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OTC Pain Medications and Their Risks

Drugstore shelves have so many choices of over-the-counter (OTC) pain medication that it can seem difficult to find one that you like. But OTC pain relievers can be divided into just 2 main types: acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen is available as a generic medicine and by the brand name Tylenol. You'll find a few different NSAIDs, such as ibuprofen, naproxen, aspirin, and ketoprofen. Some medicines, such as Excedrin Extra Strength, combine acetaminophen and aspirin.

You need a prescription to buy stronger pain relievers called opioids. Codeine, which is one type of opioid, is found in a variety of cough suppressants. In a few states, cough medicines with codeine can be bought at pharmacies without a prescription. It's also in pain relievers along with acetaminophen. Codeine can make you feel sleepy, so you need to be careful when taking it.

Using OTC pain relievers

Acetaminophen and NSAIDs are both good for treating fever and many types of pain. These include sore throat, low back pain, pain after surgery, and pain from colds, the flu, and sinusitis. Acetaminophen brings down a fever and eases pain by acting on the parts of the brain that control pain and body temperature. NSAIDs reduce pain and fever by forcing your body to make fewer hormone-like chemicals called prostaglandins. These chemicals play a role in body temperature control. They can also irritate your nerve endings, causing pain.

NSAIDs like ibuprofen are especially good at easing pain from swelling and inflammation, such as menstrual cramps and muscle sprains. Acetaminophen doesn't help with inflammation, but it's good for headaches and arthritis pain.

Woman reading label on bottle of aspirin

Risks of OTC pain relievers

Most people don't think of OTC pain relievers as dangerous because you don't need a prescription to buy them. In most cases, they are quite safe when they are used just as directed. But they can have some major risks, especially if you don't follow the directions.

NSAIDs sometimes cause bleeding in the stomach and gastrointestinal tract in older adults and others. This is true even in normal dosages. Also, children and teens under 19 should never take aspirin. It can cause a rare but potentially fatal condition called Reye syndrome.

One of the most serious problems with OTC pain relievers is taking too much of them at any one time. If you take more of a drug than is recommended, it can cause health problems. If you frequently take too much acetaminophen, it can cause serious liver damage and even death. Acetaminophen is the leading cause of acute liver failure in the U.S. Overuse of NSAIDs can cause kidney disease and kidney failure or serious stomach bleeding.

Some cough and cold medicines and allergy medicines may contain acetaminophen or an NSAID along with other ingredients. So it's important to carefully read the labels of all the drugs you might be taking. That way you won't inadvertently take a double dose of the same type of drug in 2 different products.

It's also important to know that many prescription pain medications contain acetaminophen or NSAIDs. If your doctor gives you a prescription medicine for pain, make sure you understand what's in that medicine. Don't combine it with similar OTC drugs, or this will put you at risk for overdosing. Always ask your doctor or pharmacist if you are unsure.

Another problem is taking pain relievers for many days. Most of these medicines have a recommended maximum number of days that you should take them. Look for this information on the product label. Some medicines can be used safely in the long term for chronic pain such as arthritis. You should talk about this with your doctor.

Pain relievers can react harmfully with other medications, especially blood thinners. If you take any prescription drugs, ask your doctor if you should avoid any OTC pain relievers. Also, some OTC pain relievers can make certain medical conditions worse. So find out from your doctor which ones are safe for you.

Alcohol is a concern with some OTC pain relievers, especially acetaminophen. Taking acetaminophen and drinking alcohol can lead to liver damage and failure. If you frequently have 3 or more drinks a day, talk with your doctor before taking acetaminophen. Alcohol can also increase an NSAID's risk of causing gastrointestinal bleeding and ulcers. Alcohol should never be used with an OTC pain reliever containing codeine. Mixing alcohol and opioids can cause difficulty breathing and even death.

Be especially careful when giving OTC pain relievers to children. Use only the special device that comes with the package to measure out a dose. And never give a child more than the recommended dosage. Also, check other medicines your child is taking to make sure you are not accidentally double-dosing.

Additional concerns about codeine

Medicines that contain codeine can make you feel very sleepy. This can be risky for you and those around you. In many cases, medicines with codeine are meant to be taken before bedtime, so make sure you are following all directions carefully.

If you're breastfeeding and taking codeine, your breast milk will have codeine in it. This can put your baby at risk for overdosing on codeine. Talk with your doctor before using an OTC that has codeine in it. 

Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Turley, Ray, BSN, MSN
Last Review Date: 7/30/2014
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