US Pharm. 2012;37(5):35-26.
Understanding Nonprescription Pain Products
Choosing and correctly using the right nonprescription pain
medication is important. Health care professionals often recommend an
OTC pain medication to treat mild-to-moderate pain that is expected to
be of short duration. People sometimes use nonprescription pain products
to treat occasional, familiar pain such as tension headaches, menstrual
cramps, or lower back strain. Long-term use of a nonprescription pain
medication is possible when a health care professional recommends it for
a chronic condition, such as osteoarthritis.
The two types of pain relievers that do not require a prescription
are acetaminophen (e.g., Tylenol) and nonsteroidal anti-inflammatory
drugs, or NSAIDs (aspirin, ibuprofen, and naproxen). These medications
are available in nonprescription strengths, and new labeling regulations
require that the packaging include specific instructions on how to use
the product safely and effectively.
OTC pain medication also may be found in multisymptom formulations
such as cold, allergy, and sleep products. Some OTC pain remedies
contain more than one nonprescription pain medication. Nonprescription
pain agents are sometimes added to prescription pain products to treat
It is essential for patients and their providers to be aware of any
nonprescription pain medication contained in the ingredients of a
product designed to treat mild-to-moderate pain. It is equally important
to know the actions of these medications, as well as their possible
side effects. Some pain products also lower fever, stop menstrual
cramping, or reduce inflammation. Recently, the FDA initiated a program
to help people understand how to use nonprescription pain medications
and prevent side effects.
Be Familiar With Usage Instructions for and Ingredients in Pain Medications
OTC pain medications may be divided into two categories:
acetaminophen (Tylenol is one brand) and nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin, ibuprofen (Motrin or Advil), and
naproxen (Aleve). Both types are pain relievers and fever reducers.
Acetaminophen is safe for children under 18 years of age who are
suffering from the flu or chickenpox because it does not increase the
risk of Reye’s syndrome. Acetaminophen does not treat inflammation or
relieve menstrual cramps; however, it is sometimes recommended for
relieving the pain and stiffness of arthritis in patients who cannot
take NSAIDs. Acetaminophen is a component of many combination drug
products, including those used for colds, sinus pain, migraines,
insomnia, and arthritis. This nonprescription product is also found in
prescription pain medications such as Tylenol with Codeine. The
abbreviation often used for acetaminophen on prescription medication
bottles is APAP.
Acetaminophen is safe when taken as directed, but it can be toxic to
the liver when a higher-than-recommended dosage is used or when it is
taken with other products that contain acetaminophen. People at high
risk for liver damage from acetaminophen are those with pre-existing
liver disease or those who drink three or more alcoholic beverages
daily. Symptoms of liver damage include poor appetite, nausea, and
The NSAIDs aspirin, ibuprofen, and naproxen do not require a
prescription. Because of the risk of Reye’s syndrome, aspirin is not
recommended for use in children under 18 years of age who have
chickenpox or the flu. NSAIDs also are used as anti-inflammatories and
are useful for relieving menstrual cramps.
NSAIDs are considered safe when taken as directed, but they can cause
serious gastrointestinal side effects such as stomach bleeding, as well
as kidney damage and high blood pressure. People at high risk for
toxicity from NSAIDs are those who have pre-existing stomach problems;
have heart, liver, or kidney disease; take interacting medications, such
as blood thinners or high blood pressure drugs; or drink three or more
alcoholic beverages daily.
Safe Usage of OTC Pain Products
The best way to safely use OTC pain medications is to follow the
dosing directions that appear in the “Drug Facts” section on the
product’s package. It is especially important to take the correct dose,
wait the required time between doses, take only the number of doses
allowed in 24 hours, and use the product only for the specified number
of days. If the pain is not relieved when the nonprescription medication
is used as directed, a health care professional should be contacted. It
is important to know the ingredients in all the OTC medications and
prescription drugs being taken, because nonprescription pain
medications, such as acetaminophen and NSAIDs, often are included in
products used for colds, flu, allergy symptoms, and sleep.
If you have questions about nonprescription pain medications or need
help choosing the right pain product for your condition, your pharmacist
can help. OTC pain medications can interact with several prescription
drugs. Your pharmacist can tell you whether there are any potential drug
interactions between your prescription drugs and OTC pain medications.
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