OTC Medication for pain

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Available medicines :

  • Acetaminophen (Tylenol and Panadol)
  • Aspirin
  • Diclofenac (Diclon)
  • Ibuprofen (Motrin)


Acetaminophen : The common adult dose is 500 mg to 1000 mg. The recommended maximum daily dose, for adults, is 4 grams.

Asprin : For adults doses of 300 to 1000 mg are generally taken four times a day for fever or arthritis, with a maximum dose of 8000 mg (8 grams) a day.[1]

Diclofenac : Is available in stomach acid resistant formulations (25 and 50 mg), fast disintegrating oral formulations (50 mg), slow- and controlled-release forms (75, 100 or 150 mg), suppositories (50 and 100 mg), and injectable forms (50 and 75 mg).

Ibuprofen: The oral dose is 200–400 mg (5–10 mg/kg in children) every 4–6 hours, adding up to a usual daily dose of 800–1200 mg. 1200 mg is considered the maximum daily dose for over-the-counter use [2]

Side effects:

  • Nausea/ Vomiting
  • Dyspepsia
  • Gastric ulceration/bleeding
  • Diarrhea
  • Salt and fluid retention
  • Hypertension
  • Interstitial nephritis
  • Nephrotic syndrome
  • Acute renal failure
  • Acute tubular necrosis

When to take the medicine: The medicines  should be taken after food.

When to avoid / contra indications


  • Hypersensitivity against diclofenac
  • History of allergic reactions (bronchospasm, shock, rhinitis, urticaria) following the use of Aspirin or another NSAID
  • Third-trimester pregnancy
  • Active stomach and/or duodenal ulceration or gastrointestinal bleeding
  • Inflammative intestinal disorders such as Crohn's disease or ulcerative colitis
  • Severe insufficiency of the heart (NYHA III/IV)
  • Recently, a warning has been issued by FDA not to use to treat patients recovering from heart surgery
  • Severe liver insufficiency (Child-Pugh Class C)
  • Severe renal insufficiency (creatinine clearance <30 ml/min)
  • Caution in patients with preexisting hepatic porphyria, as diclofenac may trigger attacks
  • Caution in patients with severe, active bleeding such as cerebral hemorrhage


  • Aspirin should be avoided by those known to be allergic to ibuprofen or naproxen.
  • Caution should be exercised in those with asthma or NSAID-precipitated bronchospasm.
  • It is generally recommended that one seek medical help if symptoms do not improve after a few days of therapy.
  • Caution should be taken in patients with kidney disease, peptic ulcers, mild diabetes, gout or gastritis; manufacturers recommend talking to one's doctor before using this medicine.
  • Taking aspirin with alcohol or warfarin increases the chance of gastrointestinal hemorrhage (stomach bleeding).
  • Children under the age of 16 are discouraged from using aspirin to control cold or influenza symptoms as this has been linked with Reye's syndrome.
  • Patients with hemophilia or other bleeding tendencies should not take salicylates.
  • Some sources recommend that patients with hyperthyroidism avoid aspirin because it elevates T4 levels.
  • Aspirin is known to cause hemolytic anemia in people who have the genetic disease glucose-6-phosphate dehydrogenase deficiency (G6PD), particularly in large doses and depending on the severity of the disease.
  • People living in tropical-weather countries should discontinue use while symptoms or suspicion of Dengue Fever exist, due to an irreversible syndrome relating aspirin and that disease.
  • Pain killers to be avoided in pregnancy

What should be done if other medicine(s) is also taken / Drug interaction

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Asprin: Is known to interact with other drugs. For example, acetazolamide and ammonium chloride have been known to enhance the intoxicating effect of salicyclates, and alcohol also enhances the gastrointestinal bleeding associated with these types of drugs as well. Aspirin is known to displace a number of drugs from protein binding sites in the blood, including the anti-diabetic drugs tolbutamide and chlorpropamide, the immunosuppressant methotrexate, phenytoin, probenecid, valproic acid (as well as interfering with beta oxidation, an important part of valproate metabolism) and any nonsteroidal anti-inflammatory drug. Corticosteroids may also reduce the concentration of aspirin. The pharmacological activity of spironolactone may be reduced by taking aspirin, and aspirin is known to compete with Penicillin G for renal tubular secretion.[3] Aspirin may also inhibit the absorption of vitamin C.[4][5][6]


  • Avoid alcohol druging treatment
  • Medications to be taken after food
  • Keep the medicines from the reach of children

When to seek medical help

  • The pain is not subsiding
  • Adverse effects are seen with drugs


  1. British National Formulary, 45, British Medical Journal and Royal Pharmaceutical Society of Great Britain.
  2. Non-steroidal anti-inflammatory drug From Wikipedia, http://en.wikipedia.org
  3. Katzung, Bertram G. (1998), p. 584.
  4. the Effects of Aspirin on the Metabolic Availability of Ascorbic Acid in Human Beings' The Journal of Clinical Pharmacology and New Drugs , 1973; 13:480–486 Published 1973. Accessed 31 July 2007.
  5. 'Vitamin C-aspirin interactions' Int J Vitam Nutr Res Suppl. 1982;23:83–90. Published 1982. Accessed 31 July 2007.
  6. 'Impairment of absorption of ascorbic acid following ingestion of aspirin in guinea pigs' Biochem Pharmacol. 1982 Dec 15;31(24):4035–8. Published 1982. Accessed 31 July 2007.

Written by: healthplus24.com team
Date last updated: May 12, 2015

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