The difference between over-the-counter (OTC) pain relievers

Whether it’s the throb of a headache, the sting from a minor burn or the pang of a cramp, daily discomforts can drive us to seek symptom relief. But which over-the-counter (OTC) products should someone consider? What’s the difference between acetaminophen and ibuprofen? How does someone decide what may work best for their type of pain? Are there medication interactions with anything else a person takes that they need to know about?

In this article:

What are OTC pain relievers?

OTC pain relievers are medications that can be bought at a store or online without a prescription. Depending on the product, they may help support different types of pain relief — aches from cold and flu, arthritis, back pain, earaches, headaches, toothaches and more. Not all relievers work the same way, and depending on someone’s health conditions, they may need to avoid certain products.

It’s always important to discuss any medications (including OTC medications) with a health care provider, including the recommended dose and how often they should be taken. Health care providers can also provide information about how they might interact with medical conditions.

Here’s a closer look at some of the most common OTC medications and how they may impact people’s health.

What is acetaminophen?

Often sold under the brand name Tylenol, acetaminophen has a few benefits, including relieving headache symptoms, easing common aches and pains, treating arthritis and lowering fevers.

When to be cautious: Because acetaminophen is processed by the liver, an unintentional overdose can cause liver damage. The risk increases the more someone takes it or if they pair it with alcohol use. The best practice is to adhere to the daily limits on the bottle.  Someone may be directed not to take acetaminophen if they have severe liver disease, drink three or more alcoholic beverages daily or if they are using other products that contain acetaminophen.

If someone is being treated for any liver issues, they should check with their health care provider first, says Samer Narouze, MD, PhD, chairperson of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio.

What are NSAIDs?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help relieve fever and pain, such as headaches, colds, flu and arthritis.

There are three popular kinds of NSAIDs: ibuprofen (sold under brand names Advil and Motrin), naproxen sodium (sold under the brand name Aleve) and aspirin. These medications all work in a similar way to help ease pain from arthritis, muscle sprains and bone fractures. NSAIDs also lower the level of prostaglandins in the body, which helps lower swelling, reduce fevers and prevent blood from clotting.

However, there are some subtle and important differences:

• Ibuprofen is offered in a variety of dosage forms, including in combination with other pain relievers and cold medicines. Child and infant versions are also approved for use for those ages 6 months and older.
• Naproxen sodium also comes in a variety of dosage forms, such as tablets, capsules and liquid gels. Naproxen sodium is used to ease mild pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches and backaches.  The caregivers of anyone age 12 and younger should speak to a health care provider about their child taking naproxen sodium.
• Aspirin, like ibuprofen, can be used for pain and fever. In most cases, children should not be given aspirin due to possible brain or liver damage (unless recommended by a health care professional).

When to be cautious: All NSAIDs can lead to stomach upset, bleeding or ulcers, particularly if they are taken for an extended time, says Gary Schwartz, MD, FASA, director of AABP Integrative Pain Care in Brooklyn, New York. NSAIDs can also cause kidney damage, and non-aspirin NSAIDs carry a risk of stroke or heart attack.

NSAIDs are typically not recommended later in pregnancy, because they can increase the risk of complications. Aways consult a health care provider before starting, stopping or changing any medication during pregnancy.

Remember to always read a medication’s package labeling to learn more about the product and how to take it.

What are acetaminophen and ibuprofen combination tablets?

Approved by the U.S. Food and Drug Administration (FDA) in 2020, some products combine acetaminophen and ibuprofen into one tablet. The two medications work together to temporarily relieve minor aches and pains due to headaches, menstrual cramps, toothaches and minor pain of arthritis.

When to be cautious: There are potential downsides to a dual-action medication. Since these tablets contain both acetaminophen and ibuprofen, it’s possible that the risks associated with both medications may apply.

If any of the below symptoms take place, it’s recommended to see a health care provider right away:

• Blistering, peeling or loosening of the skin
• Blood in urine
• Trouble breathing
• Trouble speaking
• Trouble swallowing

Melissa Houser, MD, a family physician at All Brains Belong VT in Montpelier, Vermont, says, “As a general rule, I’m cautious about combination products. It’s easy to inadvertently take a medication that may not be safe for that person. It also makes it more challenging to isolate which medication to blame for a side effect — or to credit with a positive impact.”

Are gel caps or tablets better?

Most pain medications come in both traditional tablet formulations and gel capsules. How does someone know which one to pick? “They both work,” says Dr. Schwartz, “although some patients find the gel caps easier to swallow. The downside is they are often more expensive.”

Tips for selecting an OTC pain reliever

There’s no one-size-fits-all option. The concept of the “strongest” OTC painkiller is up for debate since some people respond better to different medications. When considering an OTC pain medication, keep in mind that just because a medication is available without a prescription doesn’t mean it’s without risks.

OTC pain relievers have their place, but just as with any medication, the risk‑benefit balance of OTC drugs must be considered in the context of a person’s overall health profile. Taking more than the recommended amount of any medication can cause an overdose, which is common and can be very dangerous.

It’s also important that someone seek medical advice if they are taking an OTC pain reliever for a new pain problem because they might be masking a potentially serious health issue. It's recommended to talk to a health care provider if someone has been using OTC pain relievers for over 10 days. If symptoms continue or get worse, speak to a health care provider right away.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements, and prior to beginning or changing any health care practices.