Are OTC pain relievers safe?

Note: This is general advice only. If you’re concerned about your health or have questions about medications, please seek the advice of a qualified healthcare professional.

Over the counter (OTC), non-opioid pain relievers are helpful to relieve the minor aches and pains like headaches, fever, colds, flu, arthritis, toothaches and menstrual cramps. But there are real dangers with taking these meds too often, and/or taking too much.

Nonopioids are non-narcotic drugs used to treat mild to moderate pain, fever, and swelling. These medicines are stronger than most people realize. In many cases, they are all you’ll need to relieve your pain — you just need to be sure to take them as recommended by your doctor or pharmacist so you maintain pain relief.

You can buy most nonopioid pain medicines without a prescription, but you still need to talk with your healthcare provider before taking them. Some of them may have things added to them that you need to know about, and they do have side effects. Common ones, such as nausea, itching, or drowsiness, usually go away after a few days.

Also, do not take more than the label says unless your healthcare provider tells you to do so — see below for some of the dangers.

There are basically two types of OTC medications for pain relief: acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).

The basics of acetaminophen

Acetaminophen (commonly known by the brand name Tylenol), is an active ingredient found in more than 600 OTC and prescription medicines, including pain relievers, cough suppressants, and cold medications.

  • Acetaminophen reduces pain, but it is not helpful with inflammation.
  • Most of the time, people don’t have side effects from a normal dose of acetaminophen, but taking large doses of this medicine every day for a long time can damage your liver. Drinking alcohol with a typical dose can also damage the liver.
  • Make sure you tell the doctor that you’re taking acetaminophen. Sometimes it is used in other pain medicines, so you may not realize that you’re taking more than you should. Also, your doctor may not want you to take acetaminophen too often if you’re getting chemotherapy, as the medicine can cover up a fever, hiding the fact that you might have an infection.

The basics of nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (as in Advil or Motrin) and aspirin.

  • NSAIDs help control pain and inflammation, and relieve fever and headaches, minor aches and muscle soreness.
  • They act by inhibiting an enzyme that helps make a specific chemical (inhibition of intracellular cyclo-oxygenase enzymes [Cox-1 and Cox-2] which cause a decrease in synthesis of the pro-inflammatory prostaglandin).
  • The most common side effect is stomach upset or indigestion. Eating food or drinking milk when you take these drugs may stop this from happening.
  • Nonsteroidal anti-inflammatory drugs are also commonly included in many medicines taken for colds, sinus pressure, and allergies.
  • NSAIDs may also keep blood from clotting the way it should, which means that it’s harder to stop bleeding after you’ve hurt yourself. NSAIDs can also sometimes cause bleeding in the stomach.

Tell your doctor if:

  • Your stools become darker than normal
  • You notice bleeding from your rectum
  • You have an upset stomach
  • You have heartburn symptoms
  • You cough up blood

Acetaminophen and NSAIDs at a glance

Type Other names Effects & side effects
Acetaminophen Tylenol
  • Reduces pain.
  • Lowers fever. Talk to your doctor if your body temperature is above normal (98.6 degrees F) and you are taking this medicine.
  • Taking a higher dose than recommended will not provide more relief and can be dangerous.
  • Large doses can damage the liver, and may cause liver damage if you drink three or more alcoholic drinks a day.
  • Be cautious when giving acetaminophen to children. Infant drop medications can be significantly stronger than regular children’s medications. Read and follow the directions on the label every time you use a medicine. Be sure that your infant is getting the infants’ pain formula, and your older child is getting the children’s pain formula.
NSAIDs (aspirin, ibuprofen, naproxen)
  • Bayer (aspirin);
  • Ecotrin (aspirin);
  • Advil (ibuprofen);
  • Motrin (ibuprofen);
  • Nuprin (ibuprofen)
  • Aleve (naproxen)
  • Reduces pain, inflammation (swelling), and fever.
  • Can upset the stomach.
  • Can cause bleeding of the stomach lining, especially if you drink alcohol (wine, beer, etc.).
  • Use of NSAIDs, such as aspirin and ibuprofen, is a leading cause of peptic ulcers.
  • Can cause heart problems, especially in those who already have heart disease. However, aspirin does not cause heart problems.
  • Avoid these medicines if you are on anticancer drugs that may cause bleeding.
  • Lowers fever. Talk to your doctor if your body temperature is above normal (98.6°) and you are taking this medicine.
  • Use of NSAIDs can also cause kidney damage. This risk may increase in people who are over 60 years of age, are taking a diuretic (a drug that increases the excretion of urine), have high blood pressure, heart disease, or pre-existing kidney disease.
What to avoid when taking NSAIDs

Some people have conditions that NSAIDs can make worse. In general, you should avoid these drugs if you:

  • Are allergic to aspirin
  • Are getting chemotherapy
  • Are on steroid medicines
  • Have stomach ulcers or a history of ulcers, gout, or bleeding disorders
  • Are taking prescription medicines for arthritis
  • Have kidney problems
  • Have heart problems
  • Are planning surgery within a week
  • Are taking blood-thinning medicine (such as heparin or Coumadin)

This article was adapted from material by The National Institutes of Health; the National Cancer Institute; the National Cancer Institute; National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases; and the US National Library of Medicine.

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