Biceps Tendinopathy Medication

Updated: Feb 26, 2021
  • Author: Peter G Gonzalez, MD; Chief Editor: Robert H Meier, III, MD  more...
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Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage acute symptoms of pain and stiffness. No apparent advantage is noted with regard to the use of one agent over another. Liniments, including NSAID and capsaicin creams, may be considered. Acetaminophen may be used for analgesia. [32]

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Resource Center Pharmacologic Management of Pain

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Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs are most commonly used for the relief of mild to moderate pain. Although the effects in the treatment of pain tend to be patient specific, ibuprofen is usually the drug of choice (DOC) for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam. Celebrex, a cyclooxygenase-2 (COX-2) inhibitor, may also be used, although its efficacy is not greater. An improved adverse-effect profile is controversial.

Ibuprofen (Ibuprin, Advil, Motrin)

DOC for mild to moderate pain. Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Anaprox, Naprelan, Naprosyn)

For relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

For relief of mild to moderate pain and inflammation. Small dosages of ketoprofen are indicated initially in patients with small body size, in elderly patients, and in patients with renal or liver disease. Doses >75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for a response.

Celecoxib (Celebrex)

Primarily inhibits COX-2. COX-2, which is considered an inducible isoenzyme, is induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, the incidence of GI toxicity, such as endoscopic peptic ulcers, bleeding ulcers, perforations, and obstructions, may be decreased in comparison with nonselective NSAIDs. Seek the lowest dose for each patient.

Celecoxib neutralizes circulating myelin antibodies through anti-idiotypic antibodies; down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade; promotes remyelination; and may increase CSF IgG (10%).

Celecoxib has a sulfonamide chain and is primarily dependent on cytochrome P450 enzymes (hepatic enzymes) for metabolism.

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Analgesics

Class Summary

Pain control is essential for quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients with tendinitis.

Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin, NSAIDs, those who have been diagnosed with upper GI disease, and patients on oral anticoagulants.

Capsaicin topical (Dolorac, Capsin, Zostrix)

Derived from plants of the Solanaceae family. Capsaicin may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.

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