OTC Pain Relievers and Fever Reducers

  • Pharmacy Author:
    Annette (Gbemudu) Ogbru, PharmD, MBA

    Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Surprising Reasons You're in Pain Slideshow

Pregnancy/breastfeeding and aspirin

Regular aspirin consumption during pregnancy has been associated with side effects in the pregnant mother, including bleeding and complications during labor. It is unclear if aspirin taken in the first two trimesters poses a risk to the fetus. However, when taken during the third trimester, aspirin may increase the risk of bleeding in the newborn. Nevertheless, for certain mothers with diseases that are associated with a high risk for blood clotting during pregnancy and miscarriage, aspirin is actually recommended in low doses for prevention. Although very little aspirin is secreted into breast milk, most authorities recommend that nursing mothers avoid using aspirin. A woman should consult with her health care practitioner before taking any medications while pregnant or breastfeeding.

Viral infections in children and aspirin

Because aspirin causes Reye's syndrome (a potentially fatal liver disease that occurs almost exclusively in persons under the age of 15 years), aspirin should not be given to children when a viral infection is suspected.

Drug interactions and aspirin

Aspirin may interact with other medications and cause undesirable side effects. For example, high doses of aspirin can increase the activity of valproic acid (Depakene; Depakote), an effect which can cause drowsiness or behavioral changes.

High doses of aspirin also can enhance the effect of some blood sugar-lowering medications used to treat diabetes, including glyburide (Diabeta), glipizide (Glucotrol), and tolbutamide (Orinase), which can possibly lead to hypoglycemia (low blood sugar). Blood sugar levels may need to be more closely monitored in this setting.

Aspirin, when taken together with an anti-coagulant such as warfarin (Coumadin) or enoxaparin (Lovenox), can greatly impair the body's ability to form blood clots, resulting in excessive bleeding spontaneously, from ulcers, or related to a procedure. Therefore, patients on such combinations must be closely monitored by a doctor.

Low dose aspirin can raise levels of uric acid in the blood and may need to be avoided in patients with increased uric acid levels or gout.

Certain NSAIDs, particularly ibuprofen (Motrin, Advil), if taken just before aspirin or in multiples doses each day, can reduce the anti-platelet effects of aspirin treatment and theoretically render aspirin less effective in preventing heart attacks and ischemic strokes.

Salicylates other than aspirin

Choline salicylate (Arthropan) is available as a liquid. It is absorbed more quickly, but its onset of action is no different than that of aspirin. Some people find choline salicylate fishy tasting. Fortunately, it can be mixed with juice or soda prior to ingestion. It is less effective at reducing fevers in children than either aspirin or acetaminophen.

Magnesium salicylate (Arthriten; Backache) is as effective as aspirin at reducing pain. Patients with chronic kidney disease should avoid magnesium salicylate, since the magnesium may accumulate in the body.

Sodium salicylate (Scot-Tussin Original) and aspirin are equally effective in the long-term treatment of rheumatoid arthritis, but sodium salicylate is less effective at reducing pain or fever.


Acetaminophen comes in various oral formulations, including different types (elixirs or syrups) and flavors of liquids, capsules, tablets, caplets, and suppositories. The capsules contain tasteless granules that can be emptied onto a teaspoon containing a small amount of drink or soft food, and can then be swallowed. However, the granules should not be mixed in a glass of liquid since the granules will stick to glass itself. The amount of acetaminophen that is absorbed from rectal suppositories is about half that of the oral formulations.

Side effects of acetaminophen

Acetaminophen generally is safe to use, and few people develop side effects. In high doses, however, it can cause liver damage and doses of 4000 mg (4 grams) per day should not be exceeded.

Pregnancy/breastfeeding and acetaminophen

Acetaminophen has no known harmful effects on the mother, fetus, or infant and, therefore, can be used safely during pregnancy and breastfeeding.

Drug interactions and acetaminophen

It has been reported that patients with HIV-related diseases (such as AIDS) who take AZT (zidovudine; Retrovir) and acetaminophen are at an increased risk of developing suppression of their bone marrow. Such patients develop lower white and red blood cell and platelet counts and, therefore, are more susceptible to infection, anemia, and bleeding.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

There are three OTC NSAIDs; ibuprofen, naproxen sodium, and ketoprofen. All have pain relieving (analgesic), fever reducing (antipyretic), and anti-inflammatory properties. Additionally, NSAIDs are more effective than aspirin or acetaminophen for menstrual cramps.

Preparations of NSAIDs

Ibuprofen is available in tablets as well as in a pediatric suspension. Naproxen sodium is available in tablets. Ketoprofen is available as tablets and capelets.

Medically Reviewed by a Doctor on 10/9/2015

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