Oh my aching back..... Over-The-Counter Pain Relievers or Aspirin, Tylenol®, Motrin®, or Aleve®

There are many choices of over-the-counter (OTC) medicines and strength and trying to pick the best medicine can be challenging. As a pharmacist I welcome customers who ask questions (I actually wish more would). This article is meant to give you a head start the next time you are trying to choose an OTC pain reliever.

Over-The-Counter Pain Relievers

When taking a pain reliever it is important to take the lowest effective dose for the shortest time possible to reduce the chance of side effects. OTC painkillers can have severe side effects, especially at high doses. Make sure to never exceed the maximum dose and follow recommendations. Also, the generic options on all these medicines contain the same medicine at the same dose as the brand medication. I usually buy generic to save money.­­­ Also consider rest, icing, compression, and elevating injuries to reduce swelling and allow them time to heal.

Aspirin is the oldest pain and fever reliever. While once used as the “go to” medicine, it often is not recommended now. There is a condition called “Reye’s Syndrome” that can cause damage to the nervous system in those under the age of 25. Aspirin taken on a regular basis or at a very high dose can also cause bleeding in the digestive system. Aspirin comes in 325 mg and 81 mg strengths. The 325 mg strength is used for adults (this should not be used by people under age 25) who want to treat pain and fever with a dosage of 1-2 tablets every 4-6 hours as needed. The most common use of aspirin is 81 mg once daily to reduce the risk of heart attack or stroke in people with a history of cardiovascular risk. Aspirin has a “shelf-life”. After about a year or when the aspirin begins to smell sour you should get rid of old bottles. Aspirin allergies can be very severe, so avoid this medicine if you or anyone in your family is known to have an allergy.

Tylenol® contains the medicine Acetaminophen (also referred to as Paracetamol or by the initials APAP). It is usually the first pain and fever medicine that I recommend because if one doesn’t take too much, it usually has few side effects. The first thing to note is that an overdose of acetaminophen will cause liver damage that cannot be reversed.

It is very important to be careful with dosing of acetaminophen in infants and children, since their dose is based on the weight of the child and overall conditions. Parents should check with the baby’s doctor about recommended doses. The current recommendation is to treat the child if they have symptoms and not treat a fever without symptoms.

For adults the maximum dose is 4000 mg or 8 extra strength (500 mg) tablets each day if under 65 but I always suggest staying under 3000 mg if possible. The usual dose is 1-2 tabs every 4-6 hours. For those over 65 or with reduced liver function 3000 mg (6 tablets) is recommended. Acetaminophen is found in many cold and pain medicines so in considering the dosage first double check that you aren’t getting acetaminophen in your other medicines. Acetaminophen comes in 3 different strengths -325mg -regular, 500mg – extra strength, and 625mg -extended release - arthritis strength (dosed every 8 hours). If you need help figuring out the best dose for you ask your doctor or pharmacist and make sure to tell them about other medicine you are taking. I have found a regular dose of arthritis strength (650 mg) acetaminophen has helped me manage my arthritis pain.

Motrin® or Advil® both contain Ibuprofen usually in a 200mg dose. Ibuprofen belongs to a class of medicines called NSAIDs that effectively reduce pain and inflammation but also have some side effects to be aware of. Ibuprofen tends to be very effective and can be taken every 8 hours. A side effect of Ibuprofen is that it can cause blood vessels to constrict so it might raise your blood pressure. Long term use and higher doses of the NSAIDs can cause digestive bleeding and kidney disease. NSAID’s are not recommended for people with congestive heart failure.

Aleve® is another NSAID that contains Naproxen. Many people like Naproxen for pain because it is very effective and only needs to be taken every 12 hours. It has the same concern with side effects, in fact some people experience stomach distress with Naproxen so avoid taking it on an empty stomach and consider taking it with a full meal.

Since I mentioned the risk of bleeding of the digestive system, it is worth taking a moment to describe that. Since your digestive system is “on the inside” you won’t see blood if you are bleeding in your stomach or intestine. Often you will notice a change to your bowel movements, which can be dark black and tarry or look like coffee grains. If you see those black bowel movements it is time to seek the help of a doctor and stop taking your NSAIDs or aspirin.

Since I have gotten a little wordy here, I will save a discussion of topical pain relievers for another time. For many it is worth trying a “rub” or a “patch” or even a TENS unit which are all available over the counter. Remember to always follow label directions for pain medications and consult your physician or pharmacist if you do not get relief.

As with all my recommendations, let me add a caveat here. We are all individuals and your doctor knows you better then anyone else. Do not change your doctors recommendations based on a blog. Also seek medical attention right away if you have any severe problems or reactions. If you need more answers or would like a personal consultation contact me at ashbyrx.com