April 12, 2022
6 min. read

Aspirin, Ibuprofen, Acetaminophen—Which OTC Pain Reliever is Right For Me?

Medly

If you took a moment to look inside your medicine cabinet, chances are you have more than a few different over-the-counter pain relievers in store. But do you know which medications are actually better for certain kinds of pain? Most of us usually just grab whatever we’re most familiar with, or whichever medication they believe works “better” for them. 

But in reality, over-the-counter pain medications are different in a variety of ways. When you’re taking these medications, and especially if you’re going to combine them with each other or other medications, there are some crucial bits of info you should be aware of. Let’s take a look at what you need to know. 

What OTC pain relievers are available? 

The four main OTC pain relievers that are available for purchase are: 

  • Acetaminophen
  • Aspirin
  • Ibuprofen
  • Naproxen sodium

Each medication has its own benefits and risks, although they all do more or less the same thing—relieve pain. Ibuprofen, naproxen sodium, and aspirin are all non-steroidal anti-inflammatory drugs, which means they have a similar mechanism of action—how they work in the body. Acetaminophen is the only non-NSAID of the four.

You may use an OTC pain reliever for one or more of the following reasons: 

Best for combining: Acetaminophen

Acetaminophen is an active ingredient in hundreds of over-the-counter and prescription medicines. Brand names of OTC products containing acetaminophen include: 

  • Tylenol
  • Actamin
  • Feverall
  • Panadol
  • Tempra Quicklets
  • Dayquil (combined with dextromethorphan and pseudoephedrine)
  • NyQuil Cold/Flu Relief (combined with dextromethorphan and doxylamine)

Uses 

Acetaminophen is used mainly to relieve pain and fever, and is often combined with other active ingredients in medicines that treat allergy, cough, colds, flu, and sleeplessness. Its popularity is due not only to its effectiveness, but also because it has fewer side effects than other OTC pain medications and because it doesn’t interact negatively with most common drugs. For example, because of how acetaminophen works in the body, it can safely be used with non-steroidal anti-inflammatory drugs, or NSAIDs. While both acetaminophen and NSAIDs have been shown to work equally well at combating the common headache, drugs combining acetaminophen, aspirin, and caffeine may be superior for some types of migraine disorders. How you respond to each medication will vary based on the type of headache you have and your individual body chemistry. 

Acetaminophen, however, does not treat inflammation, so it may be less effective for inflammatory causes of pain, like arthritis or certain injuries. 

Side effects 

While acetaminophen is generally safe when taken at the recommended dose, it can cause a serious skin rash, hives, or itching. 

Taking more than the recommended dose, however, can cause serious damage to your liver. Make sure, when taking this medication, to stay within the daily recommended dose, and—because acetaminophen is in so many products—be sure to check the labels of the medications you take daily. If you have questions about the medications you’re taking, you can always contact your healthcare provider or pharmacists. 

Acetaminophen, unlike NSAIDs, is not associated with an increased heart attack or stroke risk, which makes it the recommended first painkiller to try for people who’ve had a heart attack

Best for heart health: Aspirin 

Aspiring is an NSAID that is used to treat pain, fever, and inflammation. Name brands that contain aspirin include: 

  • Anacin Aspirin Regimen
  • Bayer
  • Bufferin
  • Empirin
  • Genacote
  • Miniprin
  • Uni-Buff

Uses 

If you’ve had a heart attack or currently have heart disease, you can take a daily low dose of aspirin for your heart. During heart disease, your arteries are already narrowed by the buildup of plaque, and a clot can block a blood vessel and stop the flow of blood to the brain or heart. Taking a daily low-dose of aspirin can diminish the ability of your blood to clump together into clots by targeting the body’s smallest blood cells. Talk with your healthcare provider to see if a daily aspirin regimen is right for you. 

Side effects 

Excess bleeding and upset stomach are common side effects of aspirin, though this occurs most often in people who are over 70, drink alcohol, or are taking other NSAIDs or blood thinners. 

If taken during a heart attack, taking aspirin can significantly reduce the chance of death. If you suspect you are having a stroke, however, aspirin should be avoided as it can make a stroke worse by promoting bleeding. 

Best for quick action: Ibuprofen

Ibuprofen is the second NSAID on our list. It can be used to treat pain, fever, and inflammation, and is commonly used to alleviate the symptoms of a migraine, menstrual cramps, or rheumatoid arthritis. Brand names include: 

  • Advil
  • Midol
  • Motrin
  • NeoProfen
  • Ultraprin
  • Advil PM (with diphenhydramine)

Uses 

Ibuprofen is a short-acting NSAID, which starts acting much faster than other NSAIDs. For this reason, ibuprofen may be better used for acute pain and new injuries—but it will also need to be taken more frequently. 

Side effects 

Ibuprofen should be avoided if you have kidney or liver problems. If taken excessively, it can also cause high blood pressure

Best for chronic pain: Naproxen Sodium

Naproxen sodium, another NSAID, is used to treat the same symptoms and conditions as ibuprofen. It’s also sometimes used for the painful chronic conditions Paget’s disease and Bartter syndrome. Brand names include: 

  • Aleve
  • Anaprex
  • Naprosyn
  • Aleve PM (with diphenhydramine)

Uses 

Unlike ibuprofen, naproxen is a long-acting NSAID, which means it will take longer to relieve your pain, but it also lasts longer, so you won’t have to take it as often. If you’re taking pain medication regularly for a chronic condition, naproxen might be a better choice. 

Naproxen also has fewer side effects than ibuprofen, making it safer overall—you may be able to tolerate it if ibuprofen bothers you. 

Side effects 

Naproxen has a far higher risk of stomach ulcers when compared to ibuprofen. If you have a history of ulcers or irritable bowel syndrome, you may either want to avoid this medication or make sure to take it with food. 

Can I take more than one OCT pain reliever at a time?  

It’s best to proceed with caution when combining OTC pain relievers. In general, you should avoid combining NSAIDs with each other—aspirin, ibuprofen, naproxen, or prescription NSAIDs. Acetaminophen, however, can be taken safely with other NSAIDs. 

Whether you’re treating a headache or a swollen joint, it’s important to consider the benefits and risks of the pain reliever you’re choosing. Take a look at the side effects, and look out for potential drug interactions. If you have questions, it’s always best to reach out to your healthcare provider or pharmacist for further guidance. 

Sources 

  • Center for Drug Evaluation and Research. (2017, November 14). Acetaminophen Information. U.S. Food and Drug Administration.
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  • Acetaminophen (Intravenous Route). (2022, February 14). Mayo Clinic.
  • Altman R. D. (2004). A rationale for combining acetaminophen and NSAIDs for mild-to-moderate pain. Clinical and experimental rheumatology, 22(1), 110–117. 
  • Walling, L. M. (2018, February 15). Acute Migraine Headache: Treatment Strategies. American Family Physician.
  • Harvard Health. (2021, February 12). Where to turn for pain relief – acetaminophen or NSAIDs?
  • Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. (2016). Gaming Law Review and Economics, 20(10), 859–868. https://doi.org/10.1089/glre.2016.201011
  • NSAIDs: Do they increase my risk of heart attack and stroke? (2020, December 10). Mayo Clinic.
  • Harvard Health. (2020, July 12). Pain relief that’s safe for your heart.
  • Is Taking Aspirin Good for Your Heart? (n.d.). Johns Hopkins Medicine. 
  • Cryer, B., & Mahaffey, K. W. (2014). Gastrointestinal ulcers, role of aspirin, and clinical outcomes: pathobiology, diagnosis, and treatment. Journal of multidisciplinary healthcare, 7, 137–146. https://doi.org/10.2147/JMDH.S54324
  • Harvard Health. (2020a, April 14). Aspirin for heart attack: Chew or swallow?
  • Watch out for Your Kidneys When You Use Medicines for Pain. (2017, March 3). National Kidney Foundation.
  • Brutzkus JC, Shahrokhi M, Varacallo M. Naproxen. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525965/
  • Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian prescriber, 40(3), 91–93. https://doi.org/10.18773/austprescr.2017.037

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