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 severe pain.

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 vomiting.


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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