Whether it’s a headache, toe pain, or a muscle ache after a long tennis game, many of us have found our way into our local pharmacy intending to buy over-the-counter pain medications.

Most people expect over-the-counter pain medications to be safe. However, there are several important side effects everyone should be aware of.

Two common examples are pain and fever reducing medications. These two medications can be found alone or bundled with other medications in one pill for multi-symptom relief.

Acetaminophen (Tylenol)

  • Used for pain and fever.
  • Although this medication is sold over the counter, it has a black box warning issued by the FDA for “hepatotoxicity,” which means this medication can be toxic to the liver. There is a risk of acute liver failure, which can lead to liver transplantation or death, especially at doses greater than 4,000 mg per day.
  • This medication should be avoided by patients with a history of prior allergic reactions to this group of medications and by patients with severe active liver disease.
  • Caution must be taken if the patient chronically uses alcohol, is dehydrated or malnourished, or has kidney disease.
  • Adverse reactions to acetaminophen include anaphylaxis (severe allergic reaction), hypersensitivity reactions, rash, liver toxicity, acute kidney injury, chronic kidney disease if taken for a long time, anemia and low platelets.

Ibuprofen (Motrin, Advil) and naproxen (Aleve)

  • These medications belong to a class of medications called NSAIDs (non-steroidal anti-inflammatory drugs).
  • They are used for treatment of pain, fever and some inflammatory conditions such as arthritis.
  • These medications also have a black box warning issued by the FDA.

The FDA warning covers two main risks:

  • Use of NSAIDs increases the risk of serious and potentially fatal cardiovascular thrombotic events (such as heart attack and stroke).
  • NSAIDs also increase the risk of serious and potentially fatal gastrointestinal adverse events, including bleeding, ulcers, and perforation of the stomach or intestines. Elderly patients and patients with a history of peptic ulcer disease or gastrointestinal bleeding are at greater risk for serious gastrointestinal events.

Serious reactions reported with use of NSAIDs include:

  • Gastrointestinal bleeding, ulceration and perforation
  • Heart attack, stroke, blood clots
  • Hypertension
  • Heart failure
  • Kidney failure (many different types)
  • Liver toxicity
  • Anaphylaxis and allergic reactions, including Stevens-Johnson syndrome
  • Bronchospasm
  • Rashes, including sensitivity to light
  • Low platelets, anemia and low white blood cell count
  • High potassium
  • Abdominal pain, nausea, constipation
  • Ringing in the ears

Please consult with your doctor before taking any over-the-counter medications.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.