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      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
      Drugs & Diseases > Physical Medicine and Rehabilitation

      Achilles Tendon Injuries Medication

      Updated: Sep 15, 2022
      • Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD  more...
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      Medication

      Medication Summary

      Two major categories of drugs used in Achilles tendon rupture and Achilles tendinosis are analgesics (opioid and nonopioid) and nonsteroidal anti-inflammatory agents (NSAIDs). Consider side effects and patient profiles when choosing medications. Acetaminophen can result in liver damage. Opioids can result in gastrointestinal (GI) distress, constipation, and sedation and have addictive potential. NSAIDs can result in GI upset and bleeding, as well as renal damage and impaired coagulation. A new generation of cyclo-oxygenase 2 (COX-2) ̶ inhibiting NSAIDs may have fewer side effects. Currently, the only available COX-2 inhibitor is celecoxib.

      In chronic cases of paratenonitis, some authors have advocated bupivacaine injection into the sheath to disrupt adhesions. Others have suggested that 2 mL of saline injection into the sheath may lift the paratenon off the tendon and lead to improvement; this is possibly more effective when performed with ultrasonographic guidance.

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      Analgesics

      Class Summary

      Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained trauma.

      Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

      Acetaminophen is the drug of choice (DOC) for pain in patients with documented hypersensitivity to aspirin or NSAIDs, who have upper GI disease, or who are taking oral anticoagulants.

      Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Norco)

      This drug combination indicated for moderate to severe pain.

      Acetaminophen and codeine (Tylenol #2, Tylenol #3, Tylenol #4)

      This combination is indicated for the treatment of mild to moderate pain. The available dosage strengths are as follows:

      • Tylenol #2: 300 mg Tylenol/15 mg codeine

      • Tylenol #3: 300 mg Tylenol/30 mg codeine

      • Tylenol #4: 300 mg Tylenol/60 mg codeine

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      Nonsteroidal Anti-inflammatory Drugs

      Class Summary

      NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions. [94]

      Naproxen (Naprosyn, Aleve, Naprelan, Anaprox)

      Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing COX activity, which results in decreased prostaglandin synthesis.

      Ibuprofen (Motrin, Advil)

      Ibuprofen is the DOC for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

      Indomethacin (Indocin)

      Indomethacin is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

      Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)

      Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

      Ketoprofen

      Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

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      Cyclo-Oxygenase 2 Inhibitors

      Class Summary

      COX-2 inhibitors are used to control pain and inflammation, especially in cases of contraindication to conventional anti-inflammatories. Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.

      Celecoxib (Celebrex)

      Celecoxib inhibits primarily COX-2, an isoenzyme that is induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity, but at therapeutic concentrations, COX-1 isoenzyme is not inhibited and thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.

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