OTC Pain Relievers and Fever Reducers (cont.)

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In most circumstances, these medications all have very similar abilities to relieve pain and fever. Their onset of action (the interval from the time of ingestion to the start of pain relief) also are similar. Naproxen sodium may have a somewhat longer duration of pain relief (analgesia) than the other NSAIDs or aspirin. At high doses, salicylates and NSAIDs suppress inflammation and are, therefore, particularly useful in treating inflammatory diseases, such as arthritis. Acetaminophen does not have anti-inflammatory actions.

Many OTC analgesics are available in combination with other drugs. There is some evidence that caffeine and antihistamines enhance the effects of analgesics. Thus, caffeine increases the pain-relieving effects of aspirin and ibuprofen, and the antihistamines orphenadrine and phenyltoloxamine enhance the pain-relieving effects of acetaminophen. Combinations of decongestants with analgesics are logical only when nasal or sinus congestion are present, such as with sinus headaches.


Aspirin can damage the lining of the stomach and duodenum, thereby causing abdominal pain, bleeding, and/or ulcers. As a result, 1 in 5 persons who take aspirin in a dose of 2.5 grams per day or more develops ulcers and about 1 in 6 will lose enough blood from gastrointestinal bleeding to develop anemia. In an attempt to reduce the potential for these complications, some aspirin-containing tablets have been coated with a special coating that prevents the tablet from dissolving until it is past the stomach and duodenum. These "enteric-coated" aspirin products may reduce the frequency of abdominal pain, but not the bleeding or ulcers. Moreover, the onset of pain relief is delayed with enteric-coated aspirin because it takes more time for the tablets to dissolve.

Other attempts to prevent complications have included aspirin-containing products that release the aspirin slowly over time (for example, Zorprin, Measurin, Verin). Like enteric-coated products, these products are not ideal when prompt relief of pain is needed. They also do not prevent ulcers or bleeding. Buffered (for example, Bufferin) and effervescent (such as Alka-Seltzer) aspirin products are absorbed more quickly from the stomach and intestine than aspirin, but they do not act more rapidly than regular aspirin and do not reduce the risk of bleeding or ulcers. Furthermore, effervescent aspirin products contain large amounts of sodium (salt) and should be avoided in persons with high blood pressure, heart failure, or certain kidney diseases.

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