Over The Counter Pain Relievers When to Take Them, Which to Choose
If you've even been confused about whether to take acetaminophen, ibuprofen, or naproxen, read on.
Tylenol? Advil? Aspirin? What's the difference?
If you look in your medicine cabinet, chances are you have at least one—and probably more—over-the-counter (OTC) pain reliever. You may have Tylenol (acetaminophen), Advil or Motrin (ibuprofen), Aleve (naproxen), or plain old Bayer (aspirin). You might have different brand names—or generic versions. They’re familiar as pie. You’ve been using them since you were a kid.
But do you really know how to use them in the most effective and safest way? And do you really know what each one does best?
Acetaminophen: First-line relief of simple pain
There are two types of OTC painkillers: acetaminophen (Tylenol) and non-steroidal anti-inflammatories (NSAIDS such as aspirin, ibuprofen, and naproxen.) Acetaminophen reduces pain and fever but it doesn’t affect inflammation. It’s good for headaches, muscle aches, colds and sore throats, and backaches.
“Tylenol is quite effective and safe in general,” says Rick Madden, MD, a family medicine doctor in New Mexico who’s practiced for 28 years. Angela Catic, MD, a geriatrician at Beth Israel Deaconess Medical Center in Boston, agrees. “Except for people with severe liver disease, acetaminophen is the first line of defense for pain.” Even if your liver is healthy, avoid excessive amounts (more than 3,000 milligrams in 24 hours) or combining with alcoholic beverages. “If it’s run-of-the mill arthritis, headache, or backache, try acetaminophen first,” says Dr. Catic.
Ibuprofen and aspirin: When there’s inflammation
If you have pain and swelling, or other signs of inflammation, or if acetaminophen isn’t doing the trick, reach for an ibuprofen or aspirin. Both work well but can cause stomach problems. “I prefer ibuprofen for people who can take it safely,” says Dr. Madden. “Ibuprofen works a little faster than acetaminophen or aspirin or Aleve.”
Cautions: Ibuprofen can cause side effects, such as stomach bleeding, and can exacerbate pre-existing kidney problems and high blood pressure. “If you are experiencing stomach pain, or heartburn symptoms, stop and let your doctor know,” says Dr. Catic. “It might be from bleeding in the stomach.” Occasional use is usually fine, she says, “but when you’re using it on and on for months, that’s when people run into problems with side effects.”
Naproxen: For underlying inflammation (if you really need it)
Naproxen (Aleve) is a different kind of anti-inflammatory. It takes longer to kick in but works for 12 hours. “If you have underlying inflammation, naproxen is the drug of choice,” says Charles Hennekens, MD, a professor of medicine in the Charles E. Schmidt College of Medicine at Florida Atlantic University. Adds Dr. Catic, “This is the medication to reach for if you have a severe gout flare.”
As with any painkiller, though, if you need it regularly, “you should at least telephone your doctor,” says Catic. Like all NSAIDS, it can cause stomach problems and affect kidney function—“and many people may not realize when their kidney function is impaired,” she says. Dr. Hennekens agrees. “I play tennis with a lot of aging jocks—guys who’ve played in the U.S. Open—and many of them take Aleve when they wake up for inflammation, and then right before a match pop an ibuprofen,” he says. “But you shouldn’t do that without taking with your doctor first.”
Minimize the side-effects
“Hydrate well when using these meds,” says Dr. Catic. “Always take them with food—not just a couple of crackers, but a meal, or at least a sandwich.” If you are susceptible to stomach problems, and take NSAIDs regularly, talk to your doctor about whether you should also take a medication to protect your stomach, such as a proton pump inhibitor.
While some prescription drugs such as statins may not work as well in generic form, generic versions of OTC acetaminophen, ibuprofen, aspirin, and naproxen are a different story. “I have no hesitation telling my patients to look for generics,” says Dr. Madden. “Typically, the price is about half. If you’re watching your pocketbook, there’s no reason to buy the brand name.”
Natural pain solutions
If you find you're relying on OTC pain relievers more than you’d like, consider ways to reduce your pain without medications. “If you take either ibuprofen or acetaminophen all the time for headaches, you can get rebound headaches,” says Dr. Madic. “You get a new headache when the last dose wears off.” You can try to get off the treadmill by practicing relaxation exercises. “Tension headaches start in the neck and shoulders and jaw, so if you can tense your muscles and then relax them, you can sometimes stop a headache.” For arthritis, instead of relying just on painkillers, look into physical therapy, where you can “get an exercise plan that’s tailored to you,” says Dr. Catic, who adds, “I’ve had patients with back pain [who] do beautifully with yoga.”
When should you worry about how much you're taking?
“I work in a small town in New Mexico, and I get that question a lot,” says Dr. Madic. “If you are taking a painkiller more than two or three times a week, you need to have a conversation with your doctor. If it’s once a week, and you don’t have any other medical problems, you don’t need to worry.” Even little old Advil can cause serious problems if you use it all the time. In a major meta-analysis of 350,000 patients, long-term use of NSAIDS—except naproxen—posed modest increased cardiovascular risk such as heart attack or stroke according to Dr. Hennekens, the lead study author. Says Dr. Catic, “If you need pain medications on an almost daily basis for longer than a week or two, talk to your doctor.”