Primary Care in Rochester and Kasson

OTC safety: What you need to know about pain relievers

10/30/2017 by Laurie Danielson, PharmD, RPh


Most people assume over-the-counter (OTC) medications are safe and then overlook discussing their use with their care team. Pain relievers can be effective in managing minor aches and pains, but if you take them on a regular basis, talk to your care team about the risks and benefits. 


OTC nonsteroidal anti-inflammatory drugs (NSAIDs) are taken for the temporary treatment of minor aches and pains, such as headache, muscle aches, arthritis and back ache, or to reduce fever. While products containing ibuprofen, including Advil and Motrin, and naproxen, such as Aleve, are effective pain relievers, they also have several safety concerns. 

  • Bleeding is a common and potentially serious side effect. 
  • NSAIDs increase your risk for ulcers in the stomach and intestine, which also may be related to serious bleeding. 
  • They may affect blood flow to the kidneys and cause damage, particularly in people with underlying kidney disease and/or taking other medications with this risk factor. 
  • NSAIDs may increase fluid retention and can lead to increased blood pressure, which may be particularly unsafe for people with heart failure. 
  • "Rebound headaches," also known as medication overuse headaches are daily headaches that may be due to frequent NSAID use. 
  • NSAIDs may increase the risk of a heart attack or stroke. The risk increases with higher doses or extended use. 

Talk to your care team about NSAIDs if you take blood thinners or have been diagnosed with heart disease, stroke, high blood pressure, heart failure, kidney disease, asthma or have had gastric bypass surgery. If you take an NSAID more than 15 days a month for headaches, discuss alternative strategies for managing them. 


While some people have been prescribed or recommended to take aspirin daily, the U.S. Preventive Services Task Force provides guidance on who may benefit most from daily aspirin for disease prevention

Consider discussing aspirin use with your care team if you do not have a personal history of heart disease and are younger than 50 or over 70 years old. For those between 50 and 70, the decision to take aspirin depends on your risk factors. Taking aspirin daily, even low-dose or "baby" aspirin, may increase your risk for serious bleeding. This risk increases if you also take blood-thinning (anticoagulant) medication or even other OTC medicines, such as ibuprofen or naproxen. Be sure to review your personal need for aspirin with your care team if you also take blood thinners. 


Acetaminophen is found in more than 600 OTC products. A common brand name is Tylenol®. Often, acetaminophen is the primary ingredient in multi-ingredient OTC products. It can also be found in some prescription medications abbreviated as APAP, Mapap or Q-Pap. 

While risk is low for acetaminophen interacting with prescription medications, people may unintentionally exceed safe doses when combining various OTC and/or prescription sources of acetaminophen. This may lead to serious liver damage. 

Talk with your care team about safe use of acetaminophen if you have been diagnosed with a headache disorder, liver disease or consume three or more alcoholic beverages per day. 

Pediatric dosing

Pediatric formulations of pain medications may be more prone to accidental dosing errors. Be sure to read the package instructions every time. Formulations may change or look similar but be different concentrations of similar products. Be sure the active ingredient is the one you intended to give. Use the correct dosing device and measure carefully. 

If you are uncertain of the package instructions, ask for clarification at the pharmacy counter. Heed the "Keep out of reach of children" warning; many flavored OTC medications may be enticing to little ones. 

Read the labels

Read all OTC product labels carefully, especially for the active ingredient. Use this checklist when shopping for OTC medications to be sure you're familiar with the package label and important information. When starting a new prescription medication, be sure to discuss with your care team if it is compatible with the OTC medications you're currently using. 

Laurie Danielson, PharmD, RPh, is a clinical pharmacist working in Family Medicine in the Baldwin Building. She enjoys meeting with patients to optimize their medication regimens and solving medication-related problems.