OTC Pain Medicines and Their Risks
Drugstore shelves have so many choices of over-the-counter (OTC) pain medicine that
it can be hard to find one that you like. But most OTC pain relievers can be divided
into just 2 main types. They are either acetaminophen or nonsteroidal anti-inflammatory
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 is one
type of opioid. It is found in many cough medicines. Cough medicines with codeine
can be bought at drugstores without a prescription in a few states. Codeine is also
in pain relievers along with acetaminophen. Codeine can make you feel sleepy, so you
need to be careful when taking it. Codeine use also carries the following risks:
Constipation and nausea
Misuse and abuse
Other types of OTC pain relievers are sold as patches or creams that contains lidocaine,
menthol, capsaicin, or a combination of these. These products often contain lower
doses of medicines that require a prescription.
Using OTC pain relievers
Acetaminophen and NSAIDs are both good for treating fever and many types of pain.
Low back pain
Pain after surgery
Pain from exercising or doing physical activity
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. This
causes you to feel pain.
NSAIDs such as ibuprofen are especially good at easing pain from swelling and inflammation.
This can be from menstrual cramps, a sore throat, or 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. This is especially true if you
don't follow the directions. Below are some things to keep in mind.
Side effects can be serious
NSAIDs sometimes cause bleeding in the stomach and digestive tract. This is true even
in normal doses. Talk with your healthcare provider to find out what food to eat before
taking certain pain relievers such as NSAIDs. This is to reduce the risk for stomach
problems, especially if you take these medicines for a longer period of time. Children
and teens should never take aspirin. It can cause a rare but potentially fatal condition called Reye syndrome.
Too much can be harmful
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 often 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 it can
cause serious stomach bleeding. Taking too much aspirin at once can be deadly.
Read the labels carefully
Some cough and cold medicines and allergy medicines may have acetaminophen or an NSAID
along with other ingredients. So it's important to carefully read the labels of all
the medicines you take. That way, you won't accidentally 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,
understand what's in that medicine. Don't combine it with similar OTC medicines. 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.
Medicines can interact
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 taking any OTC pain relievers. Also, some OTC pain relievers can make certain
health conditions worse. So find out from your healthcare provider which ones are
safe for you.
Talk with your provider or pharmacist before buying any OTC medicine. They can help you choose a medicine that's best for you based on your health history
or condition. Tell your provider or pharmacist about any medicine or food allergies
you have. Also tell them what prescription or OTC medicines you are taking. Include
any herbal supplements, vitamins, or other product you are using. This information
will help your provider or pharmacist recommend an OTC medicine.
Adding alcohol can be dangerous
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 taken with an OTC pain reliever containing codeine.
Mixing alcohol and opioids can cause difficulty breathing and even death. If you have
a liver condition or liver disease, talk with your provider to see if it's safe for
you to use acetaminophen. If it is, find out the correct dose to take.
Double-dosing and children
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 by giving medicines with the same active
ingredient. This can lead to serious side effects or a life-threatening overdose.
When buying an OTC medicine, always read and compare the label with medicines your
child is currently taking. Once you get home, check the active ingredient or ingredients
of the OTC medicine against other OTC or prescription medicines your child is currently
taking. If you are not sure how to compare the active ingredients of the medicines,
ask your child's healthcare provider or pharmacist. Ask them if it's OK to give the
OTC medicine with the other medicines your child is currently taking.
Never give aspirin to your child unless your child’s healthcare provider tells you
to. Children who take aspirin may get a serious illness called Reye syndrome.
Always check with your child's provider or pharmacist before giving your child any
type of OTC medicine, for the first time. Check the label of the OTC medicine and
its expiration date to make sure it is safe for babies and toddlers younger than 2
Additional concerns about codeine
Medicines that have 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 breastmilk 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.