OTC Pain Medications: The Pros and Cons

OTC Pain Medications: The Pros and Cons – Pharmacy Times – by Kathleen Kenny, PharmD, RPH – Aug 2017

OTC pain medications are, by far, the most widely used of the OTC medications.

Two types of OTC pain medications are available.

  1. The first is acetaminophen (N-acetyl-p-aminophenol, or APAP), and
  2. the second is nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, and aspirin.


Acetaminophen works by inhibiting the synthesis of prostaglandins, which help transmit pain signals and induce fever, thereby easing pain and lowering fever.

Acetaminophen will not, however, reduce swelling and inflammation.

Acetaminophen may be a good choice to treat headaches, arthritis pain, and fever.

Certain patients should not take APAP, including

  • those with liver disease,
  • individuals taking blood thinners,
  • people drinking three or more alcoholic beverages daily, and
  • those with an allergy to APAP


Ibuprofen also works by inhibiting the synthesis of prostaglandins.

Ibuprofen also potentially inhibits the enzyme cyclooxygenase and prevents the formation of thromboxane A2 by platelet aggregation. Ibuprofen may be a good choice for the treatment of menstrual cramps, headaches, toothaches, backaches, arthritis, muscle sprains, and gout.


Naproxen acts similarly to ibuprofen and is a good treatment for the same conditions as well as colds.


Aspirin, also an NSAID, works in the same way as other NSAIDs but has the bonus of inhibiting platelet aggregation, thereby lowering the risk of strokes and heart attacks in certain people. Aspirin is a good option for the same conditions treated by other NSAIDs.


Per the American Gastroenterological Association (AGA), more than 30 million people in the United States use NSAIDs for pain from headaches, arthritis, and other conditions every day.

That said, the AGA also reports that NSAIDs are responsible for more than 100,000 hospitalizations and 16,500 deaths of Americans each year, commonly due to bleeding stomach ulcers

For most individuals, OTC NSAIDs are used for occasional headaches, backaches, or other acute conditions. For most patients, this kind of use is both appropriate and safe.

The bigger risk is in patients who use NSAIDs long term for chronic conditions. This can damage the gastrointestinal (GI) tract. More than half of reported bleeding ulcers are caused by NSAIDs.

Long-term use may also lead to heart risks, high blood pressure, and kidney damage


APAP seems perfectly safe when taken occasionally and in moderate doses. Acetaminophen taken in large doses can cause liver failure and possibly death.

A small group of studies have raised questions about the safety of using APAP when taken long term and at high doses to treat chronic pain.

Heavy APAP use has been associated with

  • kidney disease,
  • GI bleeding,
  • an increased risk of stroke or heart attack, and
  • high blood pressure.


Patients should know the active ingredient in their OTC pain medications. This will reduce the risk of taking more than one medication with the same ingredient.

Communication with the physician is important if a patient is taking an OTC pain reliever for more than 2 weeks. This communication may lead to the discovery of an underlying issue that is being untreated.

…like pain, for instance.

Patients should read the directions on the drug facts label carefully to ensure that they understand how much of the medication to take and how often.

In high-tech when we had to fix misbehaving computer systems set up and misconfigured by clueless others, we often threw this acronym at them: RTFM! (Read the Friggin Manual).

taking more than the recommended amount of medication will not result in faster or better results but will only lead to increased adverse and possibly lethal effects.


Author: Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has more than 20 years of experience as a community pharmacist and works as a clinical medical writer based out of Colorado Springs, Colorado. Dr. Kenny is also the Colorado Education Director for the Rocky Mountain Chapter of the American Medical Writers Association and a regular contributor to Pharmacy Times.

2 thoughts on “OTC Pain Medications: The Pros and Cons

  1. Kathy C

    A lot of people are still clueless. Physicians are not clear enough on any of this. They don’t ask the right questions. I don’t know how many people I have had to tell, “you can’t take that with that.” They think because it is over the counter it is OK. A lot of people take those “nighttime” mixtures for sleep, and when they add a prescription NSIAD, they are in trouble. The “Aspirin a Day” advertising campaign probably killed quite a few people too. Once again they are not really tracking the number of deaths or “adverse incidents”

    https://www.medpagetoday.com/psychiatry/depression/2233 Here they cite a “22 tertiary care providers.”

    “To determine whether people who inadvertently overdose on acetaminophen are at greater risk for bad outcomes, Dr. Larson and colleagues at 22 U.S. tertiary care centers examined the incidence, risk factors, and outcomes of acetaminophen-induced acute liver failure in consecutive patients seen over a six-year period. ”

    “They found that 662 patients met the established acute liver failure criteria of coagulopathy and encephalopathy, and that 42% of these patients (275) had liver failure associated with acetaminophen liver injury.

    No real tracking of how many deaths, liver transplants and overdoses nationally. Once again industry interests outweigh public health. This is particularly dangerous for chronic pain patients. I wonder how many deaths and “overdoses” were attributed to the opiates.

    Liked by 1 person

    1. Zyp Czyk Post author

      Yes, there are too many health-impacting factors that are simply not counted or even recorded. And I suspect that any health problem without a solution that could be monetized, will not get much attention. If there’s no possibility that a new drug or medical treatment can solve such health problems, they may be ignored without consequence – except for the damaged patients.



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