Although shelves hold many brands of nonprescription pain reliever, most contain one of two kinds of medicine: acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). Nonprescription NSAIDs include aspirin, ibuprofen and naproxen. Some NSAIDs are also available by prescription.

These medicines can make headaches, arthritis pain and other symptoms more manageable. All pain relievers can also cause harm, particularly when used often, at high doses, in combination with other products or by someone with certain medical conditions.

Before taking a dose: read the active-ingredient panel every time. Cold, allergy, sleep and headache products may contain the same pain reliever, making accidental double dosing possible. Ask a pharmacist or clinician when you are uncertain.

Risks to keep in view

The following concerns matter especially for people who use pain relievers several times a week, take other medicines or have an ongoing health condition.

  • Heart and circulationNSAIDs other than aspirin can increase the chance of heart attack or stroke. Risk may begin early in treatment and can rise with higher doses or longer use. People with cardiovascular disease or risk factors should seek individualized guidance.
  • Blood pressureNSAIDs can raise blood pressure and may make some blood-pressure medicines less effective. Monitoring can be important for regular users.
  • Stomach and intestinal bleedingNSAIDs can irritate the digestive tract and cause ulcers or bleeding. Risk is greater among older adults, people with a previous ulcer or bleed, and those using anticoagulants, corticosteroids or certain other medicines. An enteric coating does not eliminate systemic risk; learn more about enteric-coated aspirin.
  • Liver injuryToo much acetaminophen can severely damage the liver. It appears in numerous combination products, so add up the amount from every source and never exceed the current package directions. Liver disease, fasting and alcohol use can alter risk. A clinician or pharmacist can advise on an appropriate limit.
  • Kidney injuryNSAIDs—and, in some circumstances, acetaminophen—can affect kidney function. Dehydration, kidney disease, older age and some medicine combinations may increase vulnerability.

Using pain relievers more safely

For many people, occasional use according to the label has a relatively low risk. The safest choice still depends on the source of pain, health history, age, pregnancy status and other medicines or supplements.

  • Consider nondrug approaches. Depending on the cause, physical therapy, appropriate movement, sleep, heat or cold may help reduce reliance on medicine.
  • Use the lowest effective dose for the shortest necessary time. More is not necessarily more effective, and it can increase harm.
  • Follow the current label. Do not exceed the listed dose or duration unless a qualified clinician has given specific instructions.
  • Check every active ingredient. Avoid taking two products that contain acetaminophen or the same type of NSAID.
  • Ask before regular use. A clinician or pharmacist can account for heart, blood-pressure, stomach, liver and kidney concerns.
  • Do not start daily aspirin on your own. Aspirin can cause serious bleeding and is not appropriate preventive therapy for everyone. Read about low-dose aspirin and discuss personal benefits and risks with a clinician.

Interactions deserve attention

Pain relievers can interact with anticoagulants, blood-pressure medicines, corticosteroids and some antidepressants. Timing can also matter when ibuprofen and low-dose aspirin are used together. Never improvise a dosing schedule to manage an interaction; ask a pharmacist or prescriber to review the complete medicine list.

For more context, see NSAIDs and SSRIs.

Get urgent help for signs of a severe reaction or overdose, including trouble breathing, swelling, fainting, vomiting blood, black stools, severe chest pain, one-sided weakness or confusion. This article cannot assess an individual emergency.
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