OTC Pain Medicines and Their Risks

Drugstore shelves have so many choices of over-the-counter (OTC) pain medicine that it can be hard to find one that you like. But most OTC pain relievers can be divided into just two main types. They are either acetaminophen or nonsteroidal anti-inflammatory medicines (NSAIDs).

Acetaminophen is available as a generic medicine. You'll find a few different NSAIDs, such as ibuprofen, naproxen, aspirin, and ketoprofen. Some medicines combine acetaminophen and aspirin.

You need a prescription to buy stronger pain relievers called opioids. Codeine is one type of opioid. It is found in many cough medicines. Cough medicines with codeine can be bought at drugstores without a prescription in a few states. Codeine is also in pain relievers along with acetaminophen. Codeine can make you feel sleepy, so you need to be careful when taking it. Codeine use also carries the following risks:

  • Constipation and nausea

  • Misuse and abuse

  • Addiction

  • Overdose

  • Death

  • Slowed breathing

You would need a prescription to use certain other medicines that were originally used for other purposes but are now used for the treatment of pain. These would include duloxetine and gabapentin. Cannabidiol can be used in some states even without a healthcare provider's recommendation for pain relief.

Other types of OTC pain relievers are sold as patches or creams that contains lidocaine, menthol, capsaicin, or a combination of these. These products often contain lower doses of medicines that require a prescription.

Using OTC pain relievers

Acetaminophen and NSAIDs are both good for treating fever and many types of pain. These include:

  • Sore throat

  • Low back pain

  • Pain after surgery

  • Pain from exercising or doing physical activity

  • Pain from colds, the flu, and sinusitis

Acetaminophen brings down a fever and eases pain by acting on the parts of the brain that control pain and body temperature. NSAIDs reduce pain and fever by forcing your body to make fewer hormone-like chemicals called prostaglandins. These chemicals play a role in body temperature control. They can also irritate your nerve endings. This causes you to feel pain.

NSAIDs such as ibuprofen are especially good at easing pain from swelling and inflammation. This can be from menstrual cramps, a sore throat, or muscle sprains. Acetaminophen doesn't help with inflammation. But it's good for headaches and arthritis pain.

Man reading box of over-the-counter medication.

Risks of OTC pain relievers

Most people don't think of OTC pain relievers as dangerous because you don't need a prescription to buy them. In most cases, they are quite safe when they are used just as directed. But they can have some major risks. This is especially true if you don't follow the directions. Below are some things to keep in mind.

Side effects can be serious

NSAIDs sometimes cause bleeding in the stomach and digestive tract. This is true even in normal doses. Talk with your healthcare provider to find out what food to eat before taking certain pain relievers such as NSAIDs. This is to reduce the risk for stomach problems, especially if you take these medicines for a longer period of time. Children and teens should never take aspirin. It can cause a rare but potentially fatal condition called Reye syndrome.

Too much can be harmful

One of the most serious problems with OTC pain relievers is taking too much of them at any one time. If you take more of a medicine than is recommended, it can cause health problems. If you often take too much acetaminophen, it can cause serious liver damage and even death. Acetaminophen is the leading cause of acute liver failure in the U.S. Overuse of NSAIDs can cause kidney disease and kidney failure. Or it can cause serious stomach bleeding. Taking too much aspirin at once can be deadly.

Read the labels carefully

Some cough and cold medicines and allergy medicines may have acetaminophen or an NSAID along with other ingredients. So it's important to carefully read the labels of all the medicines you take. That way, you won't accidentally take a double dose of the same type of medicine in two different products.

It's also important to know that many prescription pain medicines contain acetaminophen or NSAIDs. If your healthcare provider gives you a prescription medicine for pain, understand what's in that medicine. Don't combine it with similar OTC medicines. This will put you at risk for overdosing. Always ask your healthcare provider or pharmacist if you are unsure.

Another problem is taking pain relievers for many days. Most of these medicines have a recommended maximum number of days that you should take them. Look for this information on the product label. Some medicines can be used safely in the long term for chronic pain such as arthritis. You should talk about this with your healthcare provider.

Medicines can interact

Pain relievers can react harmfully with other medicines, especially blood thinners. If you take any prescription medicines, ask your healthcare provider if you should avoid taking any OTC pain relievers. Also, some OTC pain relievers can make certain health conditions worse. So find out from your healthcare provider which ones are safe for you.

Talk with your provider or pharmacist before buying any OTC medicine. They can help you choose a medicine that's best for you based on your health history or condition. Tell your provider or pharmacist about any medicine or food allergies you have. Also tell them what prescription or OTC medicines you are taking. Include any herbal supplements, vitamins, or other product you are using. This information will help your provider or pharmacist recommend an OTC medicine.

Adding alcohol can be dangerous

Alcohol is a concern with some OTC pain relievers, especially acetaminophen. Taking acetaminophen and drinking alcohol can lead to liver damage and failure. If you frequently have 3 or more drinks a day, talk with your healthcare provider before taking acetaminophen. Alcohol can also increase an NSAID's risk of causing gastrointestinal bleeding and ulcers. Alcohol should never be taken with an OTC pain reliever containing codeine. Mixing alcohol and opioids can cause difficulty breathing and even death. If you have a liver condition or liver disease, talk with your provider to see if it's safe for you to use acetaminophen. If it is, find out the correct dose to take.

Double-dosing and children

Be especially careful when giving OTC pain relievers to children. Use only the special device that comes with the package to measure out a dose. And never give a child more than the recommended dosage. Also, check other medicines your child is taking to make sure you are not accidentally double-dosing by giving medicines with the same active ingredient. This can lead to serious side effects or a life-threatening overdose.

When buying an OTC medicine, always read and compare the label with medicines your child is currently taking. Once you get home, check the active ingredient or ingredients of the OTC medicine against other OTC or prescription medicines your child is currently taking. If you are not sure how to compare the active ingredients of the medicines, ask your child's healthcare provider or pharmacist. Ask them if it's OK to give the OTC medicine with the other medicines your child is currently taking.

Never give aspirin to your child unless your child’s healthcare provider tells you to. Children who take aspirin may get a serious illness called Reye syndrome.


Always check with your child's provider or pharmacist before giving your child any type of OTC medicine for the first time. Check the label of the OTC medicine and its expiration date to make sure it is safe for babies and toddlers younger than 2 years.

Additional concerns about codeine

Medicines that have codeine can make you feel very sleepy. This can be risky for you and those around you. In many cases, medicines with codeine are meant to be taken before bedtime, so make sure you are following all directions carefully. Codeine can also cause nausea and constipation.

If you're breastfeeding and taking codeine, your breastmilk will have codeine in it. This can put your baby at risk for overdosing on codeine. Talk with your healthcare provider before using an OTC that has codeine in it.

Online Medical Reviewer: Dan Brennan MD
Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Robert Hurd MD
Date Last Reviewed: 8/1/2023
© 2000-2024 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.