OTC Pain Medicines and Their Risks
Drugstore shelves have so many choices of over-the-counter (OTC) pain medicine 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 medicines
Acetaminophen is available as a generic medicine. You'll find a few different NSAIDs,
such as ibuprofen, naproxen, aspirin, and ketoprofen. Some medicines combine acetaminophen
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.
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
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 medicine 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
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 medicines you might be taking. That way you won't inadvertently take a
double dose of the same type of medicine in 2 different products.
It's also important to know that many prescription pain medicines contain acetaminophen
or NSAIDs. If your healthcare provider gives you a prescription medicine for pain,
make sure you understand what's in that medicine. Don't combine it with similar OTC
medicines, or this will put you at risk for overdosing. Always ask your healthcare
provider 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 healthcare provider.
Pain relievers can react harmfully with other medicines, especially blood thinners.
If you take any prescription medicines, ask your healthcare provider if you should
avoid any OTC pain relievers. Also, some OTC pain relievers can make certain medical
conditions worse. So find out from your healthcare provider which ones are safe for
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 healthcare provider 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. Codeine can
also cause nausea and constipation.
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 healthcare
provider before using an OTC that has codeine in it.