Over-the-counter (OTC) pain relievers are among the most widely used medications in the world. Yet recently there has been growing concern about their dangers. As a result, the FDA has begun tightening rules about warning labels and maximum doses. The FDA is also considering banning some prescription drugs that contain acetaminophen, which is the active ingredient in some over-the-counter pain relievers.
So what does all this say about using OTC pain relievers to manage pain? Are they safe or should you clear your medicine cabinet of all OTC pain medications?
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Despite all the concern, OTC pain relievers can be used safely if you follow a few simple rules. Here’s information to help you make smart decisions about using over-the-counter pain medications to manage pain.
What Are the Dangers Associated With OTC Pain Medicines?
The dangers of OTC pain medicines are well documented. Nonprescription pain medications come in two forms:
Nonsteroidal anti-inflammatory drugs, known as NSAIDs, are found in aspirin, Advil, Motrin, Aleve, and other medications.
Acetaminophen is found in Tylenol and a number of generic pain relievers.
The biggest risk with NSAIDs is severe and sometimes fatal gastrointestinal bleeding. NSAIDs can trigger an increase in stomach acid and, at the same time, reduce the stomach’s normal protective mucus layer. In some patients, these widely used drugs can also make high blood pressure worse. They can cause reversible damage to the kidneys in people over 60; those with high blood pressure, heart disease, or pre-existing kidney disease; and people taking water pills.
Acetaminophen is considered safe if used according to the directions. However, taking more than the recommended dose can cause liver disease, liver failure, and death. Often, liver damage occurs before any symptoms show up. Shockingly, acetaminophen has replaced viral hepatitis as the leading cause of acute liver failure in the United States. The risk is greatest in people who already have liver problems, such as hepatitis or cirrhosis. But anyone who takes too much of the drug for too long faces danger.
Experts say that despite growing worries, OTC painkillers can be safe and effective, even for people with chronic pain. But it’s crucial to follow a few rules.
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.