When to pre-medicate, when not to

Last Saturday morning Kathy and her best friend Ann were on a video conference call with me for a Medication Insider personal medication consultation. One of Kathy’s questions was about her first COVID-19 vaccination, which was coming up in four days. A couple of her friends had experienced some discomfort and fever the next day after receiving the vaccine. She asked if it would be okay for her to take some Tylenol® or ibuprofen the same day as her vaccination to avoid having a reaction.

I answered her, “Sometimes taking medicine to help prevent future discomfort is a good idea, but not with vaccines.”

Pre-medicating yourself with ibuprofen, naproxen, or acetaminophen (Tylenol®) could interfere with your ability to fully respond to the COVID vaccine. This would give you less protection. The good news is, most people do not experience any fever, muscle aches, or headache after either their first or their second vaccination. They mostly notice having a sore arm, but that’s it.”

The World Health Organization (WHO) states that it is safe to take acetaminophen (Tylenol®), ibuprofen, or naproxen to relieve any muscle aches, headache, or fevers after your COVID-19 vaccination. It’s just not a good idea to try to block those potential effects because it could also block your benefit from the vaccine.

Although pre-medicating before vaccination isn't recommended, there are other situations when it would be a brilliant thing to do, such as preventing motion sickness.

Whether you take ginger, meclizine (Bonine®), the original formulation of Dramamine® (dimenhydrinate), or apply a prescription-only scopolamine patch, the most effective way to treat motion sickness is to pre-medicate yourself.

You should take any motion sickness medicine at least 30 to 60 minutes before stepping onto a boat, riding in a car, entering an airplane, or riding on a roller coaster.

If you don't take your medicine beforehand, it can take more than an hour after taking it to relieve queasiness and dizziness. Believe me, I speak from personal experience on this! I gave up relying on ginger because it was too hard to remember when I needed another dose when I was traveling across multiple time zones.

It's vital to take medication first when taking an antihistamine to stave off an allergic reaction. By taking it beforehand, you can significantly reduce sneezing, nasal congestion, and sinus pressure.

Another example of when taking medication before a particular situation makes a difference is having a tooth extracted. Taking a nonsteroidal anti-inflammatory medicine (NSAID) like ibuprofen (Motrin-IB®) or naproxen (Aleve®) just before a dental extraction can dramatically block swelling and pain afterward.

NSAIDs prevent swelling and discomfort from dental procedures much better than taking acetaminophen (Tylenol®) because of how these two types of medicines work.

Does your arthritis make you stiff and sore in the morning until you get moving? Try taking a long-acting painkiller at bedtime the night before. Instead of taking Extra Strength Tylenol® 500mg, which lasts for 4-6 hours, try one or two Tylenol Arthritis® Extended Relief 650mg tablets or Tylenol 8-Hour® capsules, which last for 8-10 hours.

If you prefer to take an NSAID, avoid ibuprofen which wears off in 4-6 hours. Instead, try naproxen, which works for 8-10 hours. Be sure to take naproxen with either a full glass of water or food to reduce stomach irritation. People with heart failure, kidney problems, or who take blood thinners should avoid naproxen.

When should you pre-medicate to avoid future discomfort?

1. DON’T Pre-medicate for Vaccinations.

For best protection, avoid taking medicines for fever or pain while your immune system is busy responding to vaccination. It's okay to take them 24 hours later, however.

2. DO Pre-medicate for Motion Sickness.

Take your motion sickness medicine at least 30 minutes before you travel, and repeat when necessary.

3. Do Pre-medicate for Known Allergies.

Taking an antihistamine at least 30-60 minutes before encountering something that triggers your allergies helps prevent significant allergy attacks.

4. DO Pre-medicate for Dental Extractions.

Premedication with just one dose of an NSAID like ibuprofen or naproxen right before a tooth extraction reduces both swelling "chipmunk cheeks" and the need for strong painkillers after tooth extractions.

5.Try Pre-medicating for Morning Stiffness from Arthritis.

Because it works for up to 8-10 hours, Tylenol Arthritis® or Tylenol 8-Hour® 650mg at bedtime can get your day off to a better start, with less stiffness. Naproxen (Aleve®) also lasts for 8-10 hours.

Find out more about scheduling a 30-minute personal medication consultation for you or a loved one with Dr. Achey at www.The medication insider.com/consult.


Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. ®2021 Louise Achey


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