Analgesics and Anti-Inflammatory Drugs
OTC pain relievers (analgesics) include aspirin and other salicylates (such as choline or magnesium salicylate), ibuprofen, ketoprofen, naproxen sodium, and acetaminophen (see Section 6, Chapter 78). These drugs are used to reduce fever as well as relieve various types and degrees of pain, including headaches, menstrual cramps, and arthritis pain. OTC analgesics are reasonably safe to take for short periods of time, but their labels caution against using them for more than 7 to 10 days to treat pain. A doctor should be consulted if symptoms worsen or do not go away.
All OTC nonsteroidal anti-inflammatory drugs (NSAIDs), which encompass all OTC analgesics except acetaminophen, may irritate the stomach's lining and cause digestive upset, ulcers, and bleeding in the digestive tract. Other side effects include damage to the kidneys. A few people have a severe allergic reaction (anaphylaxis) to NSAIDs, leading to hives, itching, and severe breathing problems. Shock (see Section 3, Chapter 24) may occur. Such a reaction requires immediate medical attention. People who are allergic to aspirin or another NSAID must not use any NSAID because severe reactions are possible.
Aspirin
The oldest and least expensive OTC analgesic is aspirin (acetylsalicylic acid). Aspirin may be combined with an antacid (in a buffered product) to diminish the direct irritating effects on the stomach. The antacid creates an alkaline environment that helps aspirin dissolve and may reduce the time aspirin is in contact with the stomach lining. However, buffered aspirin can also irritate the stomach, because aspirin reduces the production of prostaglandins, which help protect the stomach's lining, and buffering does not prevent this effect.
Enteric-coated aspirin is designed to pass through the stomach intact and dissolve in the small intestine, thus minimizing direct irritation. (Enteric refers to the small intestine.) However, coated aspirin may be absorbed erratically. Eating food is likely to delay stomach emptying, the absorption of enteric-coated aspirin, and therefore pain relief.
Children and teenagers who have or may have influenza or chickenpox must not take aspirin because they could develop Reye's syndrome (see Section 23, Chapter 273). Although rare, Reye's syndrome can have serious consequences, including death.
Ibuprofen, Ketoprofen, and Naproxen Sodium
Ibuprofen, ketoprofen, and naproxen sodium are all NSAIDs. Ibuprofen was reclassified from prescription to OTC in 1984, ketoprofen in 1995, and naproxen sodium in 1994. Prescription-strength formulations of these drugs contain a larger amount of active ingredient per dose than the OTC formulations and are thus generally more effective. For OTC naproxen sodium, dosing instructions caution people not to take more than 3 caplets (or tablets) in 24 hours unless a doctor directs them to do so. People older than 65 years are cautioned not to take more than 1 caplet every 12 hours unless a doctor directs them to do so.
Acetaminophen
Originally introduced in 1955 for children's fever and pain, acetaminophen (known in some countries as paracetamol) became available over the counter in 1960. Acetaminophen, which is not an NSAID, is roughly comparable to aspirin in its pain-relieving potential and fever-lowering action.
Although acetaminophen has almost no adverse effects on the stomach, taking large doses of acetaminophen for a long time may have some risks, including risk of liver damage.
Many OTC products, such as those for allergies, colds, cough, influenza, pain, and sinus problems, contain acetaminophen. To avoid overdosing, people should check drug labels carefully and not take several products containing acetaminophen simultaneously.
 See the table Pain Relievers: Over-the-Counter Versus Prescription.
|
