Pain Relievers: Understanding Your OTC Options

Over-the-counter (OTC) pain relievers are medicines that you can buy without a prescription from your doctor. Two main types of OTC pain relievers are available. One type is acetaminophen (brand name: Tylenol). The second type is nonsteroidal anti-inflammatory drugs (also called NSAIDs). NSAIDs include the following:

Some products contain both acetaminophen and aspirin (brand names: Excedrin Extra Strength, Excedrin Migraine, Vanquish).

Acetaminophen seems to relieve pain and reduce fever by working on the parts of the brain that receive pain messages and control the body’s temperature.

NSAIDs relieve pain and fever by reducing the level of hormone-like substances (called prostaglandins) that your body makes. These substances cause the feeling of pain by irritating your nerve endings. They also are part of the system that helps your body control its temperature.

Acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, and reduce fever. NSAIDs can also reduce inflammation (redness and swelling).

OTC pain relievers can be helpful in treating many types of pain, such as pain from arthritis, earaches, back pain, and pain after surgery. They can also treat pain from the flu (influenza) or a cold, sinusitis, strep throat or a sore throat. Children who may have the flu or chickenpox should not take aspirin because they are at higher risk to develop a condition called Reye’s Syndrome.

Acetaminophen can be a good choice for relieving headaches and other common aches and pains. It can be used safely by most people on a long-term basis for arthritis and other chronic painful conditions if pain is improved. Make sure you tell your doctor about any OTC medications you take regularly.

Ibuprofen is helpful for menstrual cramps and pain from inflammation (such as muscle sprains). If ibuprofen doesn’t work for you, naproxen and ketoprofen may be options.

For most people, OTC drugs are all they need to relieve pain or reduce fever. If an OTC drug doesn’t help your pain or fever, or if you’ve been taking an OTC drug for more than 10 days for pain or 3 days for fever, call your doctor. These may be signs that you have a more serious problem or need a prescription medicine.

Side effects from OTC pain relievers aren’t common for healthy adults who only use pain relievers once in a while. However, side effects can be a concern for people who use pain relievers often or who have health problems. If you have health problems or use pain relievers often, talk to your doctor.

Acetaminophen can be used safely by most people. It can cause liver damage in people who take very high doses or who already have abnormal liver function . To reduce your risk of liver problems, never take more than the recommended dose of acetaminophen. For adults and children older than 12, this means a maximum of 8 extra-strength or 12 regular-strength pills a day.

With long-term use, NSAIDs can cause gastrointestinal (GI) problems. These problems range from upset stomach to ulcers to GI bleeding. For minor stomach upset, eating some food or drinking some milk before you take an NSAID may help. Your risk of GI problems from NSAIDs goes up the higher the dose you take and the longer you take them. Drinking alcohol may increase this risk. Acetaminophen is much less likely than NSAIDs to cause GI problems.

NSAIDs may also make high blood pressure worse. If NSAIDs are used regularly for many years, they can also hurt your kidneys. Your doctor can check for this problem with a blood test.

If you have questions about the side effects of OTC pain relievers, talk to your doctor.

You generally shouldn’t take acetaminophen if you are already taking another product containing acetaminophen. If you have severe kidney or liver disease, or if you have 3 or more drinks that contain alcohol every day, you should talk to your doctor before taking acetaminophen.

You shouldn’t take NSAIDs if you are allergic to aspirin or other pain relievers. Talk to your doctor or before you take an NSAID, especially aspirin, if you:

If certain drugs are taken at the same time, they can interact with each other and change the way your body processes them. This is called a drug interaction. When this happens, the risk of side effects increases.

For example, if someone who takes high blood pressure medicine also takes an NSAID, the high blood pressure medicine may not work as well as it should. See the drug interactions chart (PDF file: 2 pages / 50 KB. More about PDFs.) for more information on common interactions.

Many OTC drugs contain the same pain reliever or contain ingredients found in prescription drugs. By combining OTC medicines or taking a prescription drug with an OTC drug, you may be getting more than the recommended dose of the active ingredient (the substance in the medicine that works to relieve your symptoms). For example, many OTC cold medicines contain acetaminophen. If you were to take one of these products and also take acetaminophen separately, you would be taking much more acetaminophen than you intended.

See the Know What’s in the Medicines You Take chart (PDF file: 6 pages / 75 KB. More about PDFs.) to help sort out what drugs contain the same pain relievers so you can avoid taking too much.

When choosing an OTC pain reliever, check the drug label for possible side effects or interactions with other drugs you are taking. This information will appear in the “Warnings” section of the label.

Be sure to check that you are not taking two medicines that contain the same active ingredient. You will find this information in the “Active Ingredient” section.

Always read and follow the directions on the label. Be sure you understand the label information before taking the medicine. If you have any questions, ask your family doctor or pharmacist.