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Pain relievers: The pros and cons of 4

Last updated: November 2010

Next time you ask someone for “aspirin, Advil, or whatever,” think twice. Nonprescription pain relievers aren’t identical. All pose some risks, especially if, as commonly happens, people take too much or use them too often. Twenty-five percent of Americans who take over-the-counter pain relievers every day exceed the recommended dose, researchers reported in the Journal of Rheumatology in 2005. It’s especially easy to overdose in winter because many cough and cold remedies also include pain relievers and fever reducers.

Aspirin, ibuprofen, and naproxen are NSAIDs (nonsteroidal anti-inflammatory drugs), which are used to fight fever and pain, including menstrual pain. In the bloodstream, they inhibit the enzyme cyclooxygenase, thereby limiting production of prostaglandins, which promote the feeling of pain.

But they can cause stomach bleeding or kidney problems in some people. The risk for stomach bleeding might increase in people who are also taking blood thinners or steroids or those who consume alcohol. All the pain relievers listed have also been shown to raise blood pressure in some people.

Below, additional details. Note that generic versions exist for many of the products. If you’re in doubt about what’s best for you, consult your doctor.

Aspirin

(Anacin, Bayer, Bufferin, Ecotrin) Aspirin (acetylsalicylic acid) treats headaches and minor aches and pains, reduces fever, and lessens inflammation. With a doctor’s OK, some people use low-dose aspirin to prevent blood clots that can cause heart attacks and some strokes.

 

But aspirin can cause heartburn, stomach pain, and ulcers. (An enteric coating can help prevent stomach damage.) Because of a link to Reye’s syndrome, it’s not always safe for kids.

Naproxen

(Aleve) Like aspirin, naproxen is very effective in lessening inflammation. Naproxen might have a slight edge over aspirin and ibuprofen: It’s usually taken every 8 to 12 hours instead of 4 to 6. On the other hand, naproxen and ibuprofen can interfere with low-dose aspirin therapy.

Ibuprofen

(Advil, Motrin IB) Dosage differs, since 200 milligrams of ibuprofen is equal to 650 mg of aspirin or acetaminophen. Ibuprofen can be helpful for treating soft-tissue injuries such as strains and sprains, and it’s gentler on the stomach than aspirin.

Acetaminophen

(Anacin Aspirin-Free, Tylenol) Because acetaminophen has almost no adverse effects on the stomach, it’s a good option for people who suffer from acid reflux or ulcers. It might be safer than other pain relievers for children and people with bleeding disorders or those on blood thinners. But acetaminophen does little or nothing to reduce inflammation, and taking even slightly more than the maximum recommended dose for a few days can be toxic. Combining acetaminophen with moderate to large amounts of alcohol can cause liver failure. Symptoms include jaundice and nausea.

   

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