OTC

By Peter Galvin, MD

Oral nonprescription pain medications are nonopioid drugs that are available over the counter. Common ones include acetaminophen (paracetamol, brand name Tylenol), which treats pain and reduces a fever but does not reduce inflammation, and aspirin, ibuprofen, and naproxen sodium, which are nonsteroidal anti-inflammatory drugs (NSAIDs) that treat pain, reduce a fever, and reduce inflammation. They are all effective for treatment of mild to moderate pain, are widely available, low cost, and have no risk of addiction. But don’t be fooled. Just because they are available without a prescription does not mean that they are harmless. For example, acetaminophen can cause liver toxicity if the daily dose exceeds 3 to 4 grams (3000 to 4000 mg) and, if taken as an overdose, can cause fulminant liver failure and death. NSAIDs can cause gastrointestinal bleeding, even if taken at recommended dosages.

Some NSAIDs are also prescribed by doctors for pain, for example naproxen and ibuprofen, so it is important to let your doctor know if you are already taking the OTC versions of these drugs to avoid an overdosage. Prescription dosages are usually higher than OTC dosages. Also, if you plan on taking acetaminophen, you need to know the following:

• Talk to your doctor or pharmacist before you take acetaminophen if you have liver disease, take warfarin (Coumadin), or consume two or more alcoholic drinks a day.
• Acetaminophen is available in multiple strengths. Be sure to read the package label to identify the recommended dosing.
• As noted above, acetaminophen overdosage can be fatal. Anyone with an intentional or unintentional overdose needs immediate medical care.

You need to know the following if you plan to take NSAIDs:

• Before taking them, talk to your doctor or pharmacist if you are pregnant, have a history of gastrointestinal bleeding or ulcers, have liver or kidney disease, high blood pressure, heart disease including heart attack or heart failure, stroke, or if you consume more than three alcoholic drinks a day.
• NSAIDs are available in multiple dosages. Read the package label to identify the recommended dosing.
• Common side effects include nausea, heartburn, and dizziness. Take with food or milk to decrease these side effects.
• Gastrointestinal bleeding, ulcers, and stomach perforation are rare but serious side effects. Risk factors include being age 60 or older, taking a blood thinner or oral steroid, and having a history of gastrointestinal bleeding or ulcers.
• Ibuprofen and naproxen increase the risk of heart attack, heart failure, high blood pressure, and stroke, especially in those with a history of these diseases. The risk may occur shortly after starting them and may increase with higher dosages and longer duration of use.

Stop taking these drugs and seek emergency medical care if you develop hives, facial swelling, difficulty breathing, severe dizziness, or skin reactions such as skin reddening, rash, or blisters. Also, contact your doctor if you have pain that lasts more than a week despite the daily use of these medications.

For more information go to the National Library of Medicine at:

www.dailymed.nlm.nih.gov/dailymed/

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