Caution When Using Over-The-Counter Pain Relievers

Posted on Oct 05, 2012 by William J. Claiborne, DDS MS

Once upon a time, if you had pain, you took aspirin. Now, drug options have greatly expanded. For most mild to moderate pain, over-the-counter pain relievers (analgesics), like non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are the first choice.

Because these medications do not require a prescription, many assume they are safe. However, analgesics can have side effects and interact with other medicines, dietary supplements and alcohol. Because they contain the same ingredients found in many nonprescription and prescription drugs, you could be getting more of a particular pain reliever than you realize if you’re taking several medications.

Non-steroidal anti-inflammatory drugs, or NSAIDs include aspirin, ibuprofen (Advil, Motrin), naproxen sodium (Aleve, Naprosyn), and ketoprofen (Orudis).

Non-steroidal anti-inflammatory drugs reduce pain and inflammation by inhibiting production of the prostaglandins (hormone-like substances) that cause them. The down side is that they also block other prostaglandins that protect the stomach lining, regulate blood flow to the kidneys, and initiate blood clotting.

Stomach inflammation, peptic ulcers, and intestinal bleeding are major hazards for NSAID users. People who take high doses for an extended time are at greater risk, especially older adults.

Acetaminophen (Tylenol, Anacin-3, etc.) relieves pain by affecting the parts of the brain that receive pain signals. Although acetaminophen reduces pain and fever, it has no effect on inflammation, but neither does it cause the bleeding and clotting problems associated with NSAIDs.

Acetaminophen is metabolized by enzymes in the liver. Taking too much can lead to liver damage in susceptible people, such as those who drink alcohol regularly. Always check the labels of any medication to ensure you’re not exceeding the maximum recommended dose of acetaminophen.

For most, taking nonprescription pain relievers as directed is generally safe. The potential for trouble emerges when you add the following:

• Some NSAID and acetaminophen products, as well as cold, sinus, and allergy remedies, contain a combination of pain relievers. Regular and long-term use of painkillers that combine analgesics can damage the kidneys.

• Many prescription painkillers contain acetaminophen (Darvocet, Vicodin) or NSAIDS (Celebrex, Percodan). Do not take both prescription and over-the-counter painkillers without checking with the prescribing doctor first.

• NSAIDs can interact with many drugs, including ACE inhibitors, anticoagulants, beta blockers, lithium, and methotrexate. Aspirin interacts with anticonvulsants, corticosteroids, insulin, and sulfa antibiotics. If you take any of these prescription medicines, check before using NSAIDs.

• Herbal supplements such as garlic, ginger, feverfew, ginkgo, and ginseng can thin blood and should be avoided when taking an NSAID.

• NSAIDs can interfere with absorption of folic acid. If taking NSAIDs regularly, take a multivitamin daily.