Over the Counter Pain Medications: What to Consider

Melissa L. Agonia, PharmD

When you’re in pain, it’s natural to want relief. With dozens of over the counter (OTC) pain relief products on store shelves, choosing one can be overwhelming. Various medications treat similar symptoms, but they each work differently in your body. Comparing pain relievers’ active ingredients, uses, warnings, and directions can be a helpful way to understand the differences. Before you reach for one of the many products available on store shelves, it’s important to learn about the different types of OTC pain relievers and the benefits and risks of each. 

How many types of pain relievers are there and how do they differ?

There are two main OTC pain reliever options: acetaminophen (like Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDS), which include ibuprofen (brand names include Motrin and Advil), naproxen (Aleve), and aspirin.

In some cases, one type of pain reliever does a better job treating a specific kind of pain. They can all be helpful in treating muscle aches, stiffness, headaches, earaches, back pain, postoperative pain, and pain caused by a virus like the flu or the common cold.  Both acetaminophen and NSAIDs also reduce fever.  However, only NSAIDs can reduce inflammation caused by swelling and irritation.

Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the ‘pain messages’. NSAIDs are also available in a prescription strength that can be prescribed by your health care provider.

Are certain pain relievers better suited for different age groups?

Parents often used to give their children baby aspirin for fevers and illness. Now that we know more about Reye’s syndrome -- a rare but serious condition that affects the brain, kidneys and liver -- aspirin is no longer an option for children and teens during times of illness. Sick kids can safely take ibuprofen and acetaminophen if the dosage is right for their age and weight. Naproxen is not recommended for children under the age of two. Some people over the age of 60 should also use caution when taking NSAIDS, as they may be at higher risk for side effects.  In general, acetaminophen has fewer side effects, making it safer for long-term use and for children.

Can I drink alcohol if I’ve been taking OTC pain medication?

Alcohol and OTC pain relievers can be a dangerous combination, and is generally not recommended. One of the most common causes of severe liver damage is a chronic combination of acetaminophen and alcohol.

People can experience mild to serious side effects (upset stomach, pain, heartburn, or serious bleeding) if they take NSAIDs regularly and drink more than a moderate amount of alcohol, which is one drink for women and two drinks for men per day. The likelihood of experiencing side effects is higher with long term use of NSAIDs, acetaminophen and regular or heavy alcohol use.

I have high blood pressure—will an OTC pain medication affect it?

Acetaminophen is the appropriate pain relief option for those with high blood pressure. This pain reliever option does not interfere with certain blood pressure medications the way NSAIDs do. NSAIDs reduce the blood flow to your kidneys, which make them work more slowly. When your kidneys are not working well, fluid can build up in your body, causing an increase in your blood pressure.  

Can regular intake of pain relievers negatively affect my organs or other vital functions?

Side effects from OTC pain relievers are uncommon for healthy adults who only use pain relievers occasionally. However, NSAIDs can cause blood clotting, potentially putting you at a higher risk for heart problems and stroke if you use more than directed for longer than directed. Generally, people who have risk factors for heart disease may be at a greater risk for serious cardiovascular problems from NSAID use. Chronic NSAID use can also put you at risk of bleeding in the stomach and kidney damage.

A common cause of severe liver damage is often from chronic use of acetaminophen. Severe liver injury may occur if you take heavy doses of acetaminophen. 

I’ve heard that a daily dose of a pain reliever like aspirin can help my heart. Is this true?

OTC pain relievers can be a double-edged sword for people with heart problems. Daily low-dose aspirin can help ward off blood clots that can lead to a stroke or heart attack in the right patient population. On the other hand, long term non-aspirin NSAID use, especially at high doses, can interfere with the blood-thinning effect of aspirin and increase the risk of heart attack or stroke. 

Is it dangerous to combine pain relievers with other medications? 

Ibuprofen and acetaminophen contain different active ingredients. There may be times when these OTC pain relievers can be taken together or alternated, but you should always consult a health care provider before taking more than one type of medication. Certain prescriptions also contain over the counter ingredients such as Vicodin for pain, which has hydrocodone and acetaminophen. Check whether other OTC medicines you are taking contain acetaminophen as many combination medications for cold symptoms contain this active ingredient. As previously discussed, taking too much acetaminophen can cause liver damage, and taking more than one NSAID can increases your risk of stomach bleeding 

Can I take pain relievers during pregnancy?

Acetaminophen is the OTC pain reliever of choice during pregnancy. There is a possibility of adverse effects with NSAIDs use during pregnancy, and pregnant women should only use them under the guidance of a medical professional. 

How can I safely store OTC pain relievers?

Store all medicines out of reach of young children. Keep them in a cool, dry place so they do not lose effectiveness. Do not store them in bathrooms, which can get hot and humid.

Remember to always read directions on the label before taking any medicine. Learn how much to take and how often you should take it. Even if you’re in a lot of pain, it’s not safe to take more medicine than the label says. Don’t assume that a higher quantity of medicine will work better or quicker. Taking more than the recommended amount can be dangerous. For your safety, do not exceed these OTC daily recommended maximum doses:

Acetaminophen 3000mg per day
Ibuprofen 1200mg per day
Naproxen 600mg per day

Not all pain relievers are equal or appropriate for everyone. Always keep a list of your medications with you, including which OTC medicines you are using and when you are taking them. Consider your health conditions and if you have any questions about how much medicine to take, call your local pharmacist or primary care provider.

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