Nonprescription pain relievers are analgesics that can be
bought without a doctor's order (prescription). Sometimes they are
called "over-the-counter pain remedies. They include aspirin
(Bufferin, Ascriptin, Ecotrin), acetaminophen (Anacin-3, Tylenol,
Datril), and ibuprofen (Advil, Motrin, Nuprin).* Many
nonprescription pain relievers have different names, but if you
check the labels, nearly all contain one of these three medicines.
They are effective for relief of mild and moderate pain.
*The brand names that appear in this book are listed for
information only. No endorsement by NCI or ACS is implied.
Drugs are complex substances, and they may have as many as
three different names: chemical, generic, and brand. Chemical names
are long and difficult to pronounce. The U.S. Food and Drug
Administration approves the generic, shortened names by which drugs
are usually known. Drug companies give their products brand names.
For example N-(4-hydroxyphenyl) acetamide is the chemical name for
acetaminophen, which is the generic name for Tylenol. Many
nonprescription and prescription pain relievers are available under
both generic and brand names. Your doctor or pharmacist can tell
you the generic name.
Generic products tend to be less expensive than brand-name
drugs and usually are just as effective. However, because of
differences in manufacturing methods, medicines with the same
generic name produced by different companies may differ in the way
they are absorbed by the body. For this reason, your doctor may
prefer that you take a brand-name drug. You might want to ask your
doctor or pharmacist if you can use a less expensive medication.
Pharmacies are careful to obtain high-quality generic products, so
it is sometimes possible to make substitutions.
Yes. Each is a different chemical. They all have similar
pain-relieving effects, but they have some important
- Aspirin and ibuprofen reduce inflammation; acetaminophen does
- Aspirin and ibuprofen are often used to reduce the pain of
swollen joints and other inflamed areas; acetaminophen is not.
- Aspirin and ibuprofen can irritate the stomach. Sometimes they
even cause stomach bleeding. Acetaminophen does not have this
- Aspirin and ibuprofen can affect blood clotting and may cause
bleeding. Acetaminophen has no effect on blood clotting.
- When aspirin is used to treat children with viral diseases such
as the flu or chickenpox, it may cause Reye's syndrome, a rare
brain and liver disease. Acetaminophen and ibuprofen do not cause
- Ibuprofen can make existing kidney problems worse. In normal
doses, aspirin and acetaminophen usually do not injure the
Although aspirin is a very common medicine, it should not be
used by everyone. Before you take aspirin in any form, ask your
doctor or nurse if there is any reason for you not to take it.
Some people have conditions that may be made worse by aspirin
or by any product that contains aspirin. In general, aspirin should
be avoided by people who:
- Are on anticancer drugs that may cause bleeding.
- Are on steroid medicines such as prednisone.
- Will have surgery within a week.
- Are allergic to aspirin.
- Are taking blood-thinning medicine (anticoagulants such as
- Have stomach ulcers or a history of ulcers, gout, or bleeding
- Are taking prescription drugs for arthritis.
- Are taking oral medicines for diabetes or gout.
Be careful about mixing aspirin with alcohol-taking aspirin and
drinking alcohol on an empty stomach can cause stomach upset and
Yes. If your doctor does not want you to take aspirin, be sure
to read labels carefully. Many nonprescription products contain
"hidden" aspirin. For example, aspirin is in Excedrin (a pain
reliever), Coricidin (a cold or allergy medicine), and Alka-Seltzer
Some prescription pain relievers, such as Percodan and Empirin
Compound with Codeine, also contain aspirin. If you are not sure if
your prescription contains aspirin, ask your pharmacist.
The most common side effect from aspirin is stomach upset or
indigestion. Taking aspirin with food lessens the chance of this
side effect. If aspirin upsets your stomach, you can use buffered
aspirin or coated aspirin. Ask your pharmacist to tell you which
aspirin products are less likely to upset your stomach.
When some people take aspirin for long periods of time they may
- Ringing in the ears or hearing loss.
- Unusual sweating.
- Headache, dizziness, dimness of vision, confusion, fever, or
- Rapid breathing and rapid heartbeat.
- Thirst, nausea, vomiting, or diarrhea.
If you notice these symptoms, check with your doctor right
Aspirin also can cause internal bleeding, which usually is
painless. If your stools become darker than normal or you notice
unusual bruising, tell your doctor or nurse. These can be signs of
People rarely have any side effects from the usual dose of
acetaminophen. However, liver or kidney damage may result from
using large doses of this drug every day for a long time or
drinking large amounts of alcohol with the usual dose.
Serious side effects from ibuprofen are uncommon. Some people
notice that it upsets the stomach. When it is used for long periods
of time or when it is used by patients taking steroid medications,
there is an increased risk of stomach bleeding. If you have kidney
problems, ibuprofen may make them worse. And, because it may
interfere with the ability of blood to clot, it may be dangerous
for patients with low platelet counts.
The doses of these pain relievers are different for different
people. Some people get the best pain relief when they take a small
dose every 3 hours. Other people may find that a larger dose taken
less frequently works for them. You should not take a larger dose
than the label tells you without first checking with your doctor,
nurse, or pharmacist.
The usual safe dose of aspirin for adults is
two or three tablets (325 mg or 5 grains each) taken three or four
times a day. A total of eight adult aspirins a day usually does not
produce any major side effects. Many adults can safely take a total
of 12 tablets a day. Any dose higher than 12 a day, however, should
be taken only with your doctor's or nurse's advice.
The usual safe dose of acetaminophen for
adults is 2 or 3 tablets (325 mg or 5 grains each) taken three or
four times a day, for a total of 8 to 12 tablets a day.
Extra-strength forms, such as extra-strength Tylenol are equal to 1
regular tablets (500 mg or 7 grains each); you should take no more
than 8 of these tablets in 24 hours.
The usual dose of ibuprofen for adults is 1
tablet (200 mg each) every 4 to 6 hours. You should not take more
than 6 tablets in 24 hours. Larger doses should only be taken if
they are prescribed by your doctor.
The effect of aspirin begins 30 to 60 minutes after you take
it. (Coated aspirin may need 1 to 8 hours to work.) The
pain-relieving action of one dose usually lasts about 4 hours but
may last up to 12 hours.
Acetaminophen relieves pain within 10 to 60 minutes of taking
it. Its effect may last up to 6 hours.
Ibuprofen begins to relieve pain in 1 to 2 hours and lasts from
5 to 10 hours. You may need to take ibuprofen for 2 to 3 days
before you get the most pain relief.
Drugstore shelves are filled with many pain remedies. Each one
is advertised to be better and faster acting than the others. But
nearly all nonprescription pain relievers rely on aspirin,
acetaminophen, or ibuprofen for pain relief. Some brands also
contain substances called additives. Common ones include the
- Buffers (e.g., magnesium carbonate, aluminum hydroxide) to
decrease stomach upset.
- Caffeine to act as a stimulant and lessen pain.
- Antihistamines (e.g., diphenhydramine, pyrilamine) to help you
relax or sleep.
Combination products have some disadvantages. The additives can
produce undesirable effects. For example, anti histamines sometimes
cause drowsiness. You may find this acceptable at bedtime, but it
could be a problem during the day or while driving. In addition,
additives tend to increase the cost of nonprescription pain
relievers. They also can change the action of other medicines you
may be taking.
Plain aspirin, acetaminophen, or ibuprofen are probably as
effective as any combination product. But if you find that a brand
with certain additives is a better pain reliever for you, ask your
doctor, nurse, or pharmacist if the additives are safe for you. If
you have any questions about the drugs contained in your
nonprescription analgesics, ask your doctor, nurse, or
In many cases, the nonprescription medicines are all you will
need to relieve your pain, especially if you stay on top of the
pain by taking them on a regular, preventive basis. These medicines
are stronger analgesics than most people realize.
Certain doses of prescription pain relievers given by mouth are
no more effective than two or three regular tablets of aspirin,
acetaminophen, or ibuprofen. Research has shown that for most
people the usual dose of nonprescription pain relievers provides as
much pain relief as prescription medications such as codeine or
If you get pain relief from nonprescription medicines, you do
not need to take prescription pain relievers. For most people,
nonprescription pain relievers have fewer side effects than
prescription pain relievers.
You should discuss this question with your doctor or nurse.
Many people who need prescription analgesics also can benefit from
continuing to take regular doses of aspirin, acetaminophen, or
ibuprofen. The nonprescription analgesics and the stronger
prescription medicines relieve pain in different ways. When you
take both of them, your pain is attacked on two different levels.
Aspirin, acetaminophen, or ibuprofen taken four times a day might
help reduce the amount of stronger pain reliever you need.
Some prescription pain tablets contain aspirin or
acetaminophen. Ask your pharmacist or doctor how much aspirin or
acetaminophen, if any, is in your prescription. A nurse, doctor, or
pharmacist can help you figure out how much aspirin or
acetaminophen you can safely add.