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Over-the-Counter Painkillers: How to Choose

Discover safe, effective ways to use common OTC remedies

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Do you ever get a headache trying to figure out which over-the-counter (OTC) pain medication to take for different aches and pains? If so, you’re not alone. According to the Consumer Healthcare Products Association, more than 81 percent of U.S. adults use OTC medications as their first response to minor ailments.

Peek inside the average adult’s medicine cabinet and you’ll likely find four popular types of nonprescription pain relievers: acetaminophen, aspirin, ibuprofen and naproxen.

Aspirin, ibuprofen and naproxen belong to a large class of drugs known as nonsteroidal anti-inflammatory drugs, or NSAIDs. NSAIDs reduce the level of chemicals called prostaglandins that are involved in inflammation, while the fourth pain reliever, acetaminophen, blocks pain messages in the brain.


Commonly branded as TYLENOL or Excedrin, acetaminophen was introduced in 1955 and is particularly effective for treating headaches and reducing fevers.

“Acetaminophen is often the OTC pain reliever I recommend first for minor ailments,” says David Miller, MD, a family medicine doctor at Scripps Clinic Rancho Bernardo. “It is very safe when taken appropriately and is less likely to cause stomach irritation than an NSAID. Pregnant women can take it, as well as the very young including infants and children with fever.”

As with all OTC medications, read the label to check the appropriate dosage and stay within the daily limit of 4,000 milligrams. Acetaminophen is an ingredient in many cough and cold products, such as NyQuil and TheraFlu, so make sure you are not taking the medication in multiple doses without realizing it. Taking too much acetaminophen at once can damage your liver, perhaps permanently.


At one time, aspirin (commonly branded as Bayer, Bufferin or Excedrin) was the go-to pain reliever of choice to relieve arthritis, minor aches and pains, toothaches, headaches, and to reduce fevers. However, for many adults aspirin irritates the upper digestive tract and can cause upset stomach and heartburn. When the less-aggravating acetaminophen first came on the market, it gave aspirin a run for the money as America’s favorite OTC.

Since the 1970s, aspirin also has been used to help prevent and manage heart disease and stroke. The medication thins out platelets, the cells responsible for blood clots. While blood clotting helps stop bleeding when you cut yourself, clots can lead to strokes and heart attacks because they can clog the arteries supplying the heart and brain.

Dr. Miller cautions against giving aspirin to children and teens because it has been linked to Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain. It most often affects children and teenagers recovering from a virus.

“Adolescents and children should never be given aspirin for flu-like symptoms, chickenpox and other viral illnesses due to the risk of Reye’s syndrome,” says Dr. Miller.


Ibuprofen (most commonly branded as Advil or Motrin) was approved by the FDA in 1974 and may work better than other OTCs for some people, depending on the type of pain.

“I often recommend ibuprofen for menstrual cramps and sore muscles,” explains Dr. Miller.
“Ibuprofen is less of a stomach irritant than aspirin and has less of a blood-thinning effect if you have any conditions where loss of platelets would be a concern. However, it’s important to note there have been some concerns that ibuprofen can contribute to kidney damage if used inappropriately.”


The most powerful pain reliever available without a prescription, Naproxen (Aleve) became available as an OTC product in 1994 and is especially effective as an anti-inflammatory agent for conditions such as sprains, sunburns and arthritis.

Similar doses of Naproxen tend to last longer than other non-prescription pain relievers — often for eight to 12 hours, instead of four to eight hours — so fewer tablets need to be taken per day. Naproxen is not recommended for those over 65 as they are more likely to have side effects, such as ulcers and bleeding.

“With any of these pain relievers, always read the labels and discuss any questions about dosage, safety, or prescription interactions with your doctor,” stresses Dr. Miller.