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SALEM COMMUNITY HOSPITAL...Understanding over-the- counter (OTC) pain relievers

April 3, 2011
Salem News

Over-the-counter (OTC) pain relievers are medicines that a person can buy without a prescription.

"Two main types of OTC pain relievers are available," explained Family Practice physician James Gardner, M.D. "One type is acetaminophen, such as found in Tylenol. The second type is nonsteroidal anti-inflammatory drugs, known as NSAIDs."

NSAIDs include: aspirin, ibuprofen (such as in the brand names Advil or Motrin), and Naproxen, (such as in Aleve). Some products contain both acetaminophen and aspirin, like in the brand names Excedrin Extra Strength or Excedrin Migraine.

How do OTC pain relievers work?

"OTC pain relievers can be helpful in treating many types of pain, such as pain from arthritis, earaches, headaches or back pain," Dr. Gardner continued. "They can also be used to treat pain from the flu, a cold, sinusitis, strep throat or a sore throat.

"Acetaminophen relieves pain by targeting the parts of the brain that receive pain messages. It can be used safely by most people on a long-term basis for arthritis and other chronic painful conditions. It also reduces fever by controlling the body's temperature.

"NSAIDs relieve pain and fever by reducing the level of hormone-like substances called prostaglandins that the body makes," Dr. Gardner continued. "These substances cause the feeling of pain by irritating a person's nerve endings. Like acetaminophen, NSAIDs relieve the pain that is caused by muscle aches and stiffness, and are used to reduce fever and the swelling of inflammation. However, aspirin is not recommended for children."

For most people, OTC drugs are sufficient for relieving pain or reducing fever. However, if you've been taking an OTC drug for more than 10 days for pain or three days for fever with no symptom relief, check with your physician.

OTC Side Effects

An estimated 30 million Americans take NSAIDs each day, and many have no adverse effects; but NSAIDs may have negative effects for those with other medical conditions. "For people with gastrointestinal problems, these painkillers may worsen indigestion, upset stomach or peptic ulcer disease," Dr. Gardner stated. "With prolonged use, they can also cause bleeding or liver problems. NSAIDs may also make high blood pressure worse, and if they are used regularly for many years, they may also hurt your kidneys."

You shouldn't take NSAIDs if you are allergic to aspirin or other pain relievers. Check with your doctor before using an NSAID if you:

- Take blood-thinning medicine or have a bleeding disorder

- Have bleeding in the stomach or intestines, or have peptic (stomach) ulcers

- Have liver or kidney disease

- Consume three or more drinks that contain alcohol every day

Acetaminophen can be used safely by most people; however, it can cause liver damage in people who take very high doses or who already have abnormal liver function. To reduce the risk of liver problems, never take more than the recommended dose.

"People generally shouldn't take acetaminophen if they are already taking another product containing acetaminophen," Dr. Gardner suggested. "If a person has severe kidney or liver disease, or if he consumes three or more drinks that contain alcohol every day, then acetaminophen should not be used without checking first with a physician."

Medication Interactions

"If certain drugs are taken at the same time, they can interact with each other and change the way the body processes them," Dr. Gardner said. "This is called a drug interaction. Because some medicines do not work well together, a person may experience problems that are not expected, called adverse drug reactions. This is especially true as people get older and it takes them longer to break down or metabolize the drugs in their system."

There are two main types of interactions that occur when taking medicines:

- Drug-drug interactions occur when two or more medicines react with each other to cause unwanted effects, cancel each other's effectiveness, or increase one of the medicine's effects.

- Drug-food interactions result from drugs reacting with foods or beverages. For example, mixing alcohol with some medicines may cause people to feel tired and slow their reaction time. Grapefruit juice, while healthful, should not be taken with certain blood pressure-lowering medications because it can affect how the body metabolizes these drugs and increases the blood levels of those medications.

"In addition, many OTC drugs contain the same pain reliever or some of the same ingredients found in prescription drugs," he said. "By combining two or more OTC medicines or taking a prescription drug in combination with an OTC drug, you may be getting more than the recommended dose of one or more of the medication's ingredients. Talk to your doctor before combining an OTC medicine with a prescription medicine or before taking more than one OTC remedy at the same time."

"A personal medication record of all your medicines and over-the-counter drugs is helpful and should be brought along to all doctor appointments. Lastly, when using any OTC medication, always read and follow the directions on the label."

J. Gregory Gardner, M.D., is a board certified Family Practice physician affiliated with Salem Community Hospital's active medical staff and the Family Practice Center of Salem, Inc. Appointments with Dr. Gardner can be scheduled by calling his office at 2370 Southeast Boulevard in Salem, 330-332-9961.



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