Monday Pharmaceutical Mystery: November 12

A young man presents at the register buying creatine supplement. He asks what is the highest dose of ibuprofen that he could take because his muscles are extremely sore from lifting weights twice a day. He says his pain is actually getting worse, despite taking ibuprofen as prescribed on the bottle. He asks if maybe he can also take acetaminophen with ibuprofen.

Mystery: Why would someone have more pain when taking an NSAID? That is a potent anti-inflammatory and analgesic drug, and should shut down the pain and inflammation form exercised induced soreness.

Solution: The customer has rhabdomyolysis, a curious condition that can strike young healthy people, as well as debilitated and sick people. It is when the muscles become necrotic, die, and release muscle byproducts. These byproducts can permanently damage the kidneys as they leave the body. Occasionally young people get it from doing illicit drugs and alcohol, working too hard lifting weights, and crush injuries. But there are many causes for rhabdomyolysis. It can be like the perfect storm brewing.

This person should be instructed to go to a hospital emergency department or an urgent care clinic for evaluation. The customer should stop taking the creatine and let his body rest. He is high risk for renal failure if he gets dehydrated.