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Just because over-the-counter pain relievers are readily available without a prescription doesn’t mean they don’t have side effects or potential health risks.
pain relievers, ibuprofen, acetaminophen, aspirin, Reyes syndrome, prescription medicines, side effects

Medicine cabinet basics: Facts about pain relievers

If you took a long run and then woke up the next day with a throbbing ankle, what would you take to relieve the pain? What do you give a feverish toddler? When you have flu-related aches and pains with a stuffy nose, do you take ibuprofen or acetaminophen?

The shelves of drug stores are lined with options. Some pain relievers double as sleep aids, others work as decongestants. There are generics, name brands, pills and liquids in a variety of colors. Some are made specifically for children and others treat arthritis pain or menstrual cramps. How do you make a safe and effective choice?

We asked Danielle Mackey, pharmacist and program manager of investigational drug services at Providence Health & Services in Portland, to help us parse the facts.


Ibuprofen is one of a group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs). It can be used to relieve the following:

  • Mild to moderate pain, such as a toothache, migraine or achy muscles
  • Fever – for example, when you have the flu
  • Pain and inflammation (redness and swelling) caused by rheumatic diseases (conditions that affect the joints) and musculoskeletal disorders (conditions that affect the bones and muscles)
  • Pain and swelling caused by sprains and strains, such as sports injuries

Generic ibuprofen contains one ingredient: ibuprofen. However, many brand-name products that contain ibuprofen may include other active ingredients. For example, Sudafed® contains both pseudoephedrine to relieve congestion, and ibuprofen to reduce fever. Advil® and Motrin® are brand names for generic ibuprofen, but they also may contain other medications.

Mackey says it’s important to look at the active ingredients in over-the-counter medications, especially when taking them with prescription medications. “A combination of products can be dangerous,” she says.

Side effects and warnings
Just because ibuprofen is readily available without a prescription doesn’t mean that the drug is free of side effects or potential health risks. Taken on an empty stomach, even one ibuprofen tablet can cause nausea, upset stomach or vomiting.

Other side effects may include the following:

  • Mild heartburn
  • Bloating, gas, diarrhea or constipation
  • Dizziness
  • Headache
  • Nervousness
  • Mild itching or rash
  • Ringing in the ears

Ibuprofen has been proven to increase the risk of heart attack and stroke. Some people should avoid using ibuprofen altogether. Talk to your primary care provider before taking ibuprofen if you:

  • Are over age 60
  • Are pregnant or nursing
  • Have three or more drinks of alcohol every day
  • Have bleeding problems
  • Have liver or kidney disease
  • Have heart disease
  • Take a medicine to thin the blood, such as warfarin
  • Take a medicine for high blood pressure


Acetaminophen is a common nonprescription drug used for relieving mild-to-moderate pain and fever. It’s often combined with other active ingredients in medicines that treat allergy, cough, colds, flu, menstrual pain and sleeplessness.  As a prescription medicine, acetaminophen may be combined with opioid narcotics for the treatment of moderate to severe pain.

Like ibuprofen, acetaminophen is widely available in a variety of over-the-counter medications. Here are just a few of the common brand-name products that contain acetaminophen:

  • Tylenol® products
  • Actifed®
  • Alka-Seltzer Plus®
  • Excedrin®
  • Midol®
  • Mucinex®
  • Nyquil®

Don’t take too much
Acetaminophen can cause liver damage. When taking any over-the-counter product, prescription medication or combination of the two, it’s important to check the active ingredients to make sure you don’t take more than one medicine containing acetaminophen. On prescription medicines, the label may spell out acetaminophen or have a shortened version of it, such as “APAP,” “acet,” “acetamin” or “acetaminoph.” If you aren’t sure whether or not your medicine contains acetaminophen, ask your health care professional for help.

“Know what strength you need,” says Mackey. “And consider the cumulative amount for one day.”

Also be aware of these important points:

  • How many hours you must wait between doses
  • How many times you can take it each day
  • When you should not take it
  • When to talk to your health care professional

Children and medications

Parents should use caution when giving children over-the-counter medications to ease pain or a fever. Ibuprofen should not be given to children younger than 6 months old. Don’t confuse infant liquid drops and children’s “suspension” liquid. Infant drops are much more concentrated. Always read the label on the product and ask your pediatrician if the medication is safe for your child before administering it.

It’s important to know the appropriate dosage. The correct dosage may depend on these factors:

  • The child’s age
  • The child’s weight
  • The strength of the medications

Never give a child aspirin. In fact, the American Academy of Pediatrics recommends that children under the age of 19 should not be given aspirin, because of its link to a rare childhood disorder called Reye's syndrome. No medicine that is sold as suitable for children will contain aspirin.

If you have questions about over-the-counter or prescription medicines for your child, talk to your pediatrician or pharmacist. Find a Providence provider here.

Just because over-the-counter pain relievers are readily available without a prescription doesn’t mean they don’t have side effects or potential health risks.


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