Over-the-counter (OTC) Pain Relievers and Fever Reducers
- Acetaminophen
- Aspirin
- Ibuprofen
- Ketoprofen
- Naproxen sodium
All 5 active ingredients are similarly effective at relieving mild-to-moderate pain and reducing fever.
These medicines are sold under a variety of brand names. Some products have just one active ingredient and others contain a combination of ingredients designed to treat pain and other symptoms. (For example, pain relievers are often found in cough and cold preparations.)
It is important to read the labels of all products, even brand names that you recognize, as many manufacturers now make products that contain different ingredients than were found in the original preparations.
Some important differences between these medications are:
- Four of the 5 active ingredients (aspirin, ibuprofen, ketoprofen, and naproxen sodium) are nonsteroidal anti-inflammatory drugs (NSAIDs) and can reduce inflammation (swelling) at doses higher than those recommended for OTC use. Acetaminophen does not reduce inflammation at any dose. Although inflammation is commonly associated with pain, it is necessary for proper healing in many cases. For example, inflammation aids the healing of muscle injuries caused by excessive stretching or a direct hit. Not all pain is caused by inflammation. For example, osteoarthritis is painful, but inflammation is usually not present.
- Aspirin affects the function of platelets, which help to prevent bleeding. People with conditions that can result in bleeding (such as stomach ulcers) or who take drugs that prolong bleeding (such as warfarin) may experience new or worsening bleeding if they take aspirin. The nonprescription NSAIDs do impair platelet function, but not to the extent that aspirin does. Acetaminophen has no effect on platelet function.
- Largely due to its effect on platelets, only aspirin has been shown to protect against heart attacks. You should not substitute acetaminophen, ibuprofen, ketoprofen, or naproxen sodium for aspirin if you are using it to reduce your risk of a heart attack.
- Aspirin can worsen the symptoms of gout and interfere with drugs used to treat gout. Acetaminophen and the nonprescription NSAIDs do not affect uric acid excretion and can be useful for treating pain associated with gout.
- Children or teenagers with the flu or with chickenpox should not use aspirin: such use has been associated with the development of Reye’s syndrome, which can be life-threatening. To avoid accidental administration to children or teenagers who may have these conditions but have not been diagnosed, it is generally recommended that aspirin be avoided in children or teenagers during the fiu and chickenpox seasons. Acetaminophen or a nonprescription NSAID should be used instead.
- Acetaminophen is safe to use at anytime during pregnancy. Use of nonprescription NSAIDs is not recommended during the third trimester (last 3 months) of pregnancy. Aspirin should be avoided throughout pregnancy as it can harm the mother (eg, cause anemia [low red blood cell count], bleeding, prolonged pregnancy, or prolonged labor) and/or cause birth defects. Pregnant women should always talk to their doctors before taking any nonprescription medicines.
- Acetaminophen is the preferred medicine for women who are breastfeeding. A small amount of acetaminophen passes into the breast milk, but is not harmful to the baby. Nonprescription NSAIDs can also be used, but are not as safe as acetaminophen.
- These agents have different side effect profiles (SeeSafety of OTG Pain Relievers and Fever Reducers).
Co-Sponsorship provided by the American Pharmacists Association and SynerMed® Communications
Supported by an educational grant from McNeil Consumer 8 Specialty Pharmaceuticals
