Over-the-Counter Medication

Over-the-counter medications are those you can buy at the store without a prescription. Examples include:

  • acetaminophen

  • non-steroidal anti-inflammatory drugs (NSAIDs, or ‘anti-inflammatories’ for short)

  • topical analgesics.

General points to note

  • When used in prescribed doses, and for the short term, acetaminophen is a safe and effective pain reliever.

  • It is recommended to limit the dose to 3 g a day, as there have been reports of liver injury at doses of less than 4g per day.

  • Generic acetaminophen works just as well as a brand name version and usually costs less.

  • Many medications include acetaminophen with other medicines. For example oxycodone or tramadol may include acetaminophen. Even your cold medication or sleep aids might include acetaminophen. Always tell your doctor or nurse about all drugs that you are taking to make sure that you are not exceeding the recommended dose.

  • If you have migraine pain, do not take acetaminophen on more than 10 days per month, as it can make your headaches worse.

Non-steroidal anti-inflammatory drugs (NSAIDs)

General points to note

  • NSAIDs are commonly used to treat headaches, toothaches, muscle aches and menstrual cramps.

  • One of the most commonly used NSAIDs is called ibuprofen. Some brand names for ibuprofen are Advil® and Motrin®.

  • They work best in short courses to manage flare-ups of pain related to inflammation – usually shown by redness, swelling or heat.

  • NSAIDs work by interfering with particular enzymes in your body, which results in reduced inflammation and pain.

  • NSAIDs may be used with acetaminophen and opioids to more effectively manage some chronic pain conditions such as musculoskeletal pain.

  • There are many types of NSAIDs, but you can only take one type at a time.

  • Some NSAIDs, such as ibuprofen and naproxen, are available over the counter, but others, such as diclofenac, meloxicam, and celecoxib, are only available by prescription. The prescription medications section describes prescription NSAIDs.

  • Before using NSAIDs, tell your doctor if you have a bleeding disorder, asthma, kidney problems, are undergoing chemotherapy, or have ever had a stomach ulcer.

Side effects

  • One of the most common side effects of NSAIDs is stomach upset. Usually, you can avoid this by taking the correct dose and taking the medication with food, even just a glass of milk or some crackers.

  • When used regularly for a long time, or in high doses, NSAIDs can cause kidney problems and stomach ulcers, which can lead to dangerous bleeding and perforations. If you experience blood in bowel movements or severe stomach pain while taking NSAIDs, see your doctor or nurse practitioner right away and stop taking the medication.

  • In very rare cases, NSAIDs can cause bleeding problems. If you are taking NSAIDs, you may need to stop them for a period if you need to have surgery.

  • If you have migraines, don’t take NSAIDs on more than 15 days of the month, as they can make your headaches worse.

Topical analgesics

General points to note

  • Topical analgesics (pain relievers) are creams and ointments that you apply to the skin to numb the nerves just under the skin’s surface and treat pain in the immediate area.

  • Topical creams and ointments can sometimes be applied for longer periods to relieve chronic pain, usually when used with other medications such as opioids, NSAIDs, anticonvulsants or capsaicin (a substance derived from hot peppers).

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