Background first … will try to explain any chemical names/ medical terms/ acronyms in square brackets.

My mother and I both have a topical sensitivity – irritant not allergy – to anionic surfactants [foaming detergents in many household/ personal hygiene products]. Shampoo – in my case just bubbles – is a major trigger for atopic eczema, aqueous cream [1% Sodium Lauryl Sulphate] worsens contact dermatitis.

According to the patient information leaflet there is SLS in celecoxib [anti inflammatory] which I was prescribed six weeks ago. And in lansoprazole [reduces stomach acid] which I have not taken regularly in a year and a half.

I am left wondering how much SLS is in these products, if it is enough to negatively affect me, and if this has contributed to recent health issues (cystitis/ not clearly bacterial, rash on face, anxiety). All are preexisting so it may be a coincidence, but recent episodes are atypical.

I obviously have consulted my family doctor, and we have agreed a week off the celecoxib. There is a prescription for a second course of antibiotics waiting if the cystitis symptoms do not resolve or worsen.

It would be interesting to hear from anyone with stomach/ gut/ bladder/ urinary tract symptoms they or their medical team attribute to detergents/ emulsifiers in prescription or over the counter drugs.

Input from Graham Phillips [a pharmacist who posts here] would also be most welcome. 🙂 Google suggests SLS is eliminated via the kidneys, but interneting aggravates the muscukoskeletal issue that I was taking celecoxib for!

SLS was (still is) a common “ingredient” in skin products (e.g. aqueous cream as well as many branded products) the advice is avoid like the plague- its notorious for thinning the skin. In my pharmacies we stock an SLS-free version of aqueous cream and try to persuade people to purchase that instead (albeit it does cost a bit more). Anyway – is SLS is listed on the list of “ingredients” on ANY skin prep, my very strong advice is – avoid. If in doubt ask your pharmacist.

As for the SLS as an exigent in oral medication the amounts would be so small as to be irrelevant for most people. Again -speak to your own community pharmacist if in doubt

Thanks for your reply GrahamPhillips.

Facial rash improved substantially by Tuesday, right around the time the cystitis recurred! Now on second course of antibiotics (nitrofurantoin, trimethoprim). 🙁

Nitrofurantoin is preferred for two reasons: 1) Less resistance and 2) Narrower spectrum (kills more of the bad bugs and less of the good bugs). Sounds like you are taking quite a lot of meds? What does the consultant say??

Thanks again for your input.

Yes I was prescribed the nitrofurantoin first (end of week three). Urine test negative for UTI but still symptomatic hence the trimethoprim script (end of week five). Just being treated by the GP at present.

The celecoxib – and before that naproxen – were for neck/ shoulder/ upper back knotting and pain (six month history). Likely a combination of age related degeneration in the cervical spine and poor posture. I have been referred for physiotherapy so hope to be off all analgesics by the end of the year.

Just had a lightbulb moment!

Maybe the mid afternoon flare isn’t aggravated by what I eat/ drink/ take at breakfast … but rather the symptoms are relieved overnight by my amitriptyline. I take 100mg at night for insomnia and depression.; much lower doses are used for nerve pain IIRC.

When you say flare are you talking gut symptoms or musculoskeletal? FYI the max dose of amitryptiline is 150mg (but many people can’t tolerate that dose) there’s no reason why you couldn’t split the dose you are taking and see if that gives you better pain relief over the 24h. Another option is to add small increments of 10mg for the second dose and see if it helps. Risk of daytime drowsiness and beware interactions with other prescribed medicines. Suggest discuss with your GP.?

Hi Firefox – one option would be to split the dose of amitriptyline rather than take 100mg as a single dose. An alternative
is to take a second dose around noon (start with 10mg and work up). All other things being equal the max daily dose is 150mg – but many people struggle to tolerate the max dose- its very individual . Are you taking other meds and is the flare gut symptoms or other symptoms ? Suggest consult your GP before making any changes tho

PS: What are you doing to strengthen your core? That can be far more effective than pain-killers or pain-modulators ?

Hi Firefox: are you talking about a flare of gastric symptoms or musculo-skeletal symptoms? one option might be to split the dose – of amitriptyline take 75mg at night and 25mg at noon. Another option is to add in (say) 10mg at noon and increase gradually . The maximum daily dose is 150mg but many people can’t tolerate it.Suggest discuss with your GP?

Oops sorry. Trying to avoid ‘oversharing’ results in total lack of clarity!

Flare in cystitis/ urinary tract symptoms mid afternoon. Hoping it’s just an extended irritation/ inflammation after the original UTI and not truly chronic, it has eased somewhat.

Will certainly discuss again with my GP or at a wellbeing check (in two weeks) if worsening or not resolved. Just had smear and STI screen, due bloodwork at the wellbeing check so most bases covered.

Hmm why would you get a symptom flare mid afternoon? Are you drinking plenty plenty? Could it be related to something else? Just a thought but do you ever check you blood/urine sugars?

Thanks for your continued interest, Graham Phillips.

Have history of UTIs but not for many years. This episode started ~6 weeks ago. Classic UTI in triggers and symptoms. Hoping to avoid antibiotics I treated with copious cranberry drink and/ or lemon squash (hate water!). Symptoms on and off. At three weeks prescribed nitrofurantoin, symptoms still on and off but noticed pattern of mid afternoon flare.

I wondered if something I was eating/ drinking/ taking/ doing after rising was irritating the bladder. The only ‘new’ was the celecoxib, but multiple other changes (eg. increased soft drinks, which are acidic and loaded with sweeteners).

Practice nurse dip stick tested a urine sample taken mid flare, but clear of infection. Saw GP later same day, we agreed a week off the celecoxib and/ or course of trimethoprim.

Tried both changes, but bladder symptoms continue to come and go. I have considered it could be the start of interstitial cystitis, which could fit with my history of overactive sympathetic nervous system (NHS dermatologist: PP rosacea/ excessive sweating/ anxiety). But I have few night issues with bladder so not classic for interstitial.

Then it occurred to me that the amitriptyline might be treating the overactive nervous system – inc. bladder – as well as the mental health stuff … Mi afternoon flare might be as blood levels drop?

SO MANY variables with foods, drinks, drugs, daily activities, mental or physical health issues all potentially impacting the bladder symptoms.

Right now all I can do is try to monitor for patterns, await results of routine smear and STI screen, have planned bloodwork (full count, vit D, liver function, female hormones).Urine glucose by practice nurse, blood glucose last year at hospital. Low-ish risk for type 2 diabetes: healthy weight/ waist, no family history, non smoker, mid 40s, on and off heavy drinker tho.