When suffering from mild to moderate pain, patients have several over-the-counter (OTC) options for treatment. There are typically 3 different options: Acetaminophen (APAP), aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs), such as naproxen or ibuprofen.

Acetaminophen works well for fever and mild to moderate pain, especially lower back pain and osteoarthritis. Be aware that acetaminophen can be found in many different combination products, such as OTC cold and cough products and prescription pain medications. Never take more than 3000mg of APAP in 24 hours; acetaminophen overdose can cause liver toxicity and death. Patients with liver dysfunction should consult their physician first before taking acetaminophen.

Aspirin can also be taken for mild to moderate pain and fever. Certain patients should ask their physicians before taking aspirin, especially those with stomach problems (such as heartburn, upset stomach or stomach pain), bleeding problems, ulcers, asthma, liver or kidney failure, gout, diabetes, arthritis and also patients taking anticoagulants ( blood thinners). Children and teenagers should NOT use aspirin for chicken pox or flu symptoms before a doctor is consulted; aspirin should NOT be used in children without the approval from a healthcare professional due to the risk of Reye’s syndrome.

Naproxen and ibuprofen are both in the same medication class known as NSAIDs. Both of these medications have anti-inflammatory actions and help treat pain and fever. Ask a doctor before taking if you have stomach problems (such as heartburn, upset stomach or stomach pain), bleeding problems, high blood pressure, congestive heart failure, kidney or liver failure or asthma. NSAIDs do carry the risk of stomach bleeding. Factors that increase this risk are: age over 75, history of ulcers, additional use of steroids or anticoagulants, high dose or multiple NSAIDs and serious underlying health conditions.

Neither acetaminophen, aspirin, naproxen or ibuprofen should be taken without consulting your physician if you drink more than 3 alcoholic beverages per day. Alcohol can irritate the gastrointestinal tract, and patients who consume alcohol simultaneously with aspirin or NSAIDs have an increased risk of damage to the intestinal lining, including ulcers and gastrointestinal bleeding. Excessive alcohol use damages the liver, and acetaminophen is metabolized by the liver; therefore, chronic, heavy alcohol users who take acetaminophen may be at an increased risk of liver toxicity.

If you have any questions regarding over-the-counter pain and fever relievers, feel free to ask your pharmacist or other healthcare professional.