With the recent front-page news about the possible hazards of pain medications, you may be taking a look at your over-the-counter (or OTC) pain medications with a wary eye. While all drugs, including those you don't need a prescription for, can be dangerous, some basic knowledge can help you avoid the pitfalls for the pain relief you need.
Types of OTC pain medication:
The pain-relief aisle of any drug store can make it seem like there's an infinite number of pain-relief medications. But there are really only three types. Each type works in a different way and can cause different types of problems.
Aspirin: Aspirin blocks the activity of pain hormones called prostaglandins, which would otherwise send pain information to the brain. In addition, by blocking prostaglandins you reduce the pain and discomfort of inflammation (swelling and heat indicating immune function).
Acetaminophen: Acetaminophen is found in drugs like Tylenol, as well as some generic OTC medications and in prescription pain-relief products. Acetaminophen travels through your bloodstream to the brain, reducing pain-related brain activity and fever. Because it doesn't work through the hormonal system, it doesn't do as good a job of reducing swelling and inflammation as the other two types of pain medication.
Non-steroidal anti-inflammatories: These are sometimes called NSAIDs (pronounced N-Saidz). This isn't a single chemical, like acetaminophen, but a group of chemicals including ibuprofen, naproxen and ketoprofen, all of which block the production of prostaglandins, and thus pain and swelling. A number of NSAIDs are available over-the-counter, including brands like Aleve, Ibuprofen (generic) and Motrin; some newer NSAIDs, like Celebrex and Vioxx , need a prescription.
How To Take Aspirin Safely
In addition to blocking pain signals, aspirin blocks the production of blood clots. Strokes can be caused by blood clots blocking the brain's blood vessels and aspirin reduces the chance that such clots will form, so physicians will sometimes recommend a low dose of daily aspirin to prevent strokes in high-risk patients.
However, this also means that it's harder to stop bleeding if you're taking aspirin. People who are already on blood thinners (like Coumadin) should not take. Similarly, pregnant women have an increased risk of bleeding if they take aspirin, so if you need pain relief while pregnant, speak with your healthcare worker for a better options.
Aspirin can quickly lead to ulcer formation and potentially-dangerous gastric (stomach) bleeding. Enteric coating reduces the likelihood of harm, but even so, aspirin should not be taken for long periods of time without consulting a physician.
Some people are allergic to aspirin, and may experience a variety of symptoms (potentially serious) on taking it. If you're allergic to aspirin, you shouldn't take aspirin or NSAIDs without consulting a physician.
Lastly, children and teens with chicken pox, flu, or other viral illness should not be given aspirin (even children's aspirin) without first consulting a physician, as the combination of certain illnesses and aspirin can lead to a potentially fatal complication called Reye's syndrome.
How To Take Acetaminophen Safely:
Acetaminophen, taken in high doses or over long periods of time, can cause liver damage and, eventually, liver failure. If you think you may have taken too much, call a healthcare provider or poison control center right away.
Alcohol consumption can magnify the effect of acetaminophen on the liver. If you regularly have three or more alcoholic drinks per day, you should check with your healthcare provider before taking acetaminophen (or any other pain reliever).
Because of the potential for overdose, children should never be given "extra strength" acetaminophen products. Regular strength ones should be given at the stated doses for children or after speaking with a healthcare professional or pharmacist.
How To Take Over The Counter NSAIDs Safely:
NSAIDs slightly increase the risk of bleeding. People on blood thinners, pregnant or nursing women, and people at risk for internal bleeding should not take these products. They can also affect your liver's function and health and lead to gastrointestinal bleeding.
In order to avoid these effects, you shouldn't take more than one NSAID at a time or an NSAID with aspirin without first consulting a physician. If you're taking a multi-drug medication (for example, pills for relief of menstrual symptoms may include several different medications), make sure it doesn't already contain an NSAID if you're taking an NSAID separately. Lastly, pregnant and nursing women should speak with their healthcare provider before using an OTC NSAID.
Other Things To Think About:
If you find yourself taking any OTC pain reliever over a long period of time (several weeks), you should see your healthcare provider. The pain may indicate a problem that needs to be dealt with rather than masked, and there may be treatment that will take care of the problem, rather than merely covering the symptoms.
Adkinson: Middleton's Allergy: Principles and Practice, 6th ed., Ch.93, 2003
"Aspirin," Mosby's Drug Consult, Mosby, Inc, 2005
"Acetaminophen," Mosby's Drug Consult, Mosby, Inc, 2005
"NSAID," Mosby's Drug Consult, Mosby, Inc, 2005
"Ibuprofen," Mosby's Drug Consult, Mosby, Inc, 2005
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