have your say without interruptions!), and see whether you can get something sorted that does work for you. Quality of life matters, but sometimes, some health care workers forget that. Would do no harm to remind them of that fact, every once in a while.

If you do start a low carb diet and switch your medication around, hopefully with your GP monitoring the situation, I can wholeheartedly agree with Antje: a CGM would give you priceless data. They're not 100% accurate, both of mine were usually off by 1 mmol/l lower than I truly am, but they do give insight in trends quite well, so you know how you respond to the new regime.

Good luck, and i hope you feel better soon, one way or another,
Jo

 

[Melgar]

Sorry for being so late to the party.
I am in a similar position to the OP, which is why I was looking for the answer to the NSAID vs Gliclazide question.
Upon prescribing Gliclazide my GP told me she was not happy to continue my Indometacin which I had been on for 14 years without any issue (I know the received "wisdom" is that is too long) The Indometacin is for arthritis in both hips, lower spine, both shoulders and neck.
So dutifully, I stopped the Indometacin and switched to the recommended paracetamol, which might as well be a tablet of air for all the good they do. Even co-Codamol 8/500 are ineffective and the pain is now literally debilitating.

At one point I stopped taking the Gliclazide for four days so I could take some Indometacin to get some relief form the pain.
Naturally my sugars spiked back into the low double digits during my rest from Gliclazide.

Generally, the only web based information I can find on interactions between the two seems to be a situation of too low blood sugars, but since I'm on the lowest single daily dose of 40mg which puts me in the 5.5 to 8 range daily I'm pretty sure I can adjust my diet to account for any possibility of a low sugar count.

I know what you're thinking, "speak to your GP" BUT! While she is very keen to get and keep my diabetes under control, she is less inclined to listen to my concerns and often speaks over me while trying to explain them.

So has anyone tried an NSAID / Gliclazide combination?

To end on a bit of a positive, one of the best meals for me to have a 5-6 reading is x2 fish in butter source with mixed veg - Cauliflower, broccoli, Sprouts, Diced Swede, Long Beans, Baby Carrots and no more than x4 new potatoes.

@What is in a name I cannot help you with your question on drug interaction between Indomethacin and Gliclazide. I do have arthritis in all my joints, including both hips and my entire spine. I have had arthritis since my 20's. I cannot take NSAIDS as I have peptic ulcer disease . I definitely agree with you that paracetamol is totally useless, you may as well not bother. In times of need I take Robaxacet Extra strength I think the equivalent in the UK of Robax extra strength. It contains both acetaminophen (paracetamol) and methocarbamol. It's a none prescription drug here in Canada. It is meant as a muscle relaxant, but for me it gives me some relief. Although I know friends have taken it and it has done very little. I have herniated discs in my lumber and thoracic spine which can cause significant pain. It does take the edge off the pain for me. Not sure what the drug contraindications are so caution is required. Obviously everyone is different but it does help me.

 

[Michael 1701]

I take 75mg of aspirin per day along with my gliclazide. It's never caused me any problems.

 

[ianf0ster]

Mods would like to remind members that everyone’s situation is different. Please keep this in mind when posting replies.
A low carb diet is anything under 130g, low carb isn’t no carb and some members may do very well on the higher side of low carb since 100g or so is much less than they were previously eating.

 

[What is in a name]

@What is in a name I cannot help you with your question on drug interaction between Indomethacin and Gliclazide. I do have arthritis in all my joints, including both hips and my entire spine. I have had arthritis since my 20's. I cannot take NSAIDS as I have peptic ulcer disease . I definitely agree with you that paracetamol is totally useless, you may as well not bother. In times of need I take Robaxacet Extra strength I think the equivalent in the UK of Robax extra strength. It contains both acetaminophen (paracetamol) and methocarbamol. It's a none prescription drug here in Canada. It is meant as a muscle relaxant, but for me it gives me some relief. Although I know friends have taken it and it has done very little. I have herniated discs in my lumber and thoracic spine which can cause significant pain. It does take the edge off the pain for me. Not sure what the drug contraindications are so caution is required. Obviously everyone is different but it does help me.

Sadly Robaxacet Extra strength is not available in the UK.
Sorry to hear that you have so much pain and for so long.