OTC Pain Relievers, Things to Consider

OTC pain relievers
With OTC pain relievers being used for safe and effective pain relief, it’s essential that everyone knows how to choose the type of pain reliever that is right for them as an individual. But a new survey suggests that may not be the case.A full one in five Americans do not consider any key safety factors when choosing which OTC pain relievers to take, according to a national survey conducted by the U.S. Pain Foundation with support from McNeil Consumer Healthcare. Though 97 percent say they feel confident when choosing which pain reliever to take, more than half of Americans don’t even consider their pre-existing medical conditions before reaching for an OTC, and two in three do not consider other OTC medications they are taking. Below are some very vital things you should consider before buying an OTC pain reliever.

Risks Depend on the Drug and Your Health

OTC pain relievers

Got sore muscles or a raging headache? Before you reach for that bottle in the medicine cabinet for pain relief, know what you’re taking — and what side effects it might cause. Always read the label and follow directions before taking any medication.

OTC Pain Reliever Types

Pain relievers come in two main varieties. Acetaminophen (Panadol, Tylenol) and nonsteroidal anti-inflammatory drugs — better known as NSAIDs — both help to relieve pain and reduce fever. NSAIDs include ibuprofen (Advil, Motrin), aspirin, and naproxen sodium (Aleve). Pain relievers come in many forms, including: tablets, caplets, gelcaps, and liquids.

Over-the-counter (OTC) pain relievers can be incredibly helpful in treating minor aches and pains. They can help relieve fevers, headaches, and other common ailments, and can be purchased at most drug stores and pharmacies.

But OTC pain relievers are not intended for long-term use. Taylor Butler, PharmD, Clinical Pharmacist at Vanderbilt University Medical Center, tells Verywell Health that you should talk to a doctor if you’re taking OTC pain relievers regularly (several times a week for several weeks). Some OTC options can present serious side effects when used habitually, and your doctor may want to monitor your health while you’re taking them.

Let your doctor know if the OTC pain relievers you’re taking aren’t alleviating your symptoms, because you may need a stronger medication—or a different treatment method entirely. Your doctor should be aware of any other medications you’re taking in order to prevent potentially harmful drug interactions.

What to Look for in an OTC Pain Reliever

Dosage: Dosage varies by ingredient, so be sure to check the recommended daily dosage and ask your doctor for guidance, especially if you’re taking any other prescription medications. Most tablet pain relievers on this list will include the recommended dose in a single serving (one or two tablets, depending on the brand), so for minor aches and pains, refer to the product’s recommended dosage.

Form: Most pain relievers can be taken orally (like Tylenol and Advil) or as topical creams (like Voltaren or Aspercreme). Depending on the severity and location of your pain, you may want to consider opting for one over the other.

Ingredients: OTC pain relievers aren’t a one-size-fits-all treatment. Ibuprofen, acetaminophen, and naproxen are some of the most commonly-used ingredients in oral pain relievers, while lidocaine and diclofenac gels are more common for topical application. Talk to your doctor about which OTC pain reliever is right for you, as each of these can have side effects if used for long periods of time.

Age Can Affect Pain Reliever Safety

OTC pain relievers

Years ago, parents often gave their children baby aspirin for fevers and illness. Now that doctors know more about Reye’s syndrome — a rare but serious condition that affects the brain, kidneys, and liver — aspirin is a no-no for children and teens during times of  illness. Sick kids can safely take ibuprofen and acetaminophen, as long as the dosage is right for their age and weight. Seniors also should use caution when taking OTC pain relievers, because older adults are more likely to develop side effects.

Safe pain treatment is available for older adults. While they are more likely to experience pain than the general population, in many cases, older adults are under-treated. Many older adults feel pain is just a natural part of aging and don’t tell their doctors about their problem. If you or someone you love is in pain, talk to a doctor.

Treating Pain in the Elderly

Although there are a number of pain relievers that are safe for older people, doctors must take special precautions when prescribing pain medication; older patients handle pain medication differently than younger patients. For example, because kidney function declines with age, there can be less effective filtration (removal of the drug). The kidney can also be more susceptible to injury from certain types of pain medications (e.g. NSAIDs). In addition, the liver undergoes a decrease in mass and blood flow with aging, making it harder for the liver to break down some medications. The way drugs are administered to older people also can become a challenge. Decreased saliva may interfere with swallowing, and injections may be more difficult in decreased muscle mass. Also, oral drugs may be absorbed differently because of changes in stomach acid levels.

To overcome these challenges, doctors often start their older patients on the lowest recommended dose and then increase the amount of medication if necessary.

Points to Consider

If you are an older person experiencing pain, keep in mind that you run a higher-than-average risk of side effects from all drugs, including analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs also are not recommended for people with kidney, liver, or heart issues and definitely should not be taken without first discussing it with your doctor.

There is also a risk that any medications may interact with those that you are already on. But having chronic medical problems and an increased risk of side effects does not mean that your pain cannot, or should not, be aggressively treated. You may be a candidate for any of the pain-relieving therapies available. But talk to your doctor before taking any over-the-counter medications. You may need to take a lower dose than recommended on the label.

What’s the safest OTC painkiller for an older parent?

For most older adults, the safest oral OTC painkiller for daily use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day.

Acetaminophen is usually called paracetamol outside the U.S.

It is processed by the liver and in high doses can cause serious — sometimes even life-threatening — liver injury. So if an older person has a history of alcohol abuse or chronic liver disease, then an even lower daily limit will be needed, and I would strongly advise you to talk to a doctor about what daily limit might be suitable.

The tricky thing with acetaminophen is that it’s actually included in lots of different over-the-counter medications (e.g. Nyquil, Theraflu) and prescription medications (e.g. Percocet). So people can easily end up taking more daily acetaminophen than they realize. This can indeed be dangerous; research suggests that 40% of acetaminophen overdoses cases are accidental.

But when taken at recommended doses, acetaminophen has surprisingly few side-effects and rarely harms older adults. Unlike non-steroidal anti-inflammatory drugs (NSAIDs, see below), it does not put older adults at risk of internal bleeding, and it seems to have minimal impacts on kidney function and cardiovascular risk.

Drinks and Pain Relievers

drinks and OTC pain relievers

Alcohol and OTC pain relievers can be a dangerous combination. Many drugs — including pain relievers — carry warnings about drinking alcohol if you are taking medication. Always read the label and follow instructions. 

Can I drink alcohol if I’m taking painkillers?

It depends on the type of painkiller.It is usually safe to drink a moderate amount of alcohol (no more than the daily guideline of alcohol units) if you are taking a painkiller that can be bought over the counter such as paracetamol or ibuprofen; providing you get relevant advice.It is not recommended to drink alcohol if you are taking a prescription-only painkiller such as tramadol or codeine. Doing so could increase side effects such as drowsiness. 

Over-the-counter painkillers

Paracetamol and ibuprofen

Paracetamol and ibuprofen are available without a prescription. Drinking a small amount of alcohol while taking paracetamol or ibuprofen is usually safe.

Paracetamol should be used with caution if you have certain health conditions, such as liver problems. A GP or pharmacist can advise you.

If you have liver or kidney problems, do not take ibuprofen unless a GP tells you it is safe to do so.

Never take more than the recommended dose of either painkiller as this could increase the risk of side effects; some of which can be severe.

 

Aspirin

Aspirin is now less commonly used as a painkiller due to the fact that it is more likely to cause side effects than paracetamol and ibuprofen.

Children under the age of 16 should not use aspirin.

People now often take low-dose aspirin for its blood-thinning properties as this can reduce the risk of heart attacks and stroke.

Drinking a small amount of alcohol while taking aspirin is usually safe.

Drinking more than the recommended daily limits may lead to bleeding from the stomach.

 

Prescription-only painkillers

Prescription-only painkillers for moderate pain include dihydrocodeine, gabapentin and tramadol. Morphine and pethidine are used for more severe pain.

Drinking alcohol with any of these medicines may make you drowsy and increase the risk of other side effects occurring, such as nausea.

Do not drink any alcohol while you’re taking them.

Some OTC Pain Relievers Affect Blood Pressure

Some OTC pain relievers may interact with some high blood pressure medications or can increase blood pressure in people not previously diagnosed with this condition. If you take prescription high blood pressure drugs, regularly monitor your blood pressure and consult your doctor to find out what OTC pain medication would be best for you.

Most people are aware there are certain drugs and substances that can raise blood pressure and alter the effectiveness of anti-hypertensive medications. These include a number of popular, over-the-counter remedies, such as cough syrups, allergy pills, and multi-symptom cold medicines.

Some of these do so by stimulating brain chemicals, called neurotransmitters, which cause constriction (narrowing) of blood vessels. Others so by directly affecting organs like the kidneys or causing retention of fluids that can influence blood pressure.

Here are six over-the-counter (OTC) and prescription drugs you may need to watch out for if trying to control your high blood pressure.

1). Nonsteroidal Pain Relievers (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most popular over-the-counter medicines in the world today. They are used to treat headaches, reduce fever, and, when taken in higher doses, alleviate pain and inflammation. While NSAIDs are typically safe, prolonged use can lead to alterations in blood pressure.

2). Tylenol (Acetaminophen)

Tylenol (acetaminophen) is used to treat many of the same symptoms as ibuprofen and naproxen but works in a different manner. As a non-aspirin analgesic, it has a chemical structure different from that of NSAIDs and also tends to have a lesser effect on inflammation.

While generally safe, one of the concerns about Tylenol is its effect on the liver. Long-term use or overuse can cause liver damage, which, in turn, can lead to a condition called portal hypertension. With portal hypertension, blood pressure increases in the liver turn into a rise in blood pressure throughout the body.

3). Nasal Decongestants

Decongestants work by slowing the production of mucus, which can clog breathing passages. The drugs achieve this by causing the constriction of blood vessels in the nose and sinuses, opening airways and reducing the sensation of fullness caused by allergies or colds.

4). Multi-Symptom Cold and Flu Remedies

Drug stores carry dozens of pills, syrups, and tablets designed to ease cold and flu symptoms. While each has different formulations, they are largely comprised of the same or similar basket of ingredients.

Some multi-symptom remedies contain decongestants and cough suppressants to help clear nasal passages and ease breathing. Ibuprofen or acetaminophen may be included to relieve muscle aches and fever. Each of these can, directly and indirectly, alter a person’s blood pressure.

5). Hormonal Birth Control

Virtually all hormonal birth control pills, patches, and devices are associated with increased blood pressure. Vascular constriction is a common side effect of these products, particularly among women who smoke, are overweight, or are over the age of 35.

6). Antidepressant Drugs

Antidepressants work by altering chemicals in the body associated with mood, including serotonin and dopamine. Both of these compounds are known to affect blood pressure.

Dopamine is often used in emergency situations to increase blood pressure in those experiencing a critical drop. Serotonin has a similar effect which may further enhance dopamine’s effect on the cardiovascular system.

Several types and classes of antidepressant drugs have been linked to increased blood pressure, including venlafaxine, tricyclic antidepressants, and fluoxetine.

Stomachs Can Be Sensitive

Some NSAID pain relievers, such as ibuprofen and naproxen sodium, can be tough on your gut. They can irritate the lining of the stomach, leading to ulcers and bleeding, or aggravate ulcers you already have. If you have to use an NSAID pain reliever, help protect your stomach by taking the lowest possible dose for the shortest possible time and take them with food. If you need an NSAID daily for more than a week, check with your doctor.

Pain Relievers Can Overwork Kidneys

Your kidneys are two hard-working organs. They filter wastes and keep the balance of fluids and electrolytes, but NSAIDs can interfere with their ability to do these jobs. Regular use of these drugs can worsen kidney disease and lead to kidney failure. If you have chronic kidney disease, check with your doctor before using any NSAID pain reliever. More kidney-friendly alternatives may be available. Also, combining alcohol with acetaminophen can cause kidney damage. Be careful not to mix the two.

How Healthy Is Your Heart?

OTC pain relievers can be a double-edged sword for people with heart problems. Daily low-dose aspirin can help ward off blood clots that can lead to a stroke or heart attack. On the other hand, long-term non-aspirin NSAID use, especially at high doses, can interfere with the blood-thinning effect of aspirin. It can also boost blood pressure and increase the risk of heart attack or stroke. People with heart disease or high blood pressure should check with their doctor before taking NSAIDs. They are generally not recommended for people with kidney disease, heart failure, or cirrhosis.

Read Labels to Know Your Medicine

read labels for OTC pain relievers

Combination over-the-counter products — such as cold and flu remedies — often contain several drugs. To avoid taking too much, look at the list of active ingredients. For example, if a medicine contains acetaminophen, you’ll know to avoid taking more separately. Reading labels can also help you avoid drugs you’re allergic to.

Liver Dangers With Pain Relievers

Acetaminophen-containing drugs and other pain relievers are usually safe and effective when used as directed, but all medications carry risks. Acetaminophen works great for pain relief, but it can affect your liver. Severe liver injury may occur if you take an overdose of acetaminophen. Always read the label and follow instructions. To prevent liver problems, don’t take more than the recommended total daily dose. Do not drink alcohol while taking acetaminophen-containing medications. And take the lowest dose possible for the shortest period of time. People with cirrhosis should avoid NSAIDs entirely and use acetaminophen only in small doses. Talk to your doctor to see which pain reliever is right for you.

Pregnancy and Pain Relief

When you’re pregnant, just about everything that goes into your body reaches your baby too. NSAIDS are not generally recommended for pregnant women during the third trimester due to an increased risk of complications in the newborn. If you’re in pain, check with your ob-gyn to evaluate the reason for your discomfort. There may be home remedies that can help, such as a massage or lukewarm soak for back pain. Before taking any pain reliever, check with your doctor to make sure it’s safe for you and your baby.

Drug Interactions

Some drugs just don’t play well with each other. Taking two that don’t mix can lead to dangerous interactions. For example, NSAIDs increase the risk of bleeding with the blood-thinner warfarin. And acetaminophen can also increase its effects. Because some drug interactions can be life threatening, tell your doctor or pharmacist about all the medications and supplements you’re taking, even over-the-counter drugs, vitamins, or herbal remedies.

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