Many medications now available without a prescription or "over the counter" (OTC) once required a prescription. While they are considered safe and effective when used as directed on the package, they can have serious side effects if used improperly. OTC pain medications are among the most commonly used medications. They are used to treat fever, headache, menstrual cramps and minor aches and pains. There are four oral OTC analgesics available in the U.S., acetaminophen, aspirin, ibuprofen, and naproxen.

Acetaminophen is the most commonly used OTC pain medication. It was introduced in 1955. It works in the pain and fever centers in the brain. Unlike the others, acetaminophen does not have anti-inflammatory properties. At recommended doses it has few adverse effects. It is not irritating to the GI tract and does not affect blood clotting. About 600 products contain acetaminophen, including cough and cold remedies and prescription pain medications. Acetaminophen is often abbreviated as APAP which can cause confusion as many people do not realize APAP is acetaminophen. The potential risks with use of acetaminophen include kidney damage with long-term use of high doses. This risk is increased if it is taken with three or more alcohol drinks. APAP is also liver toxic. This risk is increased when used with even moderate amounts of alcohol.

Aspirin is the oldest pain reliever, introduced in 1899. It is also known as acetyl-salicylic acid and is often abbreviated as ASA. It is now actually more often used to prevent blood clotting in people that have had a previous heart attack or stroke. A low dose of 81 mg is the most common dose used to prevent blood clotting, but even at this low dose it may cause bleeding in the GI tract. Aspirin should not be used in children less than 18 years old because of a potentially fatal reaction known as Reye's syndrome in children. Potential risks include GI problems ranging from nausea to bleeding and ulceration and liver damage in those with liver disease, juvenile arthritis, and rheumatic fever. Aspirin may interfere with some high blood pressure medications and increase blood pressure.

Ibuprofen was one of the first products to be switched from prescription to OTC status. Ibuprofen and naproxen sodium are known as non-steroidal anti-inflammatory drugs (NSAID). They work by inhibiting prostaglandin production at the site of pain and inflammation. Risks with their use include GI problems ranging from nausea to GI bleeding. Although rare they can also cause kidney damage. Risk of kidney damage is increased with dehydration, use of diuretics, age over 65, high blood pressure and diabetes. They may also interfere with some high blood pressure medications and increase blood pressure.

Reference: http://www.cecity.com/apha/ce_monographs/analgesics/analgesics_print.pdf.

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