Choosing An Over-the-Counter Pain Reliver

Janet O'Mahony, M.D., is an Internal Medicine Doctor and a member of Mercy Personal Physicians Downtown in Baltimore. Dr. O'Mahony was asked to provide an internist's perspective regarding the use of over-the-counter (OTC) pain medications for a U.S. News & World Report feature.

Tylenol is generally the safest medication to use as a pain reliever. It is safer for the kidneys, does not thin the blood and should not cause ulcers. This medication can be taken as often as two pills every six hours if needed and works to relieve mild aches and pains. If you are elderly, have kidney disease, are on blood thinners, or have a sensitive stomach, this is probably the safest medication for you.

The only exception is for people with liver disease or regular alcohol drinkers. Tylenol is safe for these people too but it is easier to overdose and the highest recommended dose for them is two pills three times a day instead of the four times a day that others can safely take.

The only issue with Tylenol is overdosing is dangerous. Taking regular over the counter Tylenol in addition to meds that already contain the active ingredient in Tylenol can cause people to inadvertently take too much. Percocet or Norco are prescription pain relievers that have the active ingredient in Tylenol and many cold remedies including "cold and flu" preparations and even "cough medications" can include acetaminophen, the active ingredient in Tylenol. Some over the counter sleep aids also contain Tylenol. Tylenol overdose including intentional overdose can cause liver failure and can be deadly.

Advil and Aleve are in the same class of drugs called NSAIDs so I would consider them the same. The add anti-inflammatory affects in addition to pain relief and are better for certain kinds of pains. Joint pain and headache pains respond better to the dual action of these medications. NSAIDs can increase the blood pressure slightly and cause decreased blood flow to the kidneys. So this drug is best avoided in people with heart disease, kidney disease and uncontrolled blood pressure. These meds can irritate the lining of the stomach causing ulcers and gastritis. This is particularly dangerous in people on blood thinning medications because it can cause bleeding ulcers and sometimes significant blood loss.

I would say young healthy (under 40) person without kidney disease, heart disease, high blood pressure or blood thinners could safely take Advil and Aleve for short periods of time (less than one week at a time). If you are unsure if you have a high risk condition, ask your doctor.

Pregnant people are supposed to stick to Tylenol but breastfeeding people can take either one.

Board Certified in Internal Medicine, Dr. Janet O'Mahony received her medical degree from University of Maryland School of Medicine in Baltimore. She completed her Internship at the Baltimore VA Medical Center and Residency at Mercy Medical Center.