Oral Over the Counter Pain Medications

I have a headache, which over the counter medicine should I choose?  I have high blood pressure, is there something I can take over the counter to help?  I had a heart attack and my doctor recommends I take an aspirin, which one should I take? I twisted my ankle and it is swollen, what over the counter medicine should I choose?

These are all questions we hear frequently.  Going to the pharmacy to figure out what pain reliever you should take can be overwhelming if you don’t know exactly what you need.  While there are quite a few different brands to choose from, they’re almost all some form of ibuprofen, acetaminophen, naproxen, or aspirin.

Below are some tips to picking out the right pain reliever for you. But the best option is always to go to your local pharmacy and ask the pharmacist!

Acetaminophen

• Tylenol is the brand name that has acetaminophen. All generic products that are labeled as acetaminophen or have the active ingredient as acetaminophen are the same thing as Tylenol.  For example, we have a generic product that is simply called Pain Relief tablets and its active ingredient is Acetaminophen–it is the same thing as brand name Tylenol tablets
• This is the most recommended over the counter pain relief tablet.  It is very safe and has few drug interactions.
• Things to keep in mind:
• -It only helps with pain, it will not help with inflammation.
• -The main warnings when taking acetaminophen are:
  1. Stay under 3 grams (3,000 mg) total a day (3,000 mg or 6 of the 500 mg tabs)
  2. Don’t drink alcohol while taking acetaminophen
  3. If you have liver problems don’t take this medication without speaking to your doctor or gastroenterologist first

NSAIDs

NSAID stands for Non Steroidal Anti-Inflammatory Drugs. The two main drugs available over the counter in this drug class are Ibuprofen (Brand–Advil/Motrin)and Naproxen (Aleve).These medications work a little better than acetaminophen for most types of pain, and they will help to reduce/lessen inflammation (think sprained ankle that is swollen–they can help to decrease the swelling).

Things to note:

1. The main difference between Ibuprofen and Naproxen is how long they last- Naproxen lasts longer than Ibuprofen.
2. NSAIDs are generally safe to use but have a few more restrictions and precautions than acetaminophen
3. If you have any heart problems you shouldn’t take an NSAID without your doctor’s or cardiologist’s approval
4. If you are taking a blood thinner (i.e. Warfarin, Aspirin, Plavix, Xarelto, etc.) don’t take ibuprofen without your doctor’s approval
5. Also, if you have uncontrolled high blood pressure, use caution when taking these medications because they can increase your blood pressure even more
6. NSAIDs can cause stomach upset and can potentially cause a stomach ulcer, so if you have a history of ulcers consult your doctor before taking

Aspirin (Ecotrin, St. John’s, Bayer)

Aspirin is also a type of NSAID–the same precautions listed above apply to aspirin with the exception of some heart conditions (i.e. Heart Attack). Aspirin is usually used for those that have had a heart attack or a heart stent. For these cases the recommended dose is 81 mg (aka Baby aspirin).

Never give Aspirin to children under 18 years of age (unless advised by a doctor for very specific reasons)–it can lead to something called Reye’s Syndrome which is a very serious and dangerous condition

Here are a few more tips when using over-the-counter pain medications.

1. Acetaminophen, Ibuprofen, and Naproxen are safe in children, however acetaminophen and ibuprofen are usually recommended because they have lower dose formulations specifically made for use in children.
   • As stated above, do not use Aspirin in children under 18.
2. Ibuprofen and acetaminophen can be used to reduce a fever in adults and children.
3. As stated above, all NSAIDs can cause stomach upset–acetaminophen is usually easier on the stomach.
4. Typically if an NSAID is needed to treat pain use Ibuprofen or Naproxen.
5. Don’t take two or more NSAIDs together (i.e. using Aspirin and Ibuprofen).
6. You can take and NSAID with Acetaminophen.
7. Excedrin Migraine for migraine headaches actually has Acetaminophen and Aspirin combined in one tablet (along with caffeine).