Bay Area Medical Information
Pain Relief (Over-the-Counter)
Over-the-counter pain relievers commonly contain one or more of the following active pain relief ingredients:
  • acetaminophen (Tylenol)
  • aspirin
  • ibuprofen
  • naproxen sodium

Many prescription and OTC combination, multi-symptom cold and flu preparations also include these pain relievers as active ingredients.
Be sure to read the labels before taking so you don’t combine the same active pain relief ingredients. This could result in a toxic dose of that ingredient.

Acetaminophen (Tylenol) Acetaminophen is the most widely used pain reliever and fever reducer in the United States, and it's readily available in most parts of the world. Partly because it is so easy to obtain, acetaminophen causes more overdoses and overdose deaths than any other drug in the United States. It's frequently the drug of choice for adolescent suicide attempts. There is an antidote but it must be administered within eight to 10 hours after an overdose has been ingested. Other overdoses occur simply because people underestimate or are unaware of acetaminophen's toxicity. Many cold remedies already contain acetaminophen (Tylenol), thus overdoses can easily occur by taking acetaminophen in addition to these preparations. Parents can make a variety of mistakes in the amount of acetaminophen they give their children. Some aren't satisfied with the performance of the recommended dosage of acetaminophen, and decide more will be better. Others may mistakenly give adult tablets instead of the children's formulation. Even the children's versions of acetaminophen come in many different formulations, and the dosage varies for each one. For example, the infant drop formulation is three times as concentrated as the elixir or syrup typically given to toddlers. It's easy to see how a busy parent might assume that both liquids contain the same amount of medicine. But substituting infant drops for syrup could result in a dose of acetaminophen three times what it should be.(10)
Toxic levels of acetaminophen can result in severe liver damage or liver failure. Your liver is a vital organ--you can't live without it. People who habitually drink excessive amounts of alcohol have a higher risk of liver damage from acetaminophen. Even as few as three drinks at one time may have toxic effects on the liver when combined with certain over–the–counter medications, such as those containing acetaminophen.

Aspirin Salicylate or salicylic acid It is used to relieve pain, fever, and the inflammation associated with arthritis. Aspirin may also be used to lessen the chance of heart attack, stroke, or other problems that may occur when a blood vessel is blocked by blood clots. Aspirin helps prevent dangerous blood clots from forming, but only should be taken under the supervision of a physician.
1) Can irritate the stomach or cause GI bleeding. Aspirin should always be taken with food, preferably after a meal due to its potential for stomach irritation and GI bleeding.
2) Children and teen-agers suffering from flu-like symptoms, chickenpox and other viral illnesses shouldn't take aspirin because of the possibility of Reye syndrome. Be sure to educate teen-agers, who may take OTC medicines without their parents' knowledge.(7)
3) The anticoagulant effect of aspirin may increase the chance of serious bleeding in some people. Therefore, aspirin should be used for its preventive anticoagulant effects only when your doctor decides, after studying your medical condition and history, that the danger of blood clots is greater than the risk of bleeding. (8)
4) Aspirin is also contraindicated in: people with allergy to aspirin or NSAIDs (Advil, Motrin, Alleve, etc), 3rd trimester pregnancy. Precautions: History of asthma or peptic ulcer, severe hepatic (liver) or renal (kidney) dysfunction, bleeding disorders, diabetes, gout, pregnancy or nursing mothers. Aspirin interacts with many medicines. (9) For more contraindications and a list of drugs that interact with aspirin, click here

Ibuprofen (Advil) Useful for minor arthritic pain, fever, headaches, minor aches and pain. Always take with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions dehydration, pregnancy, nursing mothers. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with ibuprofen. For children: Use children's or junior form. Ibuprofen tends to be more effective than acetaminophen in treating high fevers (103 degrees Fahrenheit or higher). However, ibuprofen should only be given to children older than 6 months. Never give it to a child who is dehydrated or vomiting continuously. If your child has a kidney disease, asthma, an ulcer or other chronic illness, ask your pediatrician if it is safe for your child to take ibuprofen.(9,14)

Naproxen Sodium (Aleve) for minor arthritic pain, headaches, minor aches and pain. Should be taken with food and fluids as it can cause stomach irritation, ulceration or even GI bleeding. Increased risk of GI bleeding wtih alcohol. Do not take aspirin or other pain relievers with naproxen. Not recommended for children. Contraindicated in people with aspirin allergy, 3rd trimester pregnancy. Precautions gastrointestinal disease, liver or kidney disease, dehydration, pregnancy, nursing mothers.(9)

Written by N Thompson, MSN, ARNP Last updated October 2006

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