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Pain Management Health Center

Safe Use of OTC Pain Relievers

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Rule #1 for Over-the-Counter Painkillers: Don’t Take Them Lightly

“The first mistake people make,” says Penney Cowan, founder and executive director of the American Chronic Pain Association, “is thinking that if something is over-the-counter, it’s safe and they can do anything they want with it. These are potent drugs that can have severe side effects.”

Unfortunately, many people take them without a second thought. Philippe Berenger, MD, says, “We can ask patients what medicines they take. But they almost never mention over-the-counter pain meds unless we ask specifically, ‘Are you taking Tylenol or Excedrin?’” Berenger is a pain management specialist at the Cleveland Clinic Foundation.

“Patients end up compounding these drugs. They’re taking Tylenol without keeping track of how much. Then they take a course of a cold medicine with acetaminophen. Then their doctor prescribes a drug with acetaminophen in it. All of a sudden they’re at toxic doses,” says Berenger.

Rule #2 for Over-the-Counter Painkillers: Check the Ingredient Label

It’s not always easy to know how much you’re taking or even if you’re taking one of the painkillers. Steven Feinberg, MD, tells WebMD that acetaminophen and NSAIDs are found in many over-the-counter medications as well as prescription pain medicines. Feinberg is a chronic pain specialist in Palo Alto, Calif., and past president of the American Academy of Pain Medicine.

 “They’re in everything from cold and flu formulas to prescription narcotic drugs like Vicodin,” he says. “And the only way to know that is to read the fine print of the ingredient label.”

A few tips are worth remembering:

  • Acetaminophen is sometimes abbreviated APAP.
  • In other countries, the active ingredients often have different names than in the United States. In the UK, for instance, acetaminophen is called paracetamol.
  • When in doubt, ask the pharmacist.
  • Don’t mix and match over-the-counter drugs.

“If you’re taking a cold and flu preparation with acetaminophen,” Feinberg says, “you shouldn’t be taking maximum doses of Tylenol. If you’re taking a prescription pain medication, you shouldn’t be taking over-the-counter pain pills. We ask patients to bring in all their medicines -- prescription and over-the-counter. Many are getting acetaminophen from multiple sources.” That’s especially risky since acetaminophen can build up in the system. When it does, it can quickly reach toxic levels. The bottom line: never take more than one medicine that contains acetaminophen.

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