OTC Pain Meds: Which One Should I Choose?

Hey! Thanks for coming back to Helpful Pharmacist. Today we are going to tackle what I consider to be a simple topic, but one that many of my customers seem to be confused about: OTC pain meds. OTC, of course, means over-the-counter.  As pharmacists, we sometimes take for granted that everyone knows what Tylenol is, and what it is used for. However, that is definitely not the case. So we will cover all of the OTC pain meds, their uses, and side effects, so you can see how simple this category really is.

Acetaminophen

Tylenol, or acetaminophen, is a name everyone knows. It has been around forever and is trusted by many. It is one of the most commonly used of the OTC pain meds. It is great to help reduce fever, cure headaches, and reduce all types of general pain. Acetaminophen does not reduce inflammation. If you have an injury where swelling or inflammation is involved, this may not be the best choice for you.

There are a few important facts that everyone needs to know before taking acetaminophen. The most important fact is that acetaminophen can severely damage your liver. Liver damage usually occurs because of long term, consistent use. It can also occur if you were to take more than the maximum daily dose. The max daily dose for acetaminophen is 4,000 mg in a 24 hour period. This is the equivalent of 8 extra strength Tylenol tablets. The good thing about liver damage is that it is usually reversible, as long as you don’t continue whatever you are doing to damage it.

Acetaminophen overdose is extremely common. Most overdoses are unintentional, and occur because the patient is taking multiple acetaminophen-containing products without realizing it. Many OTC cold, flu, or cough medications contain acetaminophen for pain or fever. If you aren’t aware of that and you take Tylenol in addition to that product, then you are putting yourself at risk. It is extremely important to read the labels of the OTC products you buy. You must be sure they don’t contain more ingredients than you need. You also want to avoid duplication of ingredients. Other sources of acetaminophen may be prescription cough and cold medications or stronger pain meds such as Norco or Percocet.

Dosing guidelines for adults can be found here. For children look here. For children, use their weight as the guideline when choosing a dose. Weight is a much more accurate guide than age for kids. Here is another important tip for you: use a measuring spoon or syringe for liquid medications. One teaspoon = 5ml. Don’t get a real spoon out of your silverware drawer. There is no consistency with the size of household spoons. You are taking a big risk if you don’t measure your medications correctly.

NSAIDs

NSAID is an acronym that you may have seen before. It stands for Non Steroidal Anti-Inflammatory Drug. This is a fairly large class of OTC pain meds. It includes ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin, as well as several prescription strength products. You will notice that anti-inflammatory is right there in the name. We mentioned before that acetaminophen wouldn’t be good for an injury or condition where swelling or inflammation is involved. This is the class of drugs you would look to for those conditions.  NSAIDs are used for inflammation, aches, pains, headaches, and also to reduce fever.

The most common problem with NSAIDs is that they can upset your stomach. The reason for this is because sometimes they can make a hole in the protective layer of your stomach, or a stomach ulcer. This can cause a burning pain and, in worse cases, bleeding in your stomach and intestines. When used properly, and in moderation, this side effect can usually be avoided by simply making sure you eat some food before you take your medication. The food will add another layer of protection inside your stomach.

Another possible side effect of NSAIDs is that they can cause thinning of the blood. Aspirin is the most likely to thin your blood. In fact, a lot of people take aspirin just for its blood thinning properties. This side effect should not be a very big concern for most people as long as you follow the proper dosing guidelines.

There isn’t much of a difference in how all of the NSAIDs work. Naproxen (Aleve) lasts a little longer in the body than aspirin or ibuprofen, so you don’t have to take it as often. It would be dosed every 8-12 hours whereas the others would be every 4-6 hours. Naproxen is also considered to be more effective for menstrual pain and cramping.

Naproxen and ibuprofen are both available in higher strengths as prescription products. Knowing this should not make you think it is ok to take higher doses on your own. I have had many people tell me that ibuprofen goes up to 800mg behind the counter so they feel safe in taking that much of the over the counter version. I tell them that those doses are restricted to prescription-only for a reason and that they should avoid playing doctor at home. Some of you are nodding your heads right now in guilt, I know it. I am talking to you.

Most other OTC pain meds that are found in the store are just combinations of the products I have already mentioned. Beware of creative marketing when shopping for them. A lot of smart companies will label their boxes with a common condition to make you think it treats that condition specifically. This specialization will also come with a higher price tag. An example of this would be Tylenol Arthritis or Advil Migraine. Read the ingredients on the box and you will see there is no magic formula. It is just the same medication in a more expensive box. You will be just fine using the less expensive version with the same active ingredient.

I hope you learned something here. If so, please share with your friends. Helpful Pharmacist can always use your help in spreading the word. Comments are also very helpful to me. Leave one if you like. If you have a more specific or private question fell free to send me an email.