The U.S. Food and Drug Administration (FDA) wants consumers to know the risks of commonly used pain relievers. The federal agency launched an advertising campaign in 2004 based on a recommendation from the Non-prescription Drug Advisory Committee. Acetaminophen (the active ingredient in Tylenol and many other non-aspirin-containing pain relievers) and nonsteroidal anti-inflammatory drugs (NSAIDs, including Aleve, Motrin, ibuprofen and aspirin) are generally safe and effective when taken as directed. But these products can cause harm if taken incorrectly or if you have certain medical conditions.
No drug is completely safe. Any drug that is effective will also have side effects. Acetaminophen and the NSAIDs are no exception. Acetaminophen has a very good safety profile, but it can cause liver damage if taken for very long periods of time or taken in larger-than-recommended amounts. The NSAIDs also have a good safety record but can cause stomach ulcers or kidney damage if taken for long periods of time or in too large a dose.
Here are some of my recommendations on how to use these drugs safely:
- Nonsteroidal anti-inflammatory drugs
Motrin (also known as ibuprofen), Aleve (also known naproxen) and aspirin are the most commonly used NSAIDs. If you have a history of aspirin allergy, nasal polyps or aspirin-induced asthma you should stay away from all of these products. The NSAIDs can rarely cause stomach ulcers. You are at increased risk if: - You are over 60 years of age.
- You have a history of stomach ulcers.
- You are taking blood thinners such as Coumadin (also known as warfarin).
- You have other kinds of bleeding problems.
The NSAIDs also can cause kidney damage. Although the damage is usually reversible, it can be permanent in some people. You are at increased risk if: - You are over 60 years of age.
- You have high blood pressure, heart disease or kidney disease.
- You are taking diuretic drugs.
- Acetaminophen
Acetaminophen can cause serious liver damage if not taken correctly. The damage happens when a byproduct of acetaminophen builds up in the body. Taking large doses of acetaminophen either at one time or over days to weeks can cause problems. It is important to read the instructions carefully before taking products that contain acetaminophen. Overdoses can happen if you take more than one product that contains acetaminophen. People who regularly drink alcohol are at increased risk of liver damage from acetaminophen.
The labels for products that contain acetaminophen and NSAIDs have changed during the last couple of years. The new labels will give consumers better information about how to take these drugs safely. If you have any concerns about these drugs you should speak with your physician or pharmacist for advice.
Harold J. DeMonaco, M.S., is senior clinical associate in the Decision Support and Quality Management Unit at the Massachusetts General Hospital and is currently a Visiting Scholar at the MIT Sloan School of Management. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals.
