Office Talk: Over-the-Counter pain medicines

Question: So, I know I'm not supposed to take too much Tylenol, right? It's gonna kill my kidneys.

This is an area in which I see a lot of confusion. Many patients have a vague sense that Tylenol and Motrin can cause problems, but more than half the time, they are mixing up which is which. Since taking these medicines unsafely or indiscriminately can have serious consequences, and since the fact that they are OTC can lull people into a false sense of security, I figured I'd clear this up.

1)Tylenol (a.k.a. Acetaminophen)



Tylenol is a great medicine, and very safe when used properly. It can reduce fever and pain. It's safe in babies and pregnant women. It isn't the strongest pain reliever in the world, but it works. What makes Tylenol so great is that if taken in proper doses (no more than 4 grams in a 24 hour period), it's something that can be taken daily for a long time (years even...which some of my patients with arthritis do). It doesn't have a cumulative damaging effect on the liver over time, assuming you have a normal, functioning liver. The danger? It doesn't take much extra Tylenol to cause a serious overdose. It seems like such a harmless drug, that some people figure popping a few extra at at time won't hurt. But if you look at the graphs of how easily you can get into the danger zone, there isn't a lot of room for error. So stick to the doses as prescribed on the bottle. If you need more pain relief? Try a different type of drug. And remember that 'acetaminophen' is a common ingredient in most cold/cough formulations and even narcotic painkillers. So check for that, and don't double up!


2)Ibuprofen (Which belongs to the NSAID class of medicines. This includes motrin, advil, aleve, naprosyn).



Ibuprofen can also reduce pain and fever. It does have some anti-inflammatory properties, though we as physicians tend to overstate the anti-inflammatory effects. It's anti-inflammatory effects can be quite useful for sore throats, period cramps, and acute tendonitis/bursitis. For many people, the pain relief they get from NSAIDS is more potent than that which they get from Tylenol. I know that's how I feel (which is why I miss it so much when I'm pregnant!) And unlike Tylenol, it's probably fine to take a few extra than what it says to on the bottle. In fact, we frequently prescribe such doses for severe pain. And it's a lot harder to overdose with these medicines (thought it is possible). The real problem is when people start taking them on a regular basis over weeks, months, or years. That's when you run into erosion of the stomach lining (and possible bleeding ulcers), kidney dysfunction (which thereby increases blood pressure), and increased risk of bleeding in general. I actually had a patient while I was a resident who was on dialysis from prolonged, heavy use of NSAIDS. So, they are great short-term meds, but poor long-term ones.

So, to recap:
Tylenol: good for long-term use if used in proper doses. Affects the liver.
Motrin: okay to increase the dose in the short-term. Hard on the stomach and kidneys long-term.

Consider yourself informed! :)